Overview
This lecture covers the key components of a neurologic assessment, including how to assess gait, balance (Romberg test), coordination, sensory functions (stereognosis and graphesthesia), and reflexes, including the Babinski reflex.
Neurologic Assessment Components
- Observe the patient's gait for balance, posture, and abnormal movements.
- Perform the tandem walk (heel-to-toe in a straight line) to assess balance.
- Assess coordination with rapid finger movements, finger-to-nose, and heel-to-shin tests.
- Evaluate sensation for vibration, light touch, and deep touch.
- Assess stereognosis and graphesthesia for sensory perception.
- Test deep tendon reflexes and the Babinski reflex.
Romberg Test
- Patient stands with feet together and arms at sides, then closes eyes for 20+ seconds.
- Slight swaying is normal; stepping/falling is a positive (abnormal) Romberg test.
- Assesses proprioception and cerebellar function.
Stereognosis and Graphesthesia
- Stereognosis: Place a familiar object in the patient’s hand with eyes closed; they should identify it by touch.
- Graphesthesia: With the patient's eyes closed and palm up, trace a single-digit number; patient should correctly identify the number.
Reflexes and Babinski Reflex
- Deep tendon reflexes commonly assessed at the patellar and brachioradialis sites.
- Reflexes are graded from 0 (no response) to 4+ (brisk or clonus); normal is 2+.
- Muscle strength uses a different scale (normal is 5/5).
- Babinski reflex: Draw an upside-down J on the sole; toes should curl down (negative) in adults.
- Positive Babinski (toes fan out) is normal in infants but abnormal and concerning in adults.
Knowledge Check (Sample Q&A)
- Sway during Romberg test is normal unless there is falling or stepping.
- Deep tendon reflex graded as 3+ is above average without clonus.
- Positive Babinski (toes fan) is normal in infants but abnormal in older children/adults.
Key Terms & Definitions
- Gait — the manner or style of walking.
- Tandem walk — walking heel-to-toe in a straight line.
- Romberg test — balance test with feet together and eyes closed.
- Stereognosis — ability to identify objects by touch.
- Graphesthesia — ability to identify written numbers or figures traced on the skin.
- Deep tendon reflexes (DTRs) — involuntary muscle contractions tested with a reflex hammer.
- Babinski reflex — response of the toes to stimulation of the sole; normal in infants, abnormal in adults.
Action Items / Next Steps
- Review institution-specific guidelines for deep tendon reflex assessments.
- Practice procedure steps for Romberg, stereognosis, and graphesthesia tests.
- Study the grading scales for reflexes and muscle strength.
- Watch related videos on pediatric and maternity neurologic assessments.