Techniques of Physical Examination | Part Four

Nervous System

Remember symmetry: evaluate everything in terms of bilateral tests: strength, sensation and reflexes. Results must be parallel to the other side of the body. Organize by:

  • Mental Status and Speech – LOC, note any deterioration, use AVPU, Glasgow Coma Scale
  • Motor System – observe body in motion and at rest. Voluntary and involuntary movements
    • Muscle tone: small amount of tension in a normal muscle with an intact nerve supply
    • Muscle strength can grade 1-5 (5 is normal), move, press against your hand, squeeze your fingers
    • Muscle coordination: series of rapidly alternating movements
  • Sensory System: compare pain, temperature and touch bilaterally
    • Pain: with a pin, but don’t cause bleeding
    • Temperature : may skip if pain is normal, identify warm and cold sensation

Parasthesias: numbness or tingling in the arms or legs. Can indicate spinal cord damage or local circulatory problems


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