PHYSICAL ASSESSMENT OF THE NERVOUS SYSTEM
The human nervous system is highly complex and very difficult to evaluate. You
will undoubtedly have numerous opportunities to evaluate patients with neurological
complaints or injuries. A basic understanding of the essentials of the neuropsychiatric
examination is necessary to enable you to do this.
A variety of malfunctions can occur in the nervous system. Problems can take
place in the central nervous system as well as in the peripheral nervous system.
a. Central Nervous System. In the brain, there can be interference of nerve
impulses, impairment of autonomic functions, impairment of thinking processes,
impairment of seeing, hearing, and speaking, and impairment of muscle coordination.
In the spinal cord, possible problems include impairment of the spinal cord reflex arc,
impairment of touch, and impairment of movement.
b. Peripheral Nervous System. Problems in this area include the reduction or
elimination of stretch reflexes; for example, a reduction in the range of motion of a body
part. Another possible malfunction in this system is nerve paralysis.
GENERALIZED NEUROLOGICAL EXAMINATION COMPONENTS
Many patients will not require a detailed neurological examination, but a
generalized neurological examination may be helpful. A simple means of gathering a
great deal of information about the patient's neurological system is to observe the
patient walking, talking, seeing, and hearing. Watching the patient enter the room is
also important in giving the examiner information. As the patient enters the room, check
a. Posture and motor behavior.
b. Dress, grooming, and personal hygiene.
e. Manner, mood, and relation to persons and things around him.