Neurological Screen
Original Editors - Naomi O'Reilly
Top Contributors - Naomi O'Reilly and Jess Bell
Introduction[edit | edit source]
Many rehabilitation professionals worldwide now assume a first contact role, which means that they may be the first medical professional to assess a patient presenting with impairments in body function. Given this it is essential that rehabilitation professionals have the ability to recognise the key elements of the patient history, and the physical examination which may be indicative of any serious pathology or a potential risk of serious adverse events.[1] The neurological screening examination is a “quick scan" used to rule out symptoms, which may be referred from one part of the body to another.
The neurological screen has always been considered a key element of safe and appropriate practice, and is commonly used to determine a patients neurological function.[2] A basic neurologic screen can be performed rapidly with practice. The presence of an abnormal result usually warrants further investigation and onward referrals to specific specialties.[2]
Why[edit | edit source]
Clinicians utilise a neurologic screens as a differential diagnostic tool to rule in or out such things as neurological diseases or injuries to the nervous system, and helps clinicians to determine whether any signs and symptoms are caused by tissues innervated by the central nervous system (brain and spinal cord) or peripheral nervous system.
Indications[edit | edit source]
A neurological screen is most appropriate to do when red flags are present. In cases where a patient sustained a possible injury to their brain, spinal cord or peripheral nervous system or if you feel one is appropriate.You may want to perform one as well, if a patient presents with any of the following:
- Injury to the Head or Spine
- Headaches
- Blurry or Double Vision
- Loss of Smell
- Impaired Hearing
- Impaired Speech
- Dizziness
- Seizures
- Tremors
- Change in Balance
- Change in Coordination
- Changes in Sensation
- Radicular Signs
- Muscle Weakness
- Numbness or Tingling in the Arms and/or Legs.
- Changes in Bowel and Bladder Function
- Presents with Abnormal Patterns
- Altered Mental State such as confusion, memory loss, cognitive decline or reported changes in behaviour
When performing the neurological screen, it is important to keep the purpose of the examination in mind, namely to localise the lesion to the nervous system.
Reflexes[edit | edit source]
Several types of reflexes, including deep tendon reflexes, superficial reflexes, and pathological reflexes, can be tested as part of a physical examination and these all reveal something about the status of the elements of the nervous system that contribute to their functioning. Testing for deep tendon reflexes is most commonly used during a neurological screen using a reflex hammer to assesses the integrity of the stretch reflex arc of a specific nerve root, which provides information on the integrity of the specific nerve root.
The rehabilitation professional strikes over the tendon insertion to place a slight quick– stretch on the tendon, which will elicit a reflex response (for example a muscle jerk response). The most common deep tendon reflexes assessed in the upper and lower extremities include the biceps, brachioradialis, triceps, patellar and the achilles tendon.
| Segmental Innervation | Nerve Supply | Muscle |
|---|---|---|
| C5-6 | Musculocutaneous | Biceps Brachii |
| C5-6 | Radial | Brachioradialis |
| C7-8 | Radial | Triceps |
| L2-4 | Femoral | Patellar |
| S1-2 | Tibial | Achilles |
Grading of deep tendon reflexes uses a 5-point scale to characterise the stretch reflex response and compare it bilaterally to the uninjured limb.
| Grade | Description |
|---|---|
| 0 | Reflex Absent |
| 1 | Somewhat Diminished or Requires Reinforcement |
| 2 | Average |
| 3 | Brisker than Average |
| 4 | Very Brisk with Clonus |
Sensation[edit | edit source]
Peripheral Nerves[edit | edit source]
Dermatomes[edit | edit source]
Dermatomes are areas of the skin whose sensory distribution is innervated by the afferent nerve fibres from the dorsal root of a specific nerve root. Assessment of dermatomes involves bilateral comparison of light touch discrimination. During dermatome testing the examiner should alter or remove the pressure applied to one side to determine whether the patient can distinguish changes in pressure.
Strength[edit | edit source]
Myotomes[edit | edit source]
Myotomes represent a group of muscles that are innervated from a single specific nerve root. Essentially, myotomes are the motor equivalent to dermatomes. Myotomes may be assessed for various muscle groups of the upper and lower extremities. Myotome testing is performed through sustained isometric contraction of a specific muscle. Common muscles tested during myotome assessment are listed below.
| Nerve Root | Upper Limb Movement | Nerve Root | Lower Limb Movement |
|---|---|---|---|
| C2 | Neck Flexion [5] | L2 | Hip Flexion |
| C3 | Neck Extension [5] | L3 | Knee Extension |
| C4 | Neck Lateral Flexion [5] | L4 | Ankle Dorsiflexion |
| C5 | Shoulder Abduction | L5 | Big Toe Extension |
| C6 | Elbow Flexion | S1 | Ankle Plantarflexion |
| C7 | Elbow Extension | S2 | Knee Flexion [5] |
| C8 | Thumb Extension | S3-4 | Anal Wink [5] |
| T1 | Finger Abduction |
Clinical Significance[edit | edit source]
Resources[edit | edit source]
References [edit | edit source]
- ↑ Taylor A, Mourad F, Kerry R, Hutting N. A guide to cranial nerve testing for musculoskeletal clinicians. Journal of Manual & Manipulative Therapy. 2021 Nov 2;29(6):376-90.
- ↑ 2.0 2.1 Shahrokhi M, Asuncion RM. Neurologic exam. InStatPearls [Internet] 2022 Jan 20. StatPearls Publishing.
- ↑ Rodriguez-Beato FY, De Jesus O. Physiology, Deep Tendon Reflexes.
- ↑ Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.
- ↑ 5.0 5.1 5.2 5.3 5.4 Magee, David. J (2006). "3". Orthopaedic Physical Assessment (4th ed.). St. Louis: Elsevier. pp. 121–181
