Comprehensive Neurological Assessment 1
1) Subjective Assessment (what the patient b) On Observation
thinks of his inability) xi. Body built
a. Demographic Data (Name/ Age/ Occupation/ xii. Posture
Date of Admission/ Gender/ Contact details) 1. Upper extremity
b. History - Scapula – Depressed + Protracted
i. Chief complaint - Shoulder – Ad + IR + E
ii. History of present illness (how long/ - Elbow – F
how often/ when started) - Forearm – Pronated
iii. Past medical history (Other conditions - Wrist – F + UD
related to the chief complaint/ - Hand – Fisted/
associated health problems i.e. HTN/ Thumb in palm/
CHO/ DM) Clench fist
iv. Personal History (To see whether it’s
acquired. i.e. Smoking/ Alcohol)
v. Family History (To see whether it’s 2. Pelvis, Spine and Trunk
genetic. i.e. Risk analysis) - Lateral Head shift
vi. Socio-economic History (Marital status/ - Lateral F of the trunk (Convex to sound side)
Position on the family) - Asymmetrical pelvis
- Posterior pelvic tilt
Objective Assessment - Flattened lumbar lordosis
a) Vital signs - More weight on sound side (on ischeal
vii. Blood pressure tuberosity/ sound side knee)
BP stage Systolic mmHg Diastolic mmHg
Normal <120 And <80 3. Lower extremity
Elevated 120-129 And <80 In Sitting In Standing
HTN Stage 1 130-139 Or 80-89 Hip F + Ab + ER E + Ad + IR
HTN Stage 2 ≥ 140 Or ≥ 90 Knee F E
HTN Crisis >180 And/or >120 Ankle Plantar F Plantar F
viii. Temperature : 37 ° C / 98.6 ° F
ix. Respiratory rate xiii. Postural Attitude
Age Respiratory rate CPM (Synergy patterns: Primitive movements
Up to 6 month 30-60
that dominate reflex and voluntary
6-12 month 24-30
1-5 years 20-30 effort when spasticity is present
6-12 years 18-30 following a cerebrovascular accident.)
12< years 12-20 - For upper limb
Flexor Synergy Extensor Synergy
>20 Tachypnea Scapula Retraction+Elevation Protraction+Depression
<12 Bradypnea Shoulder Ab + ER Ad + IR
Elbow F E
x. Heart rate for adults : 60-100 Forearm Supination Pronation
Wrist F F or E
<60 Bradycardia
>100 Tachycardia
- For lower limb
Flexor Synergy Extensor Synergy
Hip F + Ab + ER E + Ad + IR
Knee F E
Ankle Dorsiflexion + Inv PlantarF + Inv
Toes E F
CONTACT ME AT | RIKAZ. AMM.
, Comprehensive Neurological Assessment 2
Flexor synergy dominates UL and Extensor *Mild – GCS ≥13
synergy dominates LL. *Moderate – GCS 9-12
*Severe – GCS ≤ 8
xiv. Deformity (Stiff joint / Joint contracture /
Muscle tightness / Genu recurvatum / 2. Attention and Orientation
valgus / varus deformities) Time Day, date, year, season
Place City, Hospital, Birth place
xv. External appliances (Ventilatory
Person His name, job
apparatus / NG tube/ Catheters / ECG
leads / Diapers)
3. Memory
xvi. Tropical changes (Wounds/ Pressure Immediate recall By name and address test
sores/ Color changes/ rashes / spots/ Short term memory After 5 minutes, pt. is asked again to
erythema/ scaly skin) recall what is used in immediate recall
xvii. Involuntary movements Long term memory Factual knowledge i.e. President of SL.
Fasciculation Brief spontaneous contraction of small
number of mm fibers under the skin 4. Speech
Tics Involuntary contraction of single or group Dysarthria Difficulty in articulation of speech due to
of mm resulting in stereotyped movements weakness of orolingual muscles.
Dystonia Uncontrolled involuntary movements of Dysphonia Involuntary spasm of mm of larynx produce
mm causing involuntary twists of affected hoarseness.
body part or sustained abnormal postures. Dysphasia Difficulty in comprehension or expression of
Chorea Violent irregular repetitive jerky speech due to the lesions in the language
movements areas.
Athetosis Irregular continues stream of slow flowing Aphasia Severe form of Dysphasia
writhing involuntary movements.
5. Cognition
xviii. Gait pattern Abstract Thought (to test Explain the difference
frontal lobe) between table & chair
c. On Palpation Spatial (to test parietal & Clock face and 5 pointed star
occipitallobe) Accurate clock and star
i. Muscle tone – Normal
ii. Temperature Half clock missing –
iii. Abnormal prominences Visual inattention
iv. Edema ( Location/ Pitting vs Non-pitting/ Unable to draw –
Constructional apraxia
Localized vs Generalized / indurated vs Visual and Body perception Facial recognition –
Non-indurated) identify famous faces
v. Tenderness Body perception – ask
to touch his body
parts
d. On Examination Sensory Agnosia
i. Higher Functional evaluation
1. Level of consciousness Apraxia - neurological disorder in which people
- Using Glasgow Coma Scale are unable to perform tasks or movements even
though they understand the task, are willing to
complete it, and have the physical ability to
perform the movements.
Agnosia - inability to interpret sensations and
hence to recognize things
CONTACT ME AT | RIKAZ. AMM.
