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Neurological assessments (Mental status examination. (Speech and language.…

- - - - Hold Snellen chart at comfortable reading distance about 6 m.
      - Ask the patient to cover one eye and read the chart.
      - For each eye, record smallest line patient can read.
      - If the patient uses glasses to view distant object, they should be permitted to wear them.
    - - Stand directly in front of patient
      - Have patient look you in both eyes.
      - Hold your hands midway between you and the patient far enough laterally that you can barely see them out of the corner of your eyes.
      - Wiggle a finger on one hand.
      - Ask the patient to indicate on which side the finger is moving.
      - Have patient close one eye, the examiner should close his own eye that is opposite the patient's closed eye.
      - Repeat in upper and lower temporal quadrants.
      - Move a finger or penlight into the periphery of each visual quadrant.
      - Ask patient to indicate when movement is detected.
      - It should be seen by the patient and the examiner at the same time.
  - - - Explain to patient what you intend to do.
      - Use sharp end of a broken cotton swab to test pain sensation on forehead, cheek and jaw of each side of face.
      - Ask the patient to tell whether it feels about the same on both sides.
      - If not, map out where abnormality is to see if it confirms to distribution of trigeminal nerve.
    - - Lightly touch peripheral aspect of cornea from the side with fine wisp of cotton.
      - Look for normal blink reaction of both eyes.
      - Repeat on the other.
      - If response is less than brisk, touch cornea more centrally.
- - - - Smile.
      - Puff out cheeks.
      - Close both lips and resist your attempt to open them.
      - Close both eyes and resist your attempt to open them.
      - Raise eyebrows.
  - - - Screen hearing
        
        Face patient and hold out your arms with your fingers near each ear.
        
        Rub your fingers together on one side.
        
        Ask patient to tell you when and on which side the rubbing is.
        
        Increase intensity as needed.
        
        Note any asymmetry.