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Neurology (Cranial Nerve Examination (On Occasion Our Trust Truck Acts…

- - - - Touch thumb to each finger on same hand in sequential manner
      - With patient seated, pat knees with both hands, alternating palm and dorsal side of hand
      - Accuracy of Movements
        
        Finger-to-finger test: eyes open, patient alternates touching index finger to their nose and examiner's finger, examiner changes location of finger several times, repeat with opposite hand
        
        Finger-to-nose test: eyes CLOSED, patient alternates touching nose with index finger of either hand, have patient gradually increase speed
        
        Heel-to-shin test: patient may be standing, sitting, or supine; ask patient to move heel of one foot from ankle to knee and back to ankle; repeat with opposite heel
    - - Romberg test: have patient stand with feet together, arms at side; ask patient to CLOSE their eyes for 20-30 seconds; stand close to catch patient if necessary; slight swaying is expected; positive Romberg = abnormal finding --> if positive, postpone other tests requiring balance
      - Pronator Drift: ask patient to stand, arms straight forward, palms up; have patient close eyes for 20-30 seconds; look for drift; TAP patient's arms briskly downward; arms should return to horizontal position
      - Shoulder Push: have patient stand with feet slightly apart; push shoulders with enoughforce to throw patient off balance; be ready to catch patient; recovery of balance should occur quickly
      - Balance on one foot: patient with eyes CLOSED, hands on side; balance should be maintained for 5 seconds; test both sides
      - Hop on one foot: eyes open, hop in place on one foot, then the other; should hop 5 seconds on each foot without loss of balance
- - - - Brachioradials (C5, C6): forearm flexion; hold patient's thumb to suspend the forearm in relaxation; strike about 2-3 cm above the radial styloid process; normal = flexion and supination of the forearm
      - Triceps (C5, C6): elbow extension; suspend the upper arm, important to have patient totally relax their arm; strike the triceps tendon directly just above the elbow; normal = extension of forearm
      - Biceps (C5,C6): elbow flexion; support patient's forearm on your; partially flex the arm; place thumb on bicep tendon; strike your thumb; normal = contraction of biceps and flexion of forearm
      - Patellar/Quadriceps (L2, L3, L4): knee jerk; let the lower legs dangle freely; strike tendon directly just below the patella (kneecap); normal = extension of lower leg and palpable contraction of the quadriceps
      - Achilles (S1, S2): plantar flexion; position the patient with the knee flexed and the hip externally rotated; hold the foot in dorsiflexion; strike the Achilles tendon directly; normal = foot plantar flexes against hand
      - Reinforcement: a technique used to relax the muscles and enhance the reflex response; ask patient to perform an isometric exercise in a muscle group away from the one being tested