1) Subjective Assessment (what the patient b) On Observation
thinks of his inability) xi. Body built
a. Demographic Data (Name/ Age/ Occupation/ xii. Posture
Date of Admission/ Gender/ Contact details) 1. Upper extremity
b. History - Scapula – Depressed + Protracted
i. Chief complaint - Shoulder – Ad + IR + E
ii. History of present illness (how long/ - Elbow – F
how often/ when started) - Forearm – Pronated
iii. Past medical history (Other conditions - Wrist – F + UD
related to the chief complaint/ - Hand – Fisted/
associated health problems i.e. HTN/ Thumb in palm/
CHO/ DM) Clench fist
iv. Personal History (To see whether it’s
acquired. i.e. Smoking/ Alcohol)
v. Family History (To see whether it’s 2. Pelvis, Spine and Trunk
genetic. i.e. Risk analysis) - Lateral Head shift
vi. Socio-economic History (Marital status/ - Lateral F of the trunk (Convex to sound side)
Position on the family) - Asymmetrical pelvis
- Posterior pelvic tilt
Objective Assessment - Flattened lumbar lordosis
a) Vital signs - More weight on sound side (on ischeal
vii. Blood pressure tuberosity/ sound side knee)
BP stage Systolic mmHg Diastolic mmHg
Normal <120 And <80 3. Lower extremity
Elevated 120-129 And <80 In Sitting In Standing
HTN Stage 1 130-139 Or 80-89 Hip F + Ab + ER E + Ad + IR
HTN Stage 2 ≥ 140 Or ≥ 90 Knee F E
HTN Crisis >180 And/or >120 Ankle Plantar F Plantar F
viii. Temperature : 37 ° C / 98.6 ° F
ix. Respiratory rate xiii. Postural Attitude
Age Respiratory rate CPM (Synergy patterns: Primitive movements
Up to 6 month 30-60
that dominate reflex and voluntary
6-12 month 24-30
1-5 years 20-30 effort when spasticity is present
6-12 years 18-30 following a cerebrovascular accident.)
12< years 12-20 - For upper limb
Flexor Synergy Extensor Synergy
>20 Tachypnea Scapula Retraction+Elevation Protraction+Depression
<12 Bradypnea Shoulder Ab + ER Ad + IR
Elbow F E
x. Heart rate for adults : 60-100 Forearm Supination Pronation
Wrist F F or E
<60 Bradycardia
>100 Tachycardia
- For lower limb
Flexor Synergy Extensor Synergy
Hip F + Ab + ER E + Ad + IR
Knee F E
Ankle Dorsiflexion + Inv PlantarF + Inv
Toes E F
CONTACT ME AT | RIKAZ. AMM.
, Comprehensive Neurological Assessment 2
Flexor synergy dominates UL and Extensor *Mild – GCS ≥13
synergy dominates LL. *Moderate – GCS 9-12
*Severe – GCS ≤ 8
xiv. Deformity (Stiff joint / Joint contracture /
Muscle tightness / Genu recurvatum / 2. Attention and Orientation
valgus / varus deformities) Time Day, date, year, season
Place City, Hospital, Birth place
xv. External appliances (Ventilatory
Person His name, job
apparatus / NG tube/ Catheters / ECG
leads / Diapers)
3. Memory
xvi. Tropical changes (Wounds/ Pressure Immediate recall By name and address test
sores/ Color changes/ rashes / spots/ Short term memory After 5 minutes, pt. is asked again to
erythema/ scaly skin) recall what is used in immediate recall
xvii. Involuntary movements Long term memory Factual knowledge i.e. President of SL.
Fasciculation Brief spontaneous contraction of small
number of mm fibers under the skin 4. Speech
Tics Involuntary contraction of single or group Dysarthria Difficulty in articulation of speech due to
of mm resulting in stereotyped movements weakness of orolingual muscles.
Dystonia Uncontrolled involuntary movements of Dysphonia Involuntary spasm of mm of larynx produce
mm causing involuntary twists of affected hoarseness.
body part or sustained abnormal postures. Dysphasia Difficulty in comprehension or expression of
Chorea Violent irregular repetitive jerky speech due to the lesions in the language
movements areas.
Athetosis Irregular continues stream of slow flowing Aphasia Severe form of Dysphasia
writhing involuntary movements.
5. Cognition
xviii. Gait pattern Abstract Thought (to test Explain the difference
frontal lobe) between table & chair
c. On Palpation Spatial (to test parietal & Clock face and 5 pointed star
occipitallobe) Accurate clock and star
i. Muscle tone – Normal
ii. Temperature Half clock missing –
iii. Abnormal prominences Visual inattention
iv. Edema ( Location/ Pitting vs Non-pitting/ Unable to draw –
Constructional apraxia
Localized vs Generalized / indurated vs Visual and Body perception Facial recognition –
Non-indurated) identify famous faces
v. Tenderness Body perception – ask
to touch his body
parts
d. On Examination Sensory Agnosia
i. Higher Functional evaluation
1. Level of consciousness Apraxia - neurological disorder in which people
- Using Glasgow Coma Scale are unable to perform tasks or movements even
though they understand the task, are willing to
complete it, and have the physical ability to
perform the movements.
Agnosia - inability to interpret sensations and
hence to recognize things
CONTACT ME AT | RIKAZ. AMM.
