1. History / General Questions
- Have you ever had a stroke?
- Do you have any problems with coordination?
- Have you ever felt depressed?
- Have you ever thought of harming yourself?
2. Mental Status
- Where are you?
- Why are you here?
- Are you in any pain?
- What time did the class start?
- Who was the last president of the USA?
- Who is the current president?
- Ask for judgment: “Can you walk to the Bahamas?”
- Ask abstract thinking: “What does the saying ‘People in glass houses shouldn’t throw stones’ mean?”
📋 Note:
- Patient is awake, alert, calm, cooperative.
- Posture, dress, grooming, and hygiene appropriate.
- Facial expression appropriate.
- No excessive movements. Coordinated, relaxed.
- Thought process logical, answers questions correctly.
3. Cranial Nerves
CN I – Olfactory
- (If tested) Ask patient to identify familiar smell with each nostril.
CN II – Optic
- Snellen chart: vision at 20 ft.
CN III, IV, VI – Oculomotor, Trochlear, Abducens
- Extraocular movements: follow pen in 6 directions.
- PERRLA: pupils equal, round, reactive to light & accommodation (near and far).
CN V – Trigeminal
- Light touch with cotton on forehead, cheeks, chin.
- Ask: “Tell me where I touch you.”
- Motor: palpate jaw clench.
- Protrude, retrac and side to side movement of jaw.
- No crepitus or pain.
CN VII – Facial
- Raise eyebrows, smile, frown, puff cheeks, close eyes tightly and open.
CN VIII – Acoustic
- Whisper test (stand behind, whisper 2–3 words, patient repeats).
CN IX & X – Glossopharyngeal & Vagus
- Say “Ahhh” → uvula and soft palate rise midline.
- Swallowing intact.
CN XI – Spinal Accessory
- Shrug shoulders against resistance.
- Turn head against hand resistance.
CN XII – Hypoglossal
- Stick out tongue → midline.
- Move your tongue Up, down side to side.
- Say “Light tight dynamite”
4. Motor Function
Upper Extremities
- Lift both arms forward for 5 seconds.
- Squeeze examiner’s fingers → test grip strength.
- Flex and extend elbows, check strength against resistance (biceps/triceps).
- Pronate/supinate hands rapidly (RAM test).
Lower Extremities
- While lying down, lift each leg for 5 seconds (strength).
- Push/pull against examiner’s hands with feet (dorsiflexion/plantarflexion).
- Test hip/knee strength: flexion/extension against resistance.
5. Coordination & Cerebellar Function
- Rapid alternating movements (pronation/supination of hands).
- Finger-to-finger test with examiner.
- Finger-to-nose test.
- Heel-to-shin test (laying down).
Balance
- Observe gait (walk a few steps, turn, return).
- Tandem gait (“heel-to-toe” like police sobriety test).
- Romberg test: stand with feet together, arms at side, eyes closed for 20 sec.
- Ask patient to walk normally; coordination intact if smooth and balanced.
- Walk and stay close to pt.
6. Sensory Function
- Light touch → cotton swab (say “now” when felt).
- Sharp/dull discrimination with safety pin.
- Test face, arms, hands, legs, feet (bilaterally).
- Vibration sense with tuning fork on bony prominences.
- Two-point discrimination: identify where touched (left or right)
- Stereognosis: place object (coin, key) in hand with eyes closed → identify.
- Graphesthesia: draw number on palm → identify.
7. Reflexes (if included in exam)
- Babinski (plantar response).
- Should be Negative