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Nervous System Examination Prompt

This document provides guidance on performing a neurological examination of the nervous system, including the arms, legs, cerebellum, and reflexes. The exam involves inspection for features like muscle bulk and contractures, assessing tone, power, reflexes, coordination, sensation, and gait. It emphasizes obtaining permission, explaining tests clearly to children, and distinguishing between cerebellar and sensory deficits. The goal is to thoroughly examine neurological function while keeping the child comfortable.

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aeyousef
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637 views

Nervous System Examination Prompt

This document provides guidance on performing a neurological examination of the nervous system, including the arms, legs, cerebellum, and reflexes. The exam involves inspection for features like muscle bulk and contractures, assessing tone, power, reflexes, coordination, sensation, and gait. It emphasizes obtaining permission, explaining tests clearly to children, and distinguishing between cerebellar and sensory deficits. The goal is to thoroughly examine neurological function while keeping the child comfortable.

Uploaded by

aeyousef
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Nervous System

Examination Prompt
Introduce yourself and wash your hands

General Observation
• Posture
• Dysmorphic features
• Interaction and facial expression
• Aids:
o Wheelchair
o Frame
o Orthoses
• Movements
o Leg scissoring
o Decreased movements on one side
o Decreased movements overall

ARMS
Inspect
• Muscle bulk
• Symmetry
• Scars (tendon release)
• Contractures
• Fasciculations

Tone
Ask permission first, and check if it’s painful!
• Elbow joint
• Wrist joint
• Test for clonus at the wrist joint

Power
• Shoulder abduction: C5 - C6
• Shoulder adduction: C6 - C8
• Elbow flexion: C5 - C6
• Elbow extension: C7 - C8
• Wrist flexion: C6 - C7
• Wrist extension: C6 - C7
• Finger abduction: C8 - T1

Reflexes
Remember about the Jendrassik manoeuvre if you need to reinforce the reflexes. Think
carefully about how you’ll explain this to the child!
• Biceps: C5 - C6
• Brachoradialis: C5 - C6
• Triceps: C6 - C7

Coordination
• Finger-tip
• Finger-nose

Sensation

LEGS
Inspect
• Muscle bulk
• Symmetry
• Scars (tendon release)
• Contractures
• Fasciculations

Gait
• Inspect the legs first
• Ask the child if they are able to stand/walk
• Check if they would feel more comfortable with somebody with them
• Walk to the end of the room; turn around; come back

Tone
Ask permission first, and check if it’s painful!
• Knee joint
• Ankle joint
• Check for clonus at the ankle (up to 2 beats are normal if <1 year)

Power
• Hip flexion: L1 - L2
• Hip extension: L5 - S1
• Hip adduction: L2 - L4
• Hip abduction: L4 - L5
• Knee extension: L3 - L4
• Knee flexion: S1 - S2
• Foot dorsiflexion: L4 - L5
• Foot plantar flexion: S1 - S2
• Foot inversion: L4 - L5
• Foot eversion: L5 - S1

Reflexes
Remember about the Jendrassik manoeuvre if you need to reinforce the reflexes. Think
carefully about how you’ll explain this to the child!
• Knee: L2 - L4
• Ankle: S1
• Plantar: S1

Coordination
• Heel along shin

Sensation
1. Light touch (spinothalamic)
2. Proprioception (dorsal column)
a. Big toe
b. Ankle

To finish
• Offer to inspect the spine (looking for scars)

CEREBELLAR
Using the mnemonic DANISH to remember cerebellar signs doesn’t always mean that I
could examine for them. (Dysdiadokinesis; Ataxia: Nystagmus; Intention tremor; Scanning
speech; Heel-shin coordination).
It’s also one thing knowing what the movements are, but trying to explain them to a young
child often very difficult. Practice how you describe the actions, and how you will explain
them to the child so that they can carry them out.

Inspect
• Telangiectasia
• Pes cavus
• Scars

Dysarthria
• Pay attention to the child’s speech during the introduction and when you are talking
to them
• Ask them to repeat specific words: “baby hippopotamus”

Ataxia
1. Gait:
a. Broad based
b. Unsteady (especially when turning in a circle)
c. Leaning towards a unilateral lesion
2. Sitting:
a. Truncal ataxia

Romberg’s sign
You may observe a child that has a classic ataxic gait that is classically seen in cerebellar
disease. However, a similar gait can be seen if there is a proprioception deficit. One way
of distinguishing between the two is to check for Romberg’s sign.
In a sensory deficit, Romberg’s sign will be present
In a cerebellar problem, Romberg’s signs will be absent.
Nystagmus
Check eye movements in a H pattern. Horizontal nystagmus increases on the side of the
lesion

Coordination
1. Finger-nose
a. Intention tremor
b. Dysmetria (over-shooting)

Dysdiadochokinesia
The impaired ability to perform rapid, alternating movements.
Hand tapping. I usually find it easier (and more successful) to ask the child to tap “front”
several times, and then tap “back” several times, and then change to “front-back-front-
back”.

This is useful for several reasons.


1. It lets you assess the child doing something easy first, and then build up in
complexity. If a child can’t manage tapping “front”, then they’re unlikely to
manage rapid & alternating movements.
2. It’s also easier to explain what you’re doing if you build up to it gradually

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