Neurological Assessment

Student Date

NEUROLOGICAL ASSESSMENT

AREA TESTED / HOW TESTED / RESPONSE (PEER)
(describe behavior) / Diagnosis:
RESPONSE (CLIENT)
(describe behavior)

Central function

Level of Consciousness

Mental Status

Orientation
Affect
Memory
Calculation
Judgment/Insight (Abstract thinking)

Cranial Nerves

/ HOW TESTED / RESPONSE (PEER) / RESPONSE (CLIENT)

Pupils

Size
Shape
Equality
Reaction to light
Accommodation
Consensual Light Reflex
Convergence
Conjugate movements
Peripheral vision
Reading ability
HOW TESTED / RESPONSE (PEER)
(describe behavior) / RESPONSE (CLIENT)
(describe behavior)
Nose
Smell
Auditory
Hearing
Rhine test
Weber test
Face
Motor facial
Motor: trigeminal
Sensory: trigeminal
HOW TESTED / RESPONSE (PEER)
(describe behavior) / RESPONSE (CLIENT)
(describe behavior)

Mouth

Sensory: facial
Gag reflex
(Sensory/Motor)
Glosso-pharangeal
Hypoglossal

Neck and Shoulders

Spinal Accessory (motor)

Sensory

Upper and Lower Extremities
Pain
Temperature
HOW TESTED / RESPONSE (PEER)
(describe behavior) / RESPONSE (CLIENT)
(describe behavior)
Light touch
Positioning
Stereognosis

Motor

Upper and Lower Extremities:
Muscle strength
Muscle tone
Muscle coordination
HOW TESTED / RESPONSE (PEER)
(describe behavior) / RESPONSE (CLIENT)
(describe behavior)
Reflexes:
Biceps
Triceps
Brachioradial
Achilles
Gait
Balance

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