For any doctor to say that they had a complete neuro exam of their patients, it means that they have done all the tests necessary to assess the health of their patient’s nervous system. A neurological exam is a vital part of any physical therapy treatment plan, as it helps doctors diagnose any problems with the patient’s nerves and muscles.
When performing a complete neurological exam, therapists must know what each test does and why they should perform it.
Without these tests, physicians would have a hard time diagnosing the patient. Below, we discuss some of the most common neuro exams and what they can tell therapists about their patients.
Cognitive Examination
The cognitive examination is one of the most vital parts of any neurological exam. It allows doctors to determine if a patient suffers from mental impairments like dementia or memory loss.
Physicians will ask patients questions about themselves and their experiences during this test. They will also measure how well they can concentrate on a task and whether they have difficulty planning or problem-solving.
Various cognitive tests can evaluate a patient’s cognitive abilities. These include:
- The Mini-Mental State Examination or MMSE is one of the most commonly used cognitive exams. It assesses a patient’s mental status by asking them questions about their name, address, and date of birth. The examiner will also ask them to count backward from 100 by sevens or recall three words following the presentation of a set of three objects. This test takes about 5 minutes to complete and has been proven accurate in diagnosing patients with dementia or other cognitive impairments.
- Montreal Cognitive Assessment (MoCA): This brief cognitive test takes about 10 minutes to complete. Doctors can use it for both initial screening and ongoing evaluation of patients with suspected cognitive impairment, including mild traumatic brain injury. The MoCA comprises 11 tasks that measure orientation, attention, memory, and executive function.
- Mini-Cog: This short, simple test takes only five minutes to complete and assesses a person’s attention span, memory, and language skills. The examiner will ask the patient to repeat three words following the presentation of a set of three objects, draw a clock face showing specific times, and recall five words backward.
Pupillary Reflex Test
The pupils and the brain communicate with each other through a reflex called the pupillary reflex. The pupils dilate when light enters the eye and constrict when there is darkness or dim light. This reflex helps maintain the optimal level of brightness for vision. It also helps control pupil size in response to changes in ambient lighting, providing a mechanism for adjusting visual sensitivity over short periods.
Therefore, a neurologist can use pupillary size measurement to help determine brain function. For example, if the reflex is absent, it may indicate damage to the brainstem or cerebellum.
During a pupillary reflex test, the doctor should use an NPi pupillometer to measure pupil size, which can indicate the level of brainstem and cerebellum function. The NPi pupillometer is an instrument that measures alteration in pupil size in response to light stimulation.
This device is one of the best neurological tools as it offers several benefits to the patient, such as:
- Being noninvasive (it uses light stimulation instead of needles or imaging methods)
- Providing fast and accurate results
- Offering objective information about brain function and integrity
The NPi pupillometer is a hand-held device that measures changes in pupil size in response to light stimulation. The device works by projecting an image onto the patient’s eyes simultaneously, allowing for simultaneous measurements of both pupils.
Motor Examination
Another neurological test that can assess symptoms of brain damage is the motor examination. This test measures the strength, range, and coordination of the patient’s muscle movements. It is performed by asking the patient to perform various tasks, such as stepping forward or backward with one foot while keeping their balance on a moving platform.
The results are measured in terms of how many steps they took before losing balance, how many times they stepped off-balance during each trial, and how quickly they could regain control after doing so (if at all).
The motor examination is vital because there is a link between the brain and the muscles. It is common for those with brain injuries to have difficulty moving in a coordinated manner, which can often be the first sign that something is wrong. The motor examination also helps doctors determine whether the patient has had paralysis and what treatment would be most effective (if any).
Sensory Examination
The next step in the neurological examination is to test the patient’s sensory abilities. This includes their ability to feel, smell, and see things around them and their reflexes. The doctor will check for any signs of itching or pain by touching certain parts of the patient’s body with a pin or a piece of cotton wool soaked in alcohol.
They may touch the patient’s skin lightly with their finger and ask the patient to identify which part of the body they are touching (this helps determine how well the patient can feel things). The doctor may also shine lights into the patient’s eyes and look at the pupils’ reactions.
Cranial Nerves Test
The cranial nerves are set of 12 pairs of nerves that connect the brain to the head, face, and neck. They carry information from the CNS or central nervous system to the muscles and organs in these body parts. A doctor will check for any signs of weakness or numbness by gently touching different parts of the patient’s head and face with a cotton wool bud.
Cranial Nerve One
The very first cranial nerve is the olfactory nerve. It connects the nose to the brain and allows a person to smell. The doctor will check for any problems with their patient’s sense of smell by asking them if they can distinguish different scents, such as rosemary or peppermint.
Cranial Nerve Two
The second cranial nerve is the optic nerve. It connects the eyes to the brain and allows people to see clearly. The doctor will check for any problems with their patient’s sight by asking them to read some letters off an eye chart.
Cranial Nerves Three, Four, and Six
The oculomotor, trochlear, and abducens are the third, fourth, and sixth cranial nerves. They connect to the brain and allow people to move their eyes up and down, side-to-side, and focus on specific objects in their field of vision. The doctor will check for any problems with their patient’s ability to move their eyes around by asking them to follow a pen from side to side or up and down.
Cranial Nerve Five
The fifth cranial nerve is the trigeminal nerve. It connects to the brain and allows people to feel sensations on their faces, such as pain, touch, or temperature. The doctor will check for any problems with these sensations by asking the patient where they feel pain or pressure on their face.
Cranial Nerve Seven
The seventh cranial nerve is the facial nerve. It connects to the brain and allows people to move their facial muscles to smile, frown or talk. The doctor will check for any problems with these movements by asking the patient to perform specific tasks such as smiling or sticking out their tongue.
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