come on in washing my hands hi mr. Ruffman I'm Nancy I'm a nurse from Harper College how are you doing very well thank you good I'm here today to do a neurological assessment and I'm going to start off the assessment by asking you two questions have you ever had a stroke no okay good good and do you have any other problems with your coordination or with your brain that you're aware of don't ever get meningitis or MS No all right all right good okay that's good to know so as we do this I'm going to start by checking all of your cranial nerves and then we're going to check your coordination and then we're going to check sensation and we're going to do some deep tendon reflexes so we'll start out by just talking with you and we're doing what's called a mental state so I'm first often noticing your behavior you're a week and alert and cooperative and responding well and then I'm also noticing your cognition so I'm going to ask you some kind of slight questions good so can you tell me what month it is this is the month of August okay now that's correct and can you tell me who your favorite president is he's dead but it was President Ronald Reagan not happy to know the answer to this question so I know that's correct but who's the current president ooh that's a tough one Obama Obama is the current president exactly and can you tell me who I am yes Nancy character okay good so he is oriented to person place in time and tell me why you're here today well I'm here today to be checked out of and we're doing videos for the assessment courses at Harper okay someone he is also aware of the situation so he's great at times four person place time and situation and I am also noticing that his dress is appropriate his effect is appropriate his facial expression is all appropriate for the situation I also need to screen him for depression and suicidal thoughts this is a screening that's done at every health care today it's required by the state of Illinois because suicide is a high causes a high rate of death here in our state so sir have you ever been so blue that you felt like hurting yourself no have you felt depressed or unhappy lately over the past two weeks my or Mike - these are not fun no I've been having fun okay all right so at that point I can stop my assessment if he answered yes to any of those questions and I would probe further with more questions about that so but he had took know for the first screen and then we're done all right so we're going to move on for the cranial nerves I'm going to start with cranial nerve number two and that is - we are visual acuity so we checked your visual acuity today and we would check it for this assessment as well using the snow in art I charge standing 20 feet away we would check both your right and your left eye and your vision was 2025 in both eyes and continuing on with cranial nerve number two we would do a confrontation test can you stand up and using this card can you place this over your left eye and then I will place this over my eye and tell me when you see my fingers I see them yes yes yes okay this straight at me tell me when you see my fingers yes yes yes yes okay good your peripheral vision is intact that's cranial nerve number two have a seat now we're going to check cranial nerves number three four and six can you take your glasses off you can just hold on to me for a second and I want you to follow this pen in the six cardinal positions of gaze keeping your head straight and I see conjugate movement of my eyes together in six cardinal positions of gaze right and just follow this I'm going to bring it in towards your nose nice good accommodation and then I'm going to look in your people going to shine a light in and I see that the pupils both of them respond to light by constricting and I would document that as pearl pupils are equal round reactive to light and accommodation as cranial nerves number three four and six and then moving on to cranial nerve number five number five in sensation where we are going to look at some movement of your face that can you smile and frown and show your teeth plate and I'm just going to check the muscles here so you hurt your teeth and I can feel those muscles get nice and tight they're relaxed and then also there is a sensory portion to this cranial nerve so can you close your eyes tell me when you feel the cotton whiz say now well well wonderful all right open your eyes again moving on to cranial nerve number six we are it is we're going to move on to cranial nerve number seven and can you lift your eyebrows up and down and then smile and frown it can squeak your eyes closed real tight and then open them all right I'm looking for symmetry of the face I remember with this cranial nerve damage is it Bell's palsy where you would see goofy on one side of the face or you might see that with a stroke so that's cranial nerve number seven cranial nerve number eight is the acoustic I'm going to whisper something in your ear I want you to repeat it green wall the Cubs are going to win call her rights all his acoustic nerve is intact you can put your glasses back on so that was cranial nerve number eight and then moving on for cranial nerve number nine and ten can you open your mouth really wide and say ah wonderful and I see his uvula goes up and the soft palate goes document indicates that cranial nerve number nine and ten is in 10 and then cranial nerve number eleven can you turn against my hand and turn against my hand and shrug up against my hand and cranial nerve number 11 is intact and then cranial nerve number 12 can you stick your tongue out and the tongue should be in the midline which it is so now we're going to check muscle strength so we'll start with the upper extremities can you please hold your hands out like this and we would do that for a count of ten and then can you squeeze my fingers please as hard as you can squeeze really hard hard as you can around you're not going to hurt me all right good okay so the reason that we tack strength in this manner for a neurological assessment is that this arm lift is part of the NIH Stroke