(2) Check muscle tone. Instruct the patient to relax. If the patient is in bed,
lift one of his limbs from the bed and watch it fall. When the patient sits on the edge of
the examining table, the freedom with which the legs swing indicates the muscle tone.
Check muscle strength. Instruct the patient to do the following:
Ask him to grip your hands and squeeze.
(b) Have the patient push against your palm with his foot. Compare
the strength of his muscles on each side of his body.
(c) Have the patient extend and flex his neck, elbows, wrists, fingers,
toes, hips, and knees.
(d) Instruct him to extend his spine.
(e) Ask the patient to contract and relax his abdominal muscles.
Have him rotate his shoulders.
(g) Instruct the patient to walk on his toes, then to walk on his heels.
Test the patient bilaterally (comparing muscle strength on one side of the
body with muscle strength on the other side of the body). Look for muscle
atrophy (loss of muscle strength or muscle tone).
d. Cranial Nerves. Evaluating the cranial nerves is an important part of the
neurologic examination. Taste and smell are usually not checked unless a problem is
suspected in those areas. Test the patient's pupillary reflexes. This is commonly done
by shining a light in the patient's eyes and comparing the eyes. The pupillary reflexes
are abnormal if they do not respond to light or if the pupils respond unequally. If the
pupillary reflex in both eyes are equal, write PERRLA (pupils equal round and reactive
to light and accommodation). Instruct the patient to smile and raise his eyebrows. Look
for weakness or drooping on either side of his face while he is smiling. Check to see if
there is even movement of both eyebrows.