Neurological Assessment

Original Editor - Kim Jackson Top Contributors - Manisha Shrestha, Kim Jackson, Shaimaa Eldib, Kirenga Bamurange Liliane, Admin, Rucha Gadgil and Kanzaa Rahim

Introduction

In order to provide the best care and plan the best treatment a thorough assessment must be undertaken. It is the most important step in the rehabilitation process, helps to guide our clinical reasoning and decision when making informed decisions about the rehabilitation process. Johnson & Thompson (1996) outlined that treatment can only be as good as the assessment on which it was based. So in order for us to progress and manage our treatment plan and ensure we are identifying out patients problems the assessment should be an ongoing and continuous process. A neurological assessment focuses on the nervous system to assess and identify any abnormalities that affect function and activities of daily living. It should allow us to create individual, patient-centred goals and ultimately a tailor-made treatment plan based on the client's needs.

So for the proper neurological assessment, we can use a SOAP format as a guide.

Subjective Assessment

The subjective assessment is used to provide a detailed picture of how the present condition affects the patient. 

Demographic Data

Name, Age, Gender, Occupation, Dominant hand, Address

Chief Complain

What is his/her present complaint or problem for which they have visited you?

History of Present Condition

• Progression of the Condition
• Date of Onset of Signs & Symptoms
• Medical Management
• Medical Observations
• Other management
• Previous Therapy
• Results of Specific Investigations (X-rays, CT Scans, Blood Tests)

Past Medical History 

• Co-morbidities and other non-related conditions
• Special Equipment, Technology Dependency
• Previous Surgery
• Medication History
• History of any allergies

Personal History

Marital status, occupation,

Activity

• Normal Daily Routine
• Employment
• Leisure Activities
• Smoking and drinking habits

Mobility

• General
• Indoor
• Outdoor
• Steps & Stairs
• Falls

Personal Care

• Washing
• Continence
• Dressing

Other

• Vision
• Hearing
• Swallowing
• Fatigue
• Pain
• Perceptions of own Problems/Main Concern
• Expectations of Treatment

Family History

Total number of family members, his/her primary caretaker,

Socioeconomic History

• Family income source
• Relationship with community people
• Social Situation
• Family Support
• Accommodation
• Social Service Support

Objective Assessment

On Observation

1. Built
2. Gait
3. Pattern of Movement
4. Mode of Ventilation
5. Type/ Pattern of Respiration
6. Oedema
7. Muscle Wasting
8. Pressure Sores
9. Deformity
10. Wounds
11. External Appliances
12. Posture and Balance

• Alignment and attitude of limbs
• Neglect
• Sitting Balance
• Standing Balance
  

Vital Signs

Respiratory rate

Temperature

Pulse rate

Blood pressure

O2 saturation

On Examination

Higher mental function

Communication:

Aphasia ( Broca's, Wernicke's, Global)

Cognition:

• Orientation:
  • Person:
  • Place:
  • Time:
• Calculation:
• Registration:
• Attention:
• Proverb Interpretation:
• Memory:
  • Immediate:
  • Recent:
  • Remote:
  • Verbal:
  • Visual:
• Language
• Visuospatial proficiency

There are various outcome tools via which we can address his/her cognitive status incorporating various components.

• Mini-mental Status Examination
• Mini-cog
• Montreal cognitive assessment (MoCA)

Perception:

• Body Scheme/ Body Imaging
• Agnosias/ Apraxias:

Common tools to assess perceptual problems are:

• Star Cancellation Test.
• Line Bisection Test.
• Clock Drawing Test.

Voluntary Movement

• Range of Movement
• Strength
• Endurance
• Coordination 
  Finger to Nose Test
  Heel to Shin Test
  Rapidly Alternating Movement

Involuntary Movement

• Tremor
• Clonus
• Chorea
• Associated Reactions

Tone

• Decreased / Flaccid
• Increased
  Spasticity (Clasp-knife)
  Rigidity (Cogwheel or Lead Pipe)

Reflexes

• Deep Tendon Reflexes
  Biceps (C5/6)
  Triceps (C7/8)
  Knee (L3/4)
  Ankle (S1/2)
• Plantar Response (Babinski’s Sign)

Babinski Sign Test video provided by Clinically Relevant

Sensory

• Light Touch
• Pin Prick
• Two Point Discrimination
• Vibration Sense
• Joint Position Sense
• Temperature
• Vision and Hearing

Functional Activities

• Bed Mobility
• Sitting Balance
• Transfers
• Upper Limb Function
• Mobility
• Stairs

Gait

• Pattern
• Distance
• Velocity
• Use of Walking Aids
• Orthoses
• Assistance
• Cognitive Status
• Attention
• Orientation
• Memory