A neurological exam, also called a neuro exam, is an evaluation of a person's nervous system that can be done in the healthcare provider's office. It may be done with instruments, such as lights and reflex hammers. It usually does not cause any pain to the patient. The nervous system consists of the brain, the spinal cord, and the nerves from these areas. There are many aspects of this exam, including an assessment of motor and sensory skills, balance and coordination, mental status (the patient's level of awareness and interaction with the environment), reflexes, and functioning of the nerves. The extent of the exam depends on many factors, including the initial problem that the patient is experiencing, the age of the patient, and the condition of the patient.
Why is a neurological exam done?
A complete and thorough evaluation of a person's nervous system is important if there is any reason to think there may be an underlying problem, or during a complete physical. Damage to the nervous system can cause problems in daily functioning. Early identification may help to find the cause and decrease long-term complications. A complete neurological exam may be done:
During a routine physical
Following any type of trauma
To follow the progression of a disease
If the person has any of the following complaints:
Headaches
Blurry vision
Change in behavior
Fatigue
Change in balance or coordination
Numbness or tingling in the arms or legs
Decrease in movement of the arms or legs
Injury to the head, neck, or back
Fever
Seizures
Slurred speech
Weakness
Tremor
What is done during a neurological exam?
During a neurological exam, the healthcare provider will test the functioning of the nervous system. The nervous system is very complex and controls many parts of the body. The nervous system consists of the brain, spinal cord, 12 nerves that come from the brain, and the nerves that come from the spinal cord. The circulation to the brain, arising from the arteries in the neck, is also frequently examined. In infants and younger children, a neurological exam includes the measurement of the head circumference. The following is an overview of some of the areas that may be tested and evaluated during a neurological exam:
Mental status. Mental status (the patient's level of awareness and interaction with the environment) may be assessed by conversing with the patient and establishing his or her awareness of person, place, and time. The person will also be observed for clear speech and making sense while talking. This is usually done by the patient's healthcare provider just by observing the patient during normal interactions.
Motor function and balance. This may be tested by having the patient push and pull against the healthcare provider's hands with his or her arms and legs. Balance may be checked by assessing how the person stands and walks or having the patient stand with his or her eyes closed while being gently pushed to one side or the other. The patient's joints may also be checked simply by passive (performed by the healthcare provider) and active (performed by the patient) movement.
Sensory exam. The patient's healthcare provider may also do a sensory test that checks his or her ability to feel. This may be done by using different instruments: dull needles, tuning forks, alcohol swabs, or other objects. The healthcare provider may touch the patient's legs, arms, or other parts of the body and have him or her identify the sensation (for example, hot or cold, sharp or dull).
Newborn and infant reflexes. There are different types of reflexes that may be tested. In newborns and infants, reflexes called infant reflexes (or primitive reflexes) are evaluated. Each of these reflexes disappears at a certain age as the infant grows. These reflexes include:
Blinking. An infant will close his or her eyes in response to bright lights.
Babinski reflex. As the infant's foot is stroked, the toes will extend upward.
Crawling. If the infant is placed on his or her stomach, he or she will make crawling motions.
Moro's reflex (or startle reflex). A quick change in the infant's position will cause the infant to throw the arms outward, open the hands, and throw back the head.
Palmar and plantar grasp. The infant's fingers or toes will curl around a finger placed in the area.
Reflexes in the older child and adult. These are usually examined with the use of a reflex hammer. The reflex hammer is used at different points on the body to test numerous reflexes, which are noted by the movement that the hammer causes.
Evaluation of the nerves of the brain. There are 12 main nerves of the brain, called the cranial nerves. During a complete neurological exam, most of these nerves are evaluated to help determine the functioning of the brain:
Cranial nerve I (olfactory nerve). This is the nerve of smell. The patient may be asked to identify different smells with his or her eyes closed.
Cranial nerve II (optic nerve). This nerve carries vision to the brain. A visual test may be given and the patient's eye may be examined with a special light.
Cranial nerve III (oculomotor). This nerve is responsible for pupil size and certain movements of the eye. The patient's healthcare provider may examine the pupil (the black part of the eye) with a light and have the patient follow the light in various directions.
Cranial nerve IV (trochlear nerve). This nerve also helps with the movement of the eyes.
Cranial nerve V (trigeminal nerve). This nerve allows for many functions, including the ability to feel the face, inside the mouth, and move the muscles involved with chewing. The patient's healthcare provider may touch the face at different areas and watch the patient as he or she bites down.
Cranial nerve VI (abducens nerve). This nerve helps with the movement of the eyes. The patient may be asked to follow a light or finger to move the eyes.
Cranial nerve VII (facial nerve). This nerve is responsible for various functions, including the movement of the face muscle and taste. The patient may be asked to identify different tastes (sweet, sour, bitter), asked to smile, move the cheeks, or show the teeth.
Cranial nerve VIII (acoustic nerve). This nerve is the nerve of hearing. A hearing test may be performed on the patient.
Cranial nerve IX (glossopharyngeal nerve). This nerve is involved with taste and swallowing. Once again, the patient may be asked to identify different tastes on the back of the tongue. The gag reflex may be tested.
