Neurological Assessment Vegetative
Sequence in Conducting Neurological Ax ● Sleep wake cycle
1. Mental Status Glasgow Coma Scale
2. Sensory Assessment Measured right after the accident
3. Cranial Nerve Assessment
4. Motor Assessment
5. Reflexes
Mental and Emotional Status
Can use in MSK conditions
★ Overall level of alertness
★ Excitement of Cerebral Cortex
○ Motor
○ Memory
○ Cognition
★ Alert , Coherent , Cooperative is interchangeable
Screening for Mental Status
AROUSAL
Physiologic readiness of human system for activity
Why determine the level of Arousal? SCORING
Wernicke's Aphasia - Problem in comprehension
What to do? Mild Injury Moderate Injury Severe Injury
● Give tactile cueing
● Do passive or give assistance 13 and above 9-12 8 and below
● Repetition Level of consciousness is defined as:
● In front of the mirror for visual ● Eye opening
○ 4-1
If the patient has decrease arousal: ■ Spontaneous
● Give more tactile cueing and action ■ Speech
● Less words ■ Pain
■ No response
Brocas - Difficulty in articulation of words ● Verbal Response
When to determine level of arousal? ○ 5-1
Mckenzie - Extension Bias ■ Oriented
● Prone ■ Disoriented/Confused
● Prone on elbow ■ Inappropriate words
● Extension in Lying ■ Incomprehensive sounds
● Sitting or Standing ■ No response
Williams - Flexion Bias ● Motor Response
● Posterior Pelvic Tilt ○ 6-1
○ Hands on back ■ Follows command
○ PT put hand on abdominal and lower ● Ask patient to do
back then see if it contract movement
○ Put hand at the upper back ■ Localizes
● Single knees to chest ● Ask the patient to point
○ 7 sec hold x 10 reps the location of pain
○ Observe Post. tilt ● Ask the patient to move
○ Observe Contraction of abs and control specific limb
○ Ask the pt. hug the post. knee ■ Withdraw
● Double knees to chest ■ Abnormal Flexion
● Partial sit up ● Decorticate (Cortex)
● Seated reach to toe ○ UE Flex
● Seated Flexion ○ LE Ext
■ Extension Response
Level of Consciousness ● Decerebrate (Cerebellar)
Alert ○ UE Ext
● awake , attentive ○ LE Ext
● interaction is normal and appropriate ■ No response
Lethargic
● drowsy but may slight attentiveness Factors that can affect Alertness
● drowsy and may fall asleep if not stimulated Emotion
● interaction may get diverted and difficulty in ○ Can affect the pt. in terms of attentiveness
maintaining focus or attention on task Medication
Obtunded ○ Important to know medication of the patient
● Drowsiness need minimal stimulus Time of the day
● Difficulty to arouse compared to lethargic ○ Pt. is more active at day because at night our
● confused when awake cellular activity is at rest
, ○ Antok kapag afternoon ● Includes awareness , perception , attention m,
Fatigue comprehension , judgment , decision making and
○ Know if the patient is already tired memory
○ Know the capability of the patient
Areas of Testing Cognition
Cortical Activity
○ Challenge of activity Fund of Calculation Proverb
○ Some patients became more determine if they Knowledge Interpretation
are challenged
ATTENTION General Mathematical Ability to
Awareness to the environment and , responsiveness to knowledge of capability interpret words
stimulus or task patient outside of its
usual context or
● To get the attention of coma patient , pain
Sum total of meaning
stimulus is apply (Sternal Rub) learning and
How to determine attention? experience
1. Repetition
a. Give patient words then ask the patient to ➔ Unique at each ➔ Ask the patient ➔ Time is Gold
patient questions to count ➔ Mind over Matter
repeat it
➔ Middle name ➔ Can be problem
b. Example: ➔ Favorite food solving
■ Pen-Pineapple-Apple-Pen ➔ 4+4=8
2. Spell backwards
a. Give patient a word then ask then to spell it ASSESSMENT
right Visuospatial and Praxis Impairment
b. If the patient spell it correctly at first , ask them Clock Drawing Test
to spell it backwards ○ Ask the patient to draw circle
c. Example: ○ Ask to put number
■ G-o-d > D-o-g ○ Ask the patient to put the hand in specific
ORIENTATION time (10 minutes past 11)
Mental function of knowing objects , time , surroundings ○ Need perfect ang clock
and space. ○ Normal Score: 4-5 points
How to check the orientation? ■ 1 pt clock circle
● Ask Patient ■ 1 pt number is in correct order
○ Date today ■ 1 pt number is in correct special
○ Address order
○ Time ■ 1 pt two hands
○ Location ■ 1 pt correct time
● If they answered it all , you can put ORIENTATION x 3 ,
that means the patient is oriented and aware.
Definition Questions to ask
Time Awareness of ➔ Date
today, tomorrow, ➔ Time
➔ Is it morning or afternoon?
yesterday,day, ➔ What year is it?
month, and year Ranchos Los Amigos
Place Awareness of one’s ➔ Do you know where are you
location, such as know?
