Neurological Exam

Cranial Nerve Exam
1. Describe the function of each cranial nerve. 2. Demonstrate how to test the function of each cranial nerve.

Motor Exam

 * 1) Describe the grading system for muscle strength.

Continuous and passive contraction of muscles & amount of muscle mass, respectively
 * 1) Describe muscle tone and bulk

Identify which nerve root is being tested by the following reflexes

 * Deltoid: Axillary n., C5, C6
 * Biceps: Musculocutaneous n., C5, C6
 * Triceps: Radial n., C6, C7, C8
 * Quadriceps: Femoral n., L2, L3, L4
 * Hamstrings: L5, S1, S2
 * Ankle dorsiflexion: L4, L5
 * Plantar flexion: S1, S2

Sensory
1. Demonstrate testing for light touch 2. Demonstrate testing for pain sensation 3. Demonstrate testing for vibratory sensation 4. Demonstrate position sense testing 5. Demonstrate testing for two-point discrimination 6. Define extinction, stereognosis, and graphesthesia 7. Demonstrate Romberg test and interpret an abnormal Romberg test.

Describe the grading scale for reflexes
Deep tendon reflexes are often rated according to the following scale:

* 0: absent reflex * 1+: trace, or seen only with reinforcement * 2+: normal * 3+: brisk * 4+: nonsustained clonus (i.e., repetitive vibratory movements) * 5+: sustained clonus Deep tendon reflexes are normal if they are 1+, 2+, or 3+ unless they are asymmetric or there is a dramatic difference between the arms and the legs. Reflexes rated as 0, 4+, or 5+ are usually considered abnormal.

Demonstrate the plantar reflex and describe the Babinski reflex
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 * Test the plantar reflex by scraping an object across the sole of the foot beginning from the heel, moving forward toward the small toe, and then arcing medially toward the big toe. The normal response is downward contraction of the toes. The abnormal response, called Babinski's sign, is characterized by an upgoing big toe and fanning outward of the other toes.
 * A positive/abnormal Babinski reflex is shown above.
 * In people more than 2 years old, the presence of a Babinski's reflex indicates damage to the nerve paths connecting the spinal cord and the brain (the corticospinal tract).

Define dysdiadochokinesia and demonstrate how to test rapid-alternating movements.

 * dysdiadochokinesia
 * an inability to perform rapid, alternating movements.
 * test by rapidly alternating between palms and backhand slaps against the knee
 * test with heel to shin to knee test

Define dysmetria and demonstrate how to test limb coordination (finger to nose, heel to shin)

 * dysmetria
 * Dysmetria is lack of coordination of movement typified by under- or over-shooting the intended position with the hand, arm, leg or eye. Dysmetria of a hand can make writing and picking things up difficult or even impossible. Dysmetria that involves undershooting is called hypometria and overshooting is called hypermetria. Associated with cerebellum damage.
 * test with finger to nose test

Demonstrate gait testing, including tandem gait.

 * Get up and go test
 * Observe walking
 * Great description of Gait testing (400 words) on Neuroexam.com