Neurological Screening

Sample Question for Examining Orientation and Awareness

• Person– What is your name?– How old are you?– When were you born?

• Place– Do you know where you are right know?– What kind of place is this?– What city or town do you live in?

• Time– What is today’s date?– What day of the week is it?– What year is it?

• Circumstance– Do you know why you are here?

http://www.maturespine.com/symptoms/weakness.html

Upper Quarter MyotomesLevel Action to Be Tested Muscle

C5 Shoulder shrug Deltoid

C5, C6 Elbow flexion Biceps

C6,C7 Wrist extension Wrist extensors

C7 Elbow extension, wrist flexion

Triceps, wrist flexors

C8 Thumb extension Abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis

T1 Digit abduction/adduction Interossei

Lower Quarter MyotomesLevel Action to Be Tested Muscle

L2, L3 Hip flexion Iliopsoas

L3 Knee extension Quadriceps

L4 Dorsiflexion Anterior Tibialis

L5 Great toe extension Extensor hallicus longus

S1 Plantarflexion Gastronemius

S2 Knee flexion Hamstrings

ProprioceptionUpper Extremity Lower Extremity

Shoulder Hip

Elbow Knee

Wrist Ankle

Distal phalanx of thumb Distal phalanx of great toe

Deep Tendon ReflexesRoot Level Muscle

Upper quarter: CN V Muscle of mastication

C1-4 Upper trapezius, levator scapula, deltoid

C5-6 Biceps

C5-6 Brachioradialis

C7 Triceps

C8, T1 Hypothenar

Lower quarter: L3-4 Quadriceps

S1 Gastrnemius

0=absent; 1=hyporeflexia; 2=normal; 3=hyperreflexia; 4=clonus

Babinski

http://meded.ucsd.edu/clinicalmed/neuro3.htm

http://academic.scranton.edu/faculty/kosmahle1/courses/pt351/lab351/babinski.htm

Test positive with splaying of the toes and extension of the great toe.

Cranial Nerve IntegrityCranial Nerve Function

CN II, optic radiation, visual cortex Visual field

CN II Visual acuity

CN III Pupillary reflex

CN III, IV, VI Extraocular movements

CN V, VII Facial sensation

CN VIII Labyrinthine/Auditory

CN IX Swallow

CN X Voice—if deficit may be characterized by hoarseness

CN XI Shoulder shrug

CN XII Tongue

NOTE: Ocular motility disturbances may be present with brainstem strokes, such as diplopia, oscillopsia, visual distortions, or paralysis of conjugate gaze.

O'Sullivan S, Schmitz T. Physical Rehabilitation. 5th ed2007.