2. NERVOUS SYSTEM
The nervous system consists of
1. The central nervous system (CNS)
2. The peripheral nervous system
3. The autonomic nervous system
3. STEPS OF ASSESSMENT
History collection
Physical examination
Differential diagnosis
Diagnostic evaluation
Management Plan
4. HISTORY COLLECTION
Past history
H/O Fall or trauma that may have involved the
head or spinal cord.
Family history
Alzheimer’s disease, Epilepsy, Parkinson’s disease,
Spina bifida, etc.
Personal history
Alcohol, medications and illicit drugs.
5. NEUROLOGICAL ASSESSMENT
A complete neurological assessment consists of five steps:
Consciousness and Cognition
Cranial nerves assessment
Motor system
Reflexes
Sensory system
6. CONSCIOUSNESS AND COGNITION
ASSESSMENT
Cerebral abnormalities may cause disturbances in
mental status, intellectual functioning, thought
content and emotional status.
_______________________________________________
Can you measure or calculate the conscious level ?
23. EXAMINING THE MOTOR SYSTEM
Motor ability
Muscle strength
Balance and coordination
24. MOTOR ABILITY
The patient is instructed to walk across the room, if
possible while the examiner observes posture and
gait. the muscles are inspected and palpated if atrophy
or involuntary movements is noted.
25. Muscle strength
Ask client to flex muscle and then resist when you apply
opposing force against the muscles
Compare contralateral sides
Neck, Trapezius, arms (Biceps, Triceps), wrists, fingers, hips,
legs, ankles and feet
26.
27. Balance and Co-ordination
Seat the patient. Instruct him to pat his knees with his
hands, palms down then palms up. Have him alternate
palms down and palms up rapidly.
Watch the patient to notice if his movements are stiff, slow,
non-rhythmic, or jerky.
The movements should be smooth and rhythmic as he does
the task faster.
29. BICEPS REFLEX
1- Have the patient's elbow at about a
90° angle of flexion with the arm
slightly bent down as shown in
figure 2-6.
2- Grasp the elbow with your left hand
so the fingers are behind the elbow
and your abducted thumb presses
the biceps brachial tendon.
3- Strike your thumb a series of blows
with the rubber hammer, varying
your thumb pressure with each
blow until the most satisfactory
response is obtained.
4- Normal reflex is elbow flexion
(bending(
30. TRICEPS REFLEX
Grasp the patient's wrist with
your left hand and pull his
arm across his chest so the
elbow is flexed about 90° and
the forearm is partially bent
down.
Tap the triceps brachial
tendon directly above the
olecranon process. The
normal response is elbow
extension .
Triceps reflex
Triceps jerk with
one arm flexed
Triceps
jerk with
arms
folded
31. BRACHIORADIALIS REFLEX
With the patient’s forearm resting on the lap or across
the abdomen, the brachio-radialis reflex is assessed.
A gentle strike of the hammer 2.5 to 5 cm above the
wrist results in flexion and supination of the forearm.
32. PATELLAR REFLEX
The patellar reflex is elicited by
striking the patellar tendon just
below the patella. The patient
may be in a sitting or a lying
position.
If the patient is supine, the
examiner supports the legs to
facilitate relaxation of the
muscles.
Contraction of the quadriceps
and knee extension are normal
responses.
33. ACHILLES REFLEX
To elicit an achilles reflex, the foot is dorsi-flexed at
the ankle and the hammer strikes the stretched
achilles tendon. This reflex normally produces
flexion
34. Deep tendon reflexes should be
graded on a scale of 0-4
=0 absent despite of reinforcement
=1 present only with reinforcement
=2 normal
=3 increased but normal
=4 markedly hyperactive, with clonus
35. EXAMINING THE SENSORY SYSTEM
Tactile sensation
Superficial pain
Temperature
Vibration and position sense