Neurological Assessment

By Dr.Ada Anjumn

Name: Age/Sex: Occupation: Address: Contact No: Marital Status:

Chief Complaint: Case sheet study:

History Present illness - Mental - Sleep - Speech Aphasia Dysphonia Dysarthria Dyslexia Dysgraphia

- Attack of Loss of Consciousness - Headache Duration - Special part of the day Character Situation - Tenderness - Visual disturbances - Vomitting - Vertigo - Any injury of the head

Visual disorder: - onset - frequency - duration Motor Disorders - lack of coordination - weakness – Proximal/ distal - involuntary movement - relieving factor - precipitating factor

Sensory disorders: - onset - duration - frequency - Pain - numbness/tingling - site - relieving factor - precipitating factor

Spinchtor disorders - onset - duration - frequency - difficulty in control for incontinence / retention - anal control - bladder control

Pain history: - Site - Side - Duration - Type - Nature - Radiation - Aggravating factor - Relieving factor

Past History: History: - convulsion - meningitis - infection - enchaphalitis - pneumonia - jaundice - General developmental delay - trauma/accident - Hge

- Malnutrition

Family History: - consanguity - epilepsy - disability - cardiovascular disorders - inflammation - Rh Factor

Development History - eye contact - social smile - head control - side turning - sitting - rolling - crawling - standing - walking

Socio-economical history - education - occupation carrier - tobacco - cigaratte - alcohol

Medical history - drug allergy

Surgical History: - incision - length - duration - procedure Physiotherapy treatment: - Aims - Means - Duration - Place

Objective Examination: On Observation: General - Built - Posture - Gait - Deformity - Facial expression

Local: - Oedema - Atrophy - Scar / incision / wound - Cyanosis

- Clubbing

- Neurological grafts

- Breathing

- Eye movement

- Drains

type

- Ventilators output - Instrumentation

- Fluid input /

ON PALPATION - Texture – Dryskin / scaly / smmoth - Warmth - Scar - type of edema

pitting / non pitting

- Spasm - deformity

rigid / flexible

- tone --. Hypo / hyper - swelling –sessile / pedunculated - anterior fontenelle

ON EXAMINATION General: Vital signs - BP - temperature - Respiratory rate - Heart rate

Glasgow coma scale Eye Response

Motor Response

Spontaneousl 4 y To verbal 3 stimuli To pain 2 Never

Obeys command

6

Localizes pain

5

Flexion – 4 withdrawl Abnormal flexion 3

1

Verbal Response Oriented

5

Disoriented

4

Inappropriate 3 words Incomprehensive 2 words No response 1

Abnormal extension No response

2 1

Cognitive skill - Listen to language - Understanding simple / complex commands - Name objects - Read correctly - write correctly - numerical calculation - recognize objects - dress himself  - copy geometric pattern

Intellectual function - Orientation - memory - level of memory Emotional state - personal type - emotional state - slowness of movement Speech - Articulation - Aphasia

Memory - Short term memory - long term memory - recent memory - remote memory

Cranial Nerve examination Olfactory

Smell

Optic - Visual acquity - visual field - pupil Occulomotor - pupil - occular movements - nystagmus

Trigeminal nerve - Jaw reflex - Corneal reflex - motor - sensory mandibular

chewinh and clenching opthalmic, maxillary and

Facial - Moter

Blinking, blowing, frowning, smiling, raising of eye brow - taste

Anterior 2/3rd of tongue

Vestibulocochlear

Glossopharyngeal - Gag reflex - Taste of posterior 1/3rd of tongue Vagus - swallowing - observe uvula and soft palate (asymmetry) Accessory - SCM - Trapezius Hypoglossal - Tongue movements

MOTOR SYSTEM Muscle tone

Hypotone / Hypertone (Acc. to Modified

Asworth Scale) Inspection of muscle: Circumference - Thigh - calf  - Arm - forearm Wasting Hypertrophy

Drooping of shoulder

-

- FAsciculations

-

- Joint ROM (For each joints)

-

Reflexes

-

Superficial - Abdominal

-

Plantar Deep

- Biceps

-

- Brachioradialis

- Tri ric ceps - Quadri ric ceps

-

- Hamstrings

-

- Tendoachilus

Sensory Examination Superficial sensation - light touch - Pressure

- Temperature - pain

Deep sensation - Vibration

- Crude touch

- Proprioception

- Kinesthesia

Cortical sensation - 2 point discrimination graphesthesia (traced fig.)

-

- stereognosis (Recog. Of wt)

- Barognosis

Co-ordination and balance Equilibrium and non – equilibrium tests Non – equilibrium tests o

Finger to nose

o

Finger to therapist finger

o

Finger to finger

o

Pronation / supination

o

Rebound test

o

Tapping

o

Heel on chin

Equilibrium tests

Standing in a normal



Standing – feet together



Standing on one foot



Standing, laterally flex the trunk to each side



Standing – eyes closed and open (Romberg sign)



Walking, placing the heel of one foot infront of toe of opposite foot (Tandem (Tandem walking) 

Walk and pivot



Walk in a circle



Stair climbing with and without handrails



Limb length measurement - True - Apparent - Segmental Posture - in supinesupine - in prone - in sitting sitting - in standing standing Functional assessment - dr dressing - fe feeding - to toileting - tra ran nsfer - combing - bru rus shing

Hand function – fine motor function - tip to itp - side to pad - cylindrical - Spherical - hook  Bladder and bowel - Uninhibited

- Atonic

- Autonomous Involuntary movement: - Chorea

- Athetosis

-

Gait - Stance and Swing phase - step length

- Stride length

- ca cade denc nce e - to toe e ou outt an angl gle e - Base of support

- ROM

Investigations 1. X – ray 3. M.R.I 2. CT Scan 4. Lumbar Lumbar puncture 5. Blood test

PROVISIONAL DIAGNOSIS

Management •

Problem list

•

Aims

•

Means

•

Report

Prognosis