Chapter 4: Examination of the Neurologic System

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Click here to view the Neurologic Lab Manual Video Sensory Testing.

OUTLINE

Objectives:

The student will appropriately:

1. Observe and practice taking notes while watching a demonstration of a neuro examination/evaluation.

2. Accurately demonstrate examination and handling, of a simulated patient (TA or classmate) in a timely manner.

3. Apply strategies to maximize client position, in order to complete an efficient client examination.

4. Associate a therapist's movement analysis to the choice and administration of specific tests and measures of body structure and function during a neurologic examination.

5. Demonstrate appropriate communication and cueing in all lab practices.

Activity 1. Examination of the Cranial Nerves, Tone, Reflexes, and Coordination

Students work in pairs to practice performing cranial nerve screening examination of Cranial nerves III through IX, and XI and XII. Students also assess tone using the Modified Ashworth scale, assess reflexes, sensation, and coordination.

Activity 2. The Neurologic Examination: Observation

Students view a video of an examination of a client with a UMN lesion and take notes using the "Guide for the Evaluation of the Neurologically Involved Adult".

Activity 3. Practice Examination Techniques

Students are to work in pairs and practice performing an examination, with one partner playing the role of patient with a UMN lesion and the other partner playing the role of therapist.

WORKSHEET

Activity 1. Examination of the Cranial Nerves, Tone, Reflexes, and Coordination

1. Cranial Nerve Screening: Work with a partner and perform a screening of cranial nerves III through IX, and XI and XII (Table 4-1 unshaded boxes).

   Physical therapists rarely examine CN I—the olfactory nerve, as it does not impact motor function. In addition, CN II is not typically examined by therapists though you could screen it by asking the client to identify objects or to count your fingers. Be sure that any client who uses glasses is wearing his/her glasses. Cranial nerve X is difficult to examine though you should be careful to observe vitals and use caution if there are signs of hoarseness as damage to this nerve impacts parasympathetic function and could impact response to activity/exercise. See an example of a full cranial nerve exam in Video 4-1.

2. Assessing Tone: Tone is assessed by having the person relax while you take the limb through the range of motion (ROM) passively. If you note that there is resistance to passive movement when the person is relaxed, this would be an indication of hypertonia. If there is no hypertonia during slow, easy ROM, you then passively move the arm through the range rapidly. If tone increases when the speed of passive motion is increased, ...