Chapter 3: The Neurological Examination and Evaluation: An Overview

Chapter Objectives

Upon completion of this chapter, the learner should be able to:

1. Describe the purpose of the neurological examination.

2. Select the components of the examination appropriate to the individual patient.

3. State the components of a screening neurological examination.

4. Describe the process of testing the seven key areas of the screening examination.

5. Discuss the differences between a screening examination and the examination of a patient with a known or suspected neurological diagnosis.

6. Perform and document an evaluation based on screening examination data.

Introduction

When first confronted with learning the details of conducting a neurological examination, students often feel that the amount of information to be processed is overwhelming. If, however, this task is approached as a systematic investigation in which the therapist sorts out the systems that are functioning appropriately from those demonstrating potential impairments, activity limitations, and participation restrictions, the process can flow quite easily. The purpose of this chapter is to describe the objective of the neurological examination, the overall procedure and categories of the neurological examination, and the components of the neurological screening examination. The subsequent chapters in Section II will provide the details of examining the specific actions of the nervous system (including underlying impairments and resulting functional activity limitations), describe abnormal results expected in the presence of dysfunction, and provide the foundation needed to interpret what the specific findings mean. The first step must be to understand the purpose of the neurological examination, the overall perspective gained from a screening examination, and the role the information gathered will play in refining and focusing the remainder of the neurological examination and in developing a specific plan of care for each patient.

The neurological examination can function as a screening tool or an investigative tool (Fuller, 2008). When interacting with a patient not suspected of having neurological involvement, the screening examination provides a brief process of reviewing selected functions of the nervous system to confirm that the system is intact. In the presence of suspected or known neurological pathology, the examination process is more detailed to confirm the type and extent of the neuromotor and related impairments. Within the process of examining a single patient, the screening and investigative approaches may be intertwined. For example, during the examination of a patient with a known peripheral nerve lesion, the therapist will utilize the screening process to verify that cerebral and cranial nerve functions are intact while using more detailed processes to document the extent of the disruption of the peripheral functions. Any abnormality detected during the screening examination will lead to a more detailed examination of that subsystem as described in Chapters 4, 5, 6, 7, 8, 9, 10, 11, 12, 13.

The neurological examination includes asking questions (review of the patient’s medical record, history, and review of systems) and performing tests (observation ...