ATI: CH 31 Musculoskeletal and Neurosensory (nuerosensory focus)

What are some topics to ask PT during neuro exam?

~dizzy, headaches
~seizures, triggers them
~hx of head injury or loss of consciousness
~change in vision, speech, ability to think clearly,memory loss, changein memory, or behavior
~ weakness, numbing,tremors,tingling (where?)

PT is responsive and able to open eyes and answer questions spontaneously and appropriately.

LOC: alert

PT responds to light shaking but can be confused and slow

Loc: obtunded

PT is able to open their eyes and respond but is drowsy and falls asleep easily

Loc: lethargic

PT requires painful stimuli to achieve a brief response. PT might not be able to respond verbally

Loc: stuporous

There is no response to painful stimuli


Flexion and internal rotation of upper extremity joints and legs

Abnormal posturing: decorticate rigidity

Neck and elbow extension with the wrists and fingers flexed

Abnormal posturing: decerebrated posturing

Cranial nerve 1

Olfactory, smell

Cranial nerve 2

Visual acuity, visual fields

Cranial nerve 3, 4, 6

~ 3 Oculomotor
~4 trochlear
~6 abducens
PERRLA, six cardinal positions of gaze

Cranial nerve 5

~sensory: light touch sensation to face [forehead, neck,jaw]
~motor:jaw opening,clenching, chewing

Cranial nerve 7

~sensory: taste (salt/sweet) on anterior 2/3 of tongue
~motor:facial movements

Cranial nerve 8

Hearing and balance

Cranial nerve 9

~ Sensory: taste (sour/bitter) on posterior third of tongue
~ motor: swallowing, speech sounds, gag reflex

Cranial nerve 10

~sensory: gag reflex
~motor: swallowing-speech quality

Cranial nerve 11

spinal accessory
Motor.: turning head, shrugging shoulders

Cranial nerve 12

Tongue movement

Use the mini-mental state examination to:

Assess cognitive status objectively

Mini Mental State Examination evaluates:

~ orientation to time and place
~ attention and calculation to counting backward by sevens
~ registration and recalling of objects
~language (naming objects) following commands,ability to write
~ reading

What would you use to establish a baseline of the PT's level of consciousness and ongoing assessment?

Glasgow coma scale

What is the highest GCS value that indicates full consciousness?


Expected findings of PTs coordination

Smooth, coordinated movements

Expected findings of PTs gait

Steady, smooth, and coordinated

2 tests that assess balance

Romberg, and heel-to-toe walk

How do you do a Romberg test? Expected results?

Ask PT to stand with feet together, arms at both sides and eyes closed
PT stands with minimal swaying for at least 5 seconds

Heel-to-toe walk? Expected results?

Ask PT to place heel of one foot in front of toesot other foot as they walk in straight line.
PT walks in straight line without losing balance

Assessing muscle strength?

ask patient to press against resistance
~ strength is equal or slightly stronger on dominant side

Place a familiar object in clients hand and ask them to identify it.


DTR response 4+

Very brisk with clonus

DTR response 3+

More brisk than average

DTR response 2+


DTR response 1+


DTR response 0

No response