Cranial nerve X (vagus nerve). This nerve is mainly responsible for the ability to swallow, the gag reflex, some taste, and part of speech. The patient may be asked to swallow and a tongue blade may be used to elicit the gag response.
Cranial nerve XI (accessory nerve). This nerve is involved in the movement of the shoulders and neck. The patient may be asked to turn his or her head from side to side against mild resistance, or to shrug the shoulders.
Cranial nerve XII (hypoglossal nerve). The final cranial nerve is mainly responsible for movement of the tongue. The patient may be instructed to stick out his or her tongue and speak.
Coordination exam:
The patient may be asked to walk normally or on a line on the floor.
The patient may be instructed to tap his or her fingers or foot quickly or touch something, such as his or her nose with eyes closed.
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Want to help patients stay in good health? Ready to become a medical assistant? The medical assistant will assist the physician with a patient’s physical examination and health assessment by preparing the room, preparing the patient, assisting with the physical examination, knowing the physical examination format, and assisting the patient after the physical examination is complete.
Room Preparation
The medical assistant is responsible for preparing the examination room, making sure the equipment and instruments are disinfected and sanitized, and the supplies are adequately stocked. The examination room should be clean, well lit, ventilated and at a comfortable temperature for the patient. After every physical examination and health assessment the medical assisting should disinfect the room and paper on the surfaces should be removed and replaced. The medical assistant must also make sure that the physical examination instruments are working properly and charged for the next patient examination.
Patient Preparation
Once the room is ready, the medical assistant will escort the patient to the examination room. It is the medical assistants goal to create a low-stress and comfortable atmosphere for patients. The medical assistant will record the patient’s history and check vital signs.
The medical assistant will then ask the patient to disrobe for the physical examination and health assessment and put on the examination gown. Once the patient is fully transitioned to the examination gown, the medical assistant will have the patient sit on the examination table and drape their legs for privacy. The medical assistant will then place the patient’s chart outside the examination room door and notify the physician that the patient is ready for the physical examination and health assessment.
Assisting with the Physical Examination
The medical assistant may assist the physician while performing the physical examination. The medical assistant will be responsible for handing the proper instruments and supplies to the physician. The medical assistant may also help the patient move into the appropriate position while adjusting the drape to expose the right part of the body for the physician to examine the patient.
Physical Examination Format
The physical examination and health assessment begins with the patient on the examination table with a drape sheet over the lap and covering the legs. The physician will examine the patient in an orderly and methodical sequence. First, viewing the patients head and neck. Then, examining the eyes and ears, nose and sinuses, mouth and throat, chest, breasts and abdomen, genitalia and rectum, and legs. Finally checking the patient’s reflexes.
Head and Neck – The patient’s skull, scalp, hair and face are inspected for size, shape and symmetry. The physician will look for any nodules, masses or local trauma. The trachea, lymph nodes and thyroid gland are examined for size and symmetry. Finally, the physician examines the carotid arteries to check for abnormal sounds caused by a blockage.
Eyes and Ears – The physician will inspect the fibrous tissue covering the eye for normal coloring. Then the pupils are inspected with a penlight to view their size and see if they react normally to light. The patient will follow the physician’s finger to examine proper eye movement. The ears are inspected for size, symmetry, lesions and nodules. The physician uses an otoscope to examine the interior of the ear for discoloration and fluids caused by infection. Auditory acuity is tested with the tuning fork or the audioscope.
Nose and Sinuses – the external nose is examined for abnormalities and the interior of the nose is examined using a nasal speculum and penlight. Each nostril is inspected for discharge, lesions or other signs of infection.
Mouth and Throat – the physician inspects the mucous membranes, gums, teeth, tongue, tonsils, and throat. The physician looks for any abnormalities including color, ulcerations and nodules.
Chest, Breasts & Abdomen – the physician looks for any obvious masses or swelling. With the stethoscope, the physician listens for any abnormal sounds in the lungs, heart and apical pulse while the patient takes deep breaths. The breasts of male and female patients will be examined for any abnormalities or masses. Then, the physician examines the abdomen for contour, symmetry and movement from the aorta. The physician will also use the stethoscope to listen to the bowel sounds. Finally, the physician will examine the abdomen organs for enlargement, masses, pain or tenderness.
Genitalia and Rectum – the male genitalia are inspected for lesions, swelling, masses and hair distribution. The scrotum is checked for testicular size, contour and consistency. The anus is inspected for lesions and hemorrhoids. The female genitalia and rectum are inspected for lesions, edema, cysts, discharge and hair distribution.
Legs – the legs are inspected for any abnormalities and the pulse is measured for extremity blood pressure. The legs are also inspected for varicose veins.
Reflexes – the physician uses the percussion hammer to test the patient’s reflexes by striking the biceps, triceps, patellar, Achilles and plantar tendons.
After the Physical Examination
The medical assistant will perform any follow-up treatments and procedures as ordered by the physician (i.e. flu shot administration). They will ask the patient to redress and wait for further instructions. The medical assistant will escort the patient to the front desk where they can schedule any follow-up appointments.
The medical assistant will want to dispose of any disposable supplies and equipment used during the physical examination and health assessment. from the exam room Then, the medical assistant will cover the examination table with clean paper and prepare the room for the next patient.
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