Client Neurological Assessment Nutrition:
information T P OPQRSTUV presenting problem: Diet:
R BP
Client code: __________________________________________ Amount of Meals consumed %
Rm no: __________________________________________ B: L: S:
baseline
Age: T P Headache/head injury/dizziness or vertigo/ seizures/ __________________________________
Date of R BP tremors/weakness/in coordination/numbness or _
admission: Tingling/ difficulty swallowing/difficulty speaking/ Intake & Output totals:
Time:
Reason for T P
Past hx/environmental or occupational hazards
admission: R BP __________________________________
Mental Status Assessment: _
Health Time: Orientation: __________________________________ Elimination:
Challenges: LOC: ________________________________________
ABCT: _______________________________________
______________________________________________
Cranial Nerves: for each identify motor and/or sensory
function as well as note your patient’s response
● CN I ______________________________
● CN II _____________________________
● CN III, IV & VI ____________________
_____________________________________
● CN V ____________________________
● CN VII ___________________________
● CN VIII___________________________
● CN IX & X ________________________
● CN XI ____________________________
● CN XII ___________________________
Indicate if your patient would require Glasgow Coma
Scale or Canadian Neurological Scale assessment –
(please practice both during lab)
Glasgow Coma Scale
Spontaneous--open with
Opening Response blinking at baseline 4 points
Opens to verbal command,
3 points
speech, or shout
Opens to pain, not applied to
2 points
face
None 1 point
Oriented 5 points
Confused conversation, but able
4 points
to answer questions
Verbal Response Inappropriate responses, words
3 points
discernible
Incomprehensible speech 2 points
None 1 point
Obeys commands for movement 6 points
Purposeful movement to painful
5 points
stimulus
Withdraws from pain 4 points
Motor Response Abnormal (spastic) flexion,
3 points
decorticate posture
Extensor (rigid) response,
2 points
decerebrate posture
None 1 point
GCS results _____________________________________
Interpretation of results ___________________________
PERRLA ______________
Canadian Neurological Scale
(Use your reference Card to assess Stroke Scale results) Total:
________________________________________________
Motor System - Inspect & palpate
Muscles: Inspection
● Size _____________________________
● Strength __________________________
● Tone _____________________________
● Involuntary movements ______________
Cerebellar Function
Balance & Coordination:
● Gait _____________________________
● Romberg Test _____________________
● Rapid alternating movements __________
_____________________________________
● Finger to finger Test _________________
● Finger to Nose Test __________________
● Heel to shin ________________________
Sensory System:
Spinothalamic Tract:
● Pain (sharp/dull) _______________________________
● Temperature (hot/cold) _________________________
● Light touch __________________________
Posterior column tract:
● Vibration ___________________________
● Position (kinesthesia) _________________
● Stereognosis _________________________
● Graphesthesia ________________________
● Two-point discrimination _______________
● Extinction ___________________________
● Point location ________________________
Reflexes:
Deep Tendon Reflexes:
● Bicep ______________________________
● Triceps _____________________________
● Brachioradialis _______________________
● Quadriceps __________________________
● Achilles___________________________
● Clonus ____________________________
Superficial Reflexes:
● Abdominal _________________________
● Cremasteric ________________________
● Plantar ____________________________
