Chapter 15 – Neurological system assessment

Objective Assessment

An objective assessment of the neurological system includes:

  • Brief scan of the neurological system.
  • Glasgow Coma Scale.
  • Cranial nerve testing.
  • Motor function and cerebellar testing.
  • Sensory function testing.
  • Reflex testing.

An objective assessment is usually completed after the subjective assessment, but if the client shows signs of clinical deterioration, you may proceed directly to the objective assessment and associated interventions. In this case, it is important to prioritize care after a brief scan that involves components of the primary survey. 

The order of the neurological assessment, and choices about whether a complete neurological assessment is needed, will depend on the context (primary care setting, hospital setting, long-term care, rehabilitation) and the presence of neurological symptoms and signs or history. A complete neurological assessment includes all components listed above. You should conduct a complete neurological assessment if:

  • The client reports neurological symptoms or you observe signs.
  • The brief scan reveals abnormal findings.
  • You need to track symptoms and signs when following the progression of a neurological disease. 

Screening of the neurological system also depends on the context. At a minimum, you should conduct a brief scan of the neurological system and the Glasgow Coma Scale, as detailed in the next section. Always do a screening if you are aware of changes in behaviour and communication. Table 2 presents medical terminology related to neurological findings.

Contextualizing Inclusivity

Always use a when conducting an objective assessment, because you may need to expose the body.

  • Maintain privacy by closing the door and/or curtains.
  • Ask the client if they would like a family member, friend, or another healthcare provider present.
  • Provide a drape to the client and only expose areas of the body as needed.
  • Always ask permission to touch.
  • Explain what you are doing throughout the assessment. Sometimes it is helpful to demonstrate it on yourself so the client knows what to expect.
  • Collaborate “with” the client versus “doing to” the client.
  • Use a culturally-informed approach and provide choice whenever possible to empower the client.
  • Ensure the clients know that they can take a break at any point.

Consider how a trauma-informed approach can be used when a client is unable to speak or advocate for themselves due to their neurological condition or sedation. Sometimes healthcare professionals neglect this approach when the client is unresponsive, but in fact, it is even more important in these situations.

 

Table 2: Medical terminology related to neurological findings.

 

Term

  

Definition
 

Hyposmia

  

Partial loss of the sense of smell.
 

Anosmia

  

Complete loss of the sense of smell.
 

Esthesia

  

Perception of touch sensation.
 

Hypoesthesia

  

Decreased sensitivity to touch sensation.
 

Anesthesia

  

Loss of sensitivity to touch sensation or inability to feel touch sensation.
 

Hyperesthesia

  

Increased sensitivity to touch sensation.
 

Algesia

  

Sensation of pain.
 

Hypoalgesia

  

Decreased sensitivity to pain sensation.
 

Analgesia

  

Loss of pain sensations or inability to feel pain sensation.
 

Hyperalgesia

  

Increased sensitivity to pain sensation.
 

Paresis

  

Decreased muscle strength of the voluntary muscle groups (often referred to as muscle weakness).
 

Paralysis

  

Inability to move a muscle such as a limb.
 

Paraesthesia

  

Abnormal sensory sensations such as numbness (loss of feeling) or tingling (sometimes described as pins and needles) or other characteristics such as burning and prickling.
 

Dysphagia

  

Impairment in swallowing such as difficulty swallowing or pain while swallowing.
 

Dysphasia

  

Impairment in use or comprehension of language.
 

Dysarthria

  

Neuromotor impairment in speaking in which clients have difficulty saying or forming a word, or difficulty with the strength and speed of speaking, which can result in slow or slurred speech.
 

Flaccid

  

Muscles that have no resistance and no tone (atonic).
 

Rigid

  

Increased muscle resistance that is consistent at rest and with movement.
 

Spasticity

  

Increased muscle resistance that decreases with continuous movement and worsens at extreme ROM.

References

Arthur, E., Seymour, A., Dartnall, M., Beltgens, P., Poole, N., Smylie, D.,…Schmidt, R. (2013). Trauma informed practice guide. Vancouver, B.C: BC Provincial Mental Health and Substance Use Planning Council. Retrieved from https://bccewh.bc.ca/2014/02/trauma-informed-practice-guide/

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