Skills Check 1

Question 1

Testing CN I (Olfactory)

Answer 1

• Have patient close eyes and one nostril

- Ask the patient to tell you when they smell something

Question 2

Testing CN II (Optic)

Answer 2

• Snellen Chart: have patient read the smallest line they are able
• Peripheral vision: bring finger around patient from behind, having them tell you when they see it
• Pupillary reflex (afferent)

Question 3

Testing CN III (Oculomotor)

Answer 3

• Have them follow ‘H’ pattern of pen or finger
• Observe for ptosis of upper eyelid
• Pupillary light reflex (efferent)

Question 4

Testing CN IV (Trochlear)

Answer 4

• Have them follow ‘J’ pattern down to tip of nose

- Lateral head tilts

Question 5

Testing CN V (Trigeminal)

Answer 5

• Light touch and sharp sensation in V1, V2, and V3 areas (when they feel the sensation, whether it is the cotton wisp or pin, and if there are differences from side to side of the face)
• Temperature discrimination (pt. informs examiner whether it feels hot or cold)
• Corneal reflex

Question 6

Testing CN VI (Abducens)

Answer 6

• Have them follow ‘H’ pattern of pen or finger (abducting for this nerve)
• Saccadic eye movements: have patient rapidly look between your left and right fingers (should have smooth motions and symmetry of eyes)

Question 7

Testing CN VII (Facial)

Answer 7

• Taste: assess pt’s ability to taste things on ant. 2/3 of tongue that are sweet, salty, bitter, and sour
• Facial Expression: raise eyebrows, close both eyes tightly, show teeth, puff out cheeks, smile
• (looking for resting asymmetries as well)
• Corneal reflex (contributes to efferent portion)

Question 8

Testing CN VIII (Vestibulocochlear)

Answer 8

• Weber test: place a vibrating tuning fork on apex of patient’s skull, ask patient which side of the head it sounds louder or if both sides sound equal
• Rinne test: place vibrating tuning fork on mastoid process, and the 1” from external ear canal, ask patient if there is a difference between ears or if they are equal
• Rub fingers: Begin rubbing fingers together from a distance and then bring closer to pt’s ear, ask them to tell you when they hear your fingers rubbing
• This is all assessing cochlear branch; we usually don’t test the vestibular branch because screening it is hard*

Question 9

Testing CN IX (Glossopharyngeal)

Answer 9

• Palate Elevation: ask patient to open mouth wide and say “AHHHH”, observe uvula in back of throat to assess for symmetrical soft palate rise
• Gag Reflex: touch back of pt’s throat with a tongue blade to elicit the gag reflex
• Observe for dryness of mouth or lack of salivation

Question 10

Testing CN X (Vagus)

Answer 10

• Palate Elevation: ask patient to open mouth wide and say “AHHHH”, observe uvula in back of throat to assess for symmetrical soft palate rise
• Gag Reflex: touch back of pt’s throat with a tongue blade to elicit the gag reflex
• Observe for hoarseness of voice

Question 11

Testing CN XI (Accessory)

Answer 11

• Observe for asymmetries in resting SCM and trapezius
• Have patient shrug shoulders
• Resisted turning of the head (observe SCM pop out)

Question 12

Testing CN XII (Hypoglossal)

Answer 12

• Stick out your tongue
• Say “la la la la”
• Push tongue into side of cheek
• Observe for any deviations of tongue or fasciculation while resting or active

Question 13

ANPT Core Measures

Answer 13

• Berg Balance Scale (BBS)
• Functional Gait Assessment (FGA)
• Activities-Specific Balance Confidence Scale (ABC scale)
• 10 Meter Walk Test (10mWT)
• 6 Minute Walk Test (6MWT)
• Five Times Sit-to-Stand (5TSTS)

Question 14

ANPT Core Measures

Answer 14

• Berg Balance Scale (BBS)
• Functional Gait Assessment (FGA)
• Activities-Specific Balance Confidence Scale (ABC scale)
• 10 Meter Walk Test (10mWT)
• 6 Minute Walk Test (6MWT)
• Five Times Sit-to-Stand (5TSTS)

Question 15

5 main areas of coordination

Answer 15

1. reciprocal motion
2. movement composition
3. movement accuracy
4. fixation of limb holding
5. balance