Chapter 9: Neurologic Exam

OBJECTIVES

• 1) Understand the parts of the neurologic examination and how they are performed

• 2) Determine when the systems review indicates the need for further evaluation and which evaluative methods to utilize

• 3) Choose appropriate outcome measures based on both the individual characteristics of the client as well as the measurement characteristics of the tool

• 4) Determine how to adapt and modify the neurologic examination based on the individual characteristics of the client

OVERVIEW OF THE NEUROLOGIC EVALUATION AS A PROCESS

An examination of the neurologic system is an essential component of a comprehensive physical examination for every client that a physical therapist sees. The examination may be limited to a screening as described under the System Review section, or in those clients who have sustained damage to any aspect of the neurologic system, it should be a comprehensive and systematic examination that surveys the functioning of nerves delivering sensory information to the brain and those carrying motor commands to muscles and organs (peripheral nervous system) as well as neural networks that support high level multisystem processing and coordination of sensorimotor function (central nervous system). A careful neurological examination can help to determine impairments and their possible cause(s), functional loss, and focus of treatment.

The examination begins with a history that helps the clinician to localize the problem. For example, symptoms that occur unexpectedly might suggest a blood vessel or seizure problem. Those that are not as sudden might suggest a possible tumor. Symptoms that have a variable course with recurrences and remissions but worsen over time suggest a disease that destroys nerve cells. Others that are chronic and progressive indicate a degenerative disorder. In cases of trauma, symptoms may be evident upon inspection, and causes may be explained by third-party witnesses. The history assists the clinician to diagnose conditions and better focus their examination.

The examination is an ongoing process and continues throughout the course of treatment. While this chapter will attempt to lay out the path of the evaluation in a more step-by-step manner, it is actually more of a cyclical process. As the clinician generates hypotheses, based on the examination, they then design the intervention to address these hypotheses. After trying the intervention and observing the response, the original hypothesis is modified, and the impact on activity limitations is reassessed. Thus, the examination informs the intervention, which in turn, informs the examination (Figure 9-1).

COMPONENTS OF THE ADULT NEUROLOGIC EVALUATION