Neuro checks are used to assess an individuals neurological functions and level of consciousness in order determine whether or not individual is functioning properly and reacting appropriately to the tests being performing.
These assessments allow medical professionals to diagnose potential neurological conditions and identify where an individual may fit on the level of consciousness scale.
The purpose of a neurological assessment is to make sure an individuals neurological functions aren’t impaired or non responsive after an injury or surgery.
These checks / assessments are often performed on individuals dealing with head injuries, cervical injuries or CVS and may be performed every 15 minutes, 30 minutes or in other timed increments as needed.
The tests assess the visual, verbal, audible, physical, mental and emotional responses of the individual being assessed.
When performing a neuro check / assessment the following tests may be performed.
Neuro check / assessment:
- Check for level of consciousness or LOC (full consciousness, lethargy, obtundation, stupor, coma)
- Perform a pupil check (PERRLA: pupils equal, round, react to light and accommodation)
- Check for and observe facial symmetry (have the patient smile and lift eyebrows)
- Perform an A/O (alert & oriented) and do a comparison against the patients baseline
- Perform tongue midline (have patient stick their tongue out and observe any sideways deviation)
- Check and observe the patients speech clarity for slurs, impediments or incoherence
- Perform light touch (feather), cotton or pressure tests (observe physical response, sensitivity to touch and check for numbness or lack of movement)
- Check and observe patients grasp strength (have them squeeze your finger)
- Have patient raise each arm and wiggle fingers. Push against arms to check for arm strength, balance, tremors or drifting
- Have patient lift each leg and wiggle toes. Push against legs to check for leg strength, balance, tremors or drifting.
Prior to and while performing these tests it is important to assess the patients level of conciseness and compare it against their baseline, and previous test results.
Check for deviations from their previous tests and note any improvements or declines in their performance during these assessments.
The levels of consciousness (LOC) are re as follows:
Full consciousness: The patient is alert, attentive and follows commands. They are able to answer questions appropriately and respond well to stimuli, physical examinations and mental tests. If they are asleep they respond quickly to external stimuli such as loud noise or pain, and once awake are attentive and alert.
Lethargy: The patient is aware and consciousness, however they are drowsy and respond slowly to simuli, questions and commands. The patient is able to perform their tasks, but inattentively and at a slower pace. (The patient appears to be sleepy and drowsy, without any other signs of neurological impairment)
Obtundation: Arousal is difficult and the patient requires constant stimulation to follow basic commands. The patient may be able to provide short verbal responses (one or two words), but will drift back into unconsciousness or sleep without constant and immediate simulation.
Stupor: The patient requires vigorous and continuous stimulation in order to provide any response. Painful stimulation may be required to arouse the patient, and when he/she does respond it is typically a brief wine or moan. The patient may also make movements or responses to withdraw from the pain or remove the (typically painful) stimuli.
Coma: The patient does not respond to stimuli, even if it is continuous or painful. There are no physical or verbal responses, except for possible reflex responses in certain situations. Reflex responses may occur without stimulation and stimulation may or may not be responded to when applied.
Depending on the individuals level of consciousness their ability to respond to these assessments will vary.
Aside from performing standard physical assessments you may also ask the individual a series of questions to test their cognitive and emotional condition; if they are conscious and able to respond.
These questions will help you assess and evaluate any potential neurological complications that the patient may be dealing with such as memory loss, difficulty responding to stimuli, physical limitations and their ability to respond to various questions.
Questions that may be asked to assess neurological and physiological functions:
- What is your name, where are you from, what year is it?
- Can you smile for me and lift your eyebrows (check for symmetry and proper facial response)
- Can you please stick your tongue out (check to see if the tongue deviates to one side)
- Do you have a headache, physical pain, tingling or numbness in any part of your body? (even if the patient say’s they feel o.k. you should still perform a variety of physical tests to determine their condition)
- Is your vision impaired, blurred or are you seeing double? (use a pen light / flashlight to check pupil size, response and eye movement)
- Can you raise your arms in the air for 10 seconds and move your fingers?
- Can you touch your nose with each index finger?
- Can you squeeze my finger (check for physical strength and neurological response)
- Can you lift each leg and wiggle your toes (observe difficulty / area of movement, non responsiveness, tremors or drifting)
The tests that are performed on an individual may vary depending on their injury, neurological condition, physical condition or level of consciousness, therefore not all of these tests may be performed on every individual and some variations may be required depending on their individuals age, health and physical abilities.
For example when dealing with an elderly patient it may be better to ask them what month it is rather than asking them what day it is or what the date is. Some physical tests may also be modified or changed to adapt to older patients, such as having them lift their arms for shorter periods of time or having them perform shorter movements on mobility checks.
If an individual appears to perform well on most question based assessments, but answers one or two of them wrong ask them a different, but similar question and observe their response as they may have simply forgotten the answer at that moment.
In most medical situations where a neuro assessment is required the hospital or healthcare center may provide you with a checklist of neuro checks that can be performed on the individual to assess whether or not they are reacting properly to the checks and what their level of conciseness may be.
If you are unsure of what checks should be performed be sure to ask your coworkers if they have any assessment checklist or sheets they use during these medical situations.