Scale that's used across the nation for our assessment of stroke and doing the finger finger squeeze is an easy way to check assessment of strength of the upper extremities if you give two fingers the person can squeeze as hard as they want they're not going to hurt you if you give your whole hand or you give three fingers you may come back with your fingers like that which is usually not very pleasant and then for the lower extremities on heavy lay back for a minute to probably want to lay back and I want to lift this leg up off the bet and we do that for a count of five one two three four five good and then lift this one up again to account a five one two three four five and relax again that is part of the NIH Stroke Scale that's why we use that method and then if you can press down against my hands and pull up against my hands that also tells strength of the lower extremities okay so from there we're going to do some tests of your coordination so can you do this if you touch your for each finger as quickly as you can and do with the other hand all right good and now touch your nose and then touch my finger both as quickly as you can all right that's good one caution while you're doing this is that when your client has their their finger to the nose okay at that time you can move it but don't as they start for your finger don't move it right at that time all right that's not a fair test then so you can move it while the fingers there but then hold still as soon as they start coming towards your finger so we're going to check coordination of the lower extremities - so can you take your shin and just end your kill just run it down your shin and then do it out of this other side just run it right straight down all right and then can you stand up for a moment going to do the Romberg's test put your feet together and put your hands at your stand up straight put your hands at your side put your hands at your side and close your eyes and we would count to 20 seconds and he should be able to maintain the standing straight and still without falling over make sure you're here just in case a person does start to lose balance so I don't get hurt so 1-10 11-20 very good you can open your eyes and can you walk like a couple steps towards that outlet there just like about three or four steps just normal and then come back and walk heel to toe heel to toe like this you can relax your arms okay good fantastic so your coordination and is intact and then we're going to check the sensory system so the first thing that I'm going to do is check your sharp dull discrimination so you start this fight you have in your eyes open and explaining this is sharp and this is dull you can use a paper clip that you've opened up you can also use a cotton swab to do this whatever you're comfortable with so close your eyes and then you're going to tell me whether you feel sharp or dull and do this all over so sharp though sharp sharp sharp that was dull sure cannot drop a lot when you're doing this sure sharp sharp sharp don't sure go all right you can open your eyes again we're going to check your light sensation I'm just going to use a cotton ball and I just want to say now when you feel that so close your eyes say now when you feel kind of all now now now now now now-now-now now oh all right good last thing eyes closed and hold out your hand and tell me what's in your hand you can feel it with your hand it's a it's a coin okay good open your eyes all right so let's offer our testing of sensation now we're going to move on to the deep tendon reflexes so start this by having you just relax your arm here all right I want to be really really really asked for this to work and you can talk to Amy over there by your wellness my half the way I'm going to do this is Kevin flex a little bit so I can find that tendon and then he have him relax you really have to be relaxed to this will not work you also have to hold pressure on the tendon pretty firmly and see my thumb is on there pretty firm use the pointy part of the reflex hammer and you have to give it a good whack and I could feel his tendon moving I'm going to looking for is where his fingers to which I did not see there we go now we saw it a little bit there okay and then we were do the same thing on the other side again I'm going on flex so that I can feel where that tendon is I'm going to hold it pretty firmly now I have very poor aim to do it with my other hand but if you can hit your thumb with your left hand that would be lovely I'm not too good at that okay so relax your hand talk to EB over there hello hold it firmly and what I'm looking for there we go it's for those fingers to me so they haven't tends to be a little bit stubborn sometimes when you're trying to do that it's important for the person to relax then we're going to move on to the patellar reflex okay so you're going to feel where that B camp is and then right below there is where you're going ken you want the person to be really relaxed when you hit you know on a hit like this one hit loosely like that when you hit it bounces off right so you should be able to little kick from doing that which doesn't seem to be working well with be relaxed yes after you sir oh well we got a little one there okay okay okay into our Lancer all right one more time yeah be careful that you don't get kicked in the thing okay lay back down for a second that's the way I'm going to get my I'm going to get my payback right now last thing is the baboon side reflex okay so you're going to draw J up the side of the foot and across the sole of the foot normal response for an adult is curling of the toes so draw up the foot and across so either no response or curling up the coast is normal a normal response is a fanning out of the toes and reflection of the great toe that would be an abnormal response so a negative is normal just like if you get an x-ray and it's negative that's normal so negative is curling up the toes okay like that a positive Babinski is bad and that's the Fanning and flexing off the toes okay I think that we are done with our call assessment