➔ Address
one’s immediate ➔ What kind of place is this?
surroundings
Person Awareness of one’s ➔ Name
own identity, and ➔ Middle Name
➔ Age
of individuals in ➔ Birthplace
the immediate
environment
Object Awareness of
objects or features
of objects
Space Awareness of one’s
body in
relationship to the
immediate
physical space
Geriatric Depression Scale
Sequence in Conducting Neurological Ax ● Sleep wake cycle
1. Mental Status Glasgow Coma Scale
2. Sensory Assessment Measured right after the accident
3. Cranial Nerve Assessment
4. Motor Assessment
5. Reflexes
Mental and Emotional Status
Can use in MSK conditions
★ Overall level of alertness
★ Excitement of Cerebral Cortex
○ Motor
○ Memory
○ Cognition
★ Alert , Coherent , Cooperative is interchangeable
Screening for Mental Status
AROUSAL
Physiologic readiness of human system for activity
Why determine the level of Arousal? SCORING
Wernicke's Aphasia - Problem in comprehension
What to do? Mild Injury Moderate Injury Severe Injury
● Give tactile cueing
● Do passive or give assistance 13 and above 9-12 8 and below
● Repetition Level of consciousness is defined as:
● In front of the mirror for visual ● Eye opening
○ 4-1
If the patient has decrease arousal: ■ Spontaneous
● Give more tactile cueing and action ■ Speech
● Less words ■ Pain
■ No response
Brocas - Difficulty in articulation of words ● Verbal Response
When to determine level of arousal? ○ 5-1
Mckenzie - Extension Bias ■ Oriented
● Prone ■ Disoriented/Confused
● Prone on elbow ■ Inappropriate words
● Extension in Lying ■ Incomprehensive sounds
● Sitting or Standing ■ No response
Williams - Flexion Bias ● Motor Response
● Posterior Pelvic Tilt ○ 6-1
○ Hands on back ■ Follows command
○ PT put hand on abdominal and lower ● Ask patient to do
back then see if it contract movement
○ Put hand at the upper back ■ Localizes
● Single knees to chest ● Ask the patient to point
○ 7 sec hold x 10 reps the location of pain
○ Observe Post. tilt ● Ask the patient to move
○ Observe Contraction of abs and control specific limb
○ Ask the pt. hug the post. knee ■ Withdraw
● Double knees to chest ■ Abnormal Flexion
● Partial sit up ● Decorticate (Cortex)
● Seated reach to toe ○ UE Flex
● Seated Flexion ○ LE Ext
■ Extension Response
Level of Consciousness ● Decerebrate (Cerebellar)
Alert ○ UE Ext
● awake , attentive ○ LE Ext
● interaction is normal and appropriate ■ No response
Lethargic
● drowsy but may slight attentiveness Factors that can affect Alertness
● drowsy and may fall asleep if not stimulated Emotion
● interaction may get diverted and difficulty in ○ Can affect the pt. in terms of attentiveness
maintaining focus or attention on task Medication
Obtunded ○ Important to know medication of the patient
● Drowsiness need minimal stimulus Time of the day
● Difficulty to arouse compared to lethargic ○ Pt. is more active at day because at night our
● confused when awake cellular activity is at rest
, ○ Antok kapag afternoon ● Includes awareness , perception , attention m,
Fatigue comprehension , judgment , decision making and
○ Know if the patient is already tired memory
○ Know the capability of the patient
Areas of Testing Cognition
Cortical Activity
○ Challenge of activity Fund of Calculation Proverb
○ Some patients became more determine if they Knowledge Interpretation
are challenged
ATTENTION General Mathematical Ability to
Awareness to the environment and , responsiveness to knowledge of capability interpret words
stimulus or task patient outside of its
usual context or
● To get the attention of coma patient , pain
Sum total of meaning
stimulus is apply (Sternal Rub) learning and
How to determine attention? experience
1. Repetition
a. Give patient words then ask the patient to ➔ Unique at each ➔ Ask the patient ➔ Time is Gold
patient questions to count ➔ Mind over Matter
repeat it
➔ Middle name ➔ Can be problem
b. Example: ➔ Favorite food solving
■ Pen-Pineapple-Apple-Pen ➔ 4+4=8
2. Spell backwards
a. Give patient a word then ask then to spell it ASSESSMENT
right Visuospatial and Praxis Impairment
b. If the patient spell it correctly at first , ask them Clock Drawing Test
to spell it backwards ○ Ask the patient to draw circle
c. Example: ○ Ask to put number
■ G-o-d > D-o-g ○ Ask the patient to put the hand in specific
ORIENTATION time (10 minutes past 11)
Mental function of knowing objects , time , surroundings ○ Need perfect ang clock
and space. ○ Normal Score: 4-5 points
How to check the orientation? ■ 1 pt clock circle
● Ask Patient ■ 1 pt number is in correct order
○ Date today ■ 1 pt number is in correct special
○ Address order
○ Time ■ 1 pt two hands
○ Location ■ 1 pt correct time
● If they answered it all , you can put ORIENTATION x 3 ,
that means the patient is oriented and aware.
Definition Questions to ask
Time Awareness of ➔ Date
today, tomorrow, ➔ Time
➔ Is it morning or afternoon?
yesterday,day, ➔ What year is it?
month, and year Ranchos Los Amigos
Place Awareness of one’s ➔ Do you know where are you
location, such as know?
➔ Address
one’s immediate ➔ What kind of place is this?
surroundings
Person Awareness of one’s ➔ Name
own identity, and ➔ Middle Name
➔ Age
of individuals in ➔ Birthplace
the immediate
environment
Object Awareness of
objects or features
of objects
Space Awareness of one’s
body in
relationship to the
immediate
physical space
Geriatric Depression Scale
