How to Do a Neurosensory Evaluation

To determine if a patient has any neurological diseases or damage, several tests must be performed to examine the various aspects of the patient's central and peripheral nervous systems. The neurological exam is a preliminary test that determines if there is a problem and identifies the gross general location of the problem. Follow-up testing is required, if the neurological exam identifies a problem.

Things You'll Need

• Tuning fork
• Reflex hammer
• Common, pleasant-smelling object
• Soft object and a pointy object
• Piece of candy
• Tongue depressor
• Blunt object
• Cotton swab

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Instructions

• 1

  Test cranial nerve I (olfactory) by telling the patient to close his eyes and identify the smell of a common, non-painful substance, such as an orange or banana. Do not use noxious compounds like ammonia or smelling salts. If the patient cannot identify the substance, there is a problem with CN I.

• 2

  Test CN II (optic). Use a vision chart to directly test visual acuity -- or test by using the confrontation method. With the confrontation method, have the patient cover one eye, and you cover your opposing eye. For example, the patient covers his right eye and you cover your left eye.

  Stand about 12 to 18 inches apart and tell the patient to look directly at your nose. Hold out one, two, or three fingers to your side and slowly move your hand between the patient and yourself. Have the patient tell you how many fingers he can see -- as soon as he can see them.

  If the patient can see it at about the same time you do, then he has adequate vision.

• 3

  Test CN III, IV and VI (oculomotor, trochlear and abducens) by holding up a finger in front of the patient. Ask the patient to look directly at your finger while keeping his head still. Trace the letter H with your finger, always making sure to come back to the middle.

  With your finger, trace to one direction and then move your finger up, until the patient cannot move his eyes any farther, then all the way down, then back up to the center. Do the same thing on the other side. If the patient cannot completely follow your finger, something is wrong with cranial nerve III, IV or VI.

• 4

  Test CN V (trigeminal) by lightly dabbing a cotton swab in the patient's eye to see if he can feel it. Ask the patient to open his jaw against resistance, and test if he has general sensation over his forehead, cheeks and lower jaw, using a pointy object.

• 5

  Test CN VII (facial) by asking the patient to raise his eyebrows, blow out his cheeks, close his eyelids against resistance, smile, frown and taste a piece of candy on the front portion of his tongue.

• 6

  Test CN VIII (vestibulocochlear) by using a tuning fork. Perform the Weber test -- a test that checks the lateralization of your hearing -- by vibrating the fork and placing it on the top, middle of the patient's forehead and ask the patient if the sound is louder in one ear.

  Perform the Rinne test -- determines if sounds of air conduction are greater than bone conduction -- by vibrating the fork and placing it against the mastoid process (bone behind the ear) until the patient can no longer hear it. Move the fork directly in front of the patient's ear and ask if he can hear it there.

• 7

  Test CN IX and X (glossopharyngeal and vagus) by having the patient open his mouth and say "Ahh." Use a tongue depressor and verify that his palate is rising equally on both sides of the mouth. Observe for normal swallowing and speaking.

• 8

  Test CN XI (accessory) by asking the patient to rotate his head from side to side against resistance and shrug his shoulders against resistance.

• 9

  Test CN XII (hypoglossal) by observing the patient as he sticks his tongue straight out. If the patient's tongue sticks out to either side, there may be a problem with CN XII.

• 10

  Test and compare general sensation side-to-side over all four extremities by asking the patient to distinguish a soft item from a pointy item in all four extremities and the midline.

• 11

  Test the patient's strength in all four extremities. Test extension and flexion in arms, wrists and legs. Ask the patient to flex and extend against resistance. Also test the foot for dorsiflexion and plantarflexion by asking the patient to move his foot up and down against resistance.

• 12

  Test the five major reflexes, tricep, bicep, bracioradialis, patellar and Achilles, by using a reflex hammer. Test for a Babinski sign by rubbing a blunt object along the lateral portion of the foot from heel to toe and observing for elevation of the big toe.

• 13

  Test the cerebellum. Ask the patient to rub his shin with the heel of his opposite foot. Ask the patient to touch his nose and then try to touch your finger, which you have positioned about an arm's-length in front of his face. Ask the patient to quickly slap his legs with both hands, alternating the front and back of his hands. Observe the speed and precision with which the patient completes these tasks.

• 14

  Test the patient's gait and walking ability. Ask him to walk normally, on his heels and on his tiptoes. Be ready to catch the patient, if he is likely to fall.