Neurological assessment.
Motor system.
Visual inspection.
Note muscle bulk.
Look for generalized or focal muscle wasting or hypertrophy.
Look for extraneous movements like tremor or muscle twitching.
Note speed of movement.
Tone (muscle tension at rest).
Ask patient to relax.
Flex and extend patient's wrists, elbows, ankles, and knees.
Look for resistance that is decreased or increased.
Strength and endurance.
Isolate muscle you are testing so patient can't use strong muscles that have similar function to compensate for weak one being tested.
Fix proximal joints when testing distally.
If testing pronation, fix the humerus, so patient can't use shoulder to compensate for weak pronation.
When testing deltoid, press outstretched hand rather than on elbow.
Have patient walk on toes.
Have patient do deep knee bend without using arms.
Ask the patient to get out of chair without using arms.
Reflexes.
Muscle stretch reflexes.
Position limb and place muscle in slight tension.
Quickly tap the tendon to which muscle is attached.
Observe vigor and briskness of response.
Compare side to side.
If reflexes are diminished or absent, try reinforcing the reflex by distraction or contraction of other muscles.
Sensory system.
Pain.
Use a safety pin.
Test for a distal gradient of sensory loss in leg by applying stimulus at toes and marching your way up to knee.
Ask patient if sensation is about the same or it changes as you move up the leg.
In the patient complaining of sensory symptoms, move stimulus from abnormal area to normal area.
Ask patient to report when stimulus begins to feel stronger.
Station and gait.
Observe the patient do the following.
Rise from a seated position.
Walk across room, turn, and come back.
Walk on toes.
Walk on heels.
Pay attention to the following.
Posture of body and extremeties.
Base of gait ( how far apart are the legs).
Length, speed, and rhythm of steps
Arm swing (is it reduced unilaterally or bilaterally).
Steadiness.
Meningeal signs.
Ask patient to flex and extend neck.
Passively flex and extend patient's neck.
Observe for palpable stiffness on either active or passive movement.
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