Skill Performance Evaluation: Neurological Examination

Directions: You will have 20 minutes to complete the skill. All critical (C) steps and 80% of the noncritical steps must
be performed or verbalized. Special tests (S) will be performed if requested by the instructor.
Start: End:
Performed Verbalized
Washes hands and dons appropriate personal protective equipment. C
Introduces self to patient using first and last name. Y/N
Notes general appearance and vital signs. Y/N
Cranial Nerves (CNs)
1. CN I, olfactory: check nasal patency and sense of smell in each nostril separately (Use two
Y/N Y/N
different scents.)
2. CN II, optic nerve: visual acuity (OD, OS, OU) with correction if needed (Use Rosenbaum
Y/N
chart.)
Y/N
3. Visual field screening by confrontation Y/N
4. Inspect optic fundi Y/N
5. CN II, optic; CN III, oculomotor: size, shape of pupil, and reaction to light (direct and
Y/N
consensual) Y/N
6. Near reaction Y/N
7. CN III, oculomotor; IV, trochlear; VI, abducens: extraocular movements Y/N Y/N
8. CN V, trigeminal (motor): temporal and masseter Y/N
Y/N
9. Sensory: light touch sensation on forehead, cheeks, and jaw Y/N
10. Corneal reflex S
11. CN VII, facial: raise eyebrows, frown, close eyes, show teeth, smile, and puff cheeks Y/N Y/N
12. CN VIII, acoustic (vestibulocochlear): assess hearing Y/N Y/N
13. CN IX, glossopharyngeal; X, vagal: voice quality, movement of soft palate Y/N Y/N
14. Gag reflex Y/N
15. CN XI, spinal accessory: shrug shoulders and turn head Y/N Y/N
16. CN XII, hypoglossal: fasciculations, symmetry, and tongue deviation, movement, strength Y/N Y/N
Coordination
1. Upper extremity: rapid alternating movements/point-to-point movements Y/N
2. Lower extremity: rapid alternating movements/point-to-point movements Y/N
3. Gait: walk across room, tandem walk Y/N
4. Walk on toes and heels Y/N
5. Hop in place, or shallow knee bend Y/N
6. Stance: Romberg and pronator drift Y/N
Motor System
1. Observe body position during movement and at rest Y/N Y/N
2. Tremors, tics, or fasciculations Y/N Y/N
3. Inspect muscle size and contour, noting symmetry and any atrophy Y/N Y/N
4. Muscle tone, looking for resistance to passive stretch, upper and lower extremities Y/N Y/N
Muscle Strength Testing; Upper Extremity
1. Elbow flexion and extension Y/N Y/N
2. Wrist extension Y/N Y/N
3. Grip strength Y/N Y/N
4. Finger abduction Y/N Y/N
5. Opposition of the thumb Y/N Y/N
Muscle Strength Testing; Lower Extremity
1. Hip flexion and extension Y/N Y/N
2. Hip abduction and adduction Y/N Y/N
3. Knee flexion and extension Y/N Y/N

Developed by Albany Medical College, Center for Physician Assistant Studies | Bickley: Bates’ Guide to Physical Examination
and History Taking, Twelfth Edition. Copyright © 2017 Wolters Kluwer Health
 Skill Performance Evaluation: Neurological Examination

Directions: You will have 20 minutes to complete the skill. All critical (C) steps and 80% of the noncritical steps must
be performed or verbalized. Special tests (S) will be performed if requested by the instructor.
Start: End:
Performed Verbalized
4. Ankle dorsiflexion and plantar flexion Y/N Y/N
Sensory System
1. Test for light touch generally and pain (Sharp or dull?) distally Y/N
2. Vary pace of testing; areas should be tested randomly Y/N
3. Compare symmetric areas on both sides of body Y/N
Special Tests
1. Temperature S Y/N
2. Proprioception (position) S Y/N
3. Vibration S Y/N
4. Discriminative sensations: stereognosis, graphesthesia, two-point discrimination, point
S Y/N
localization, extinction
Deep Tendon Reflexes
1. Upper extremity: biceps, triceps, brachioradialis Y/N
2. Lower extremity: knee jerk, ankle jerk Y/N
3. Cutaneous stimulation reflexes: abdominal, plantar S Y/N
Special Techniques
Meningeal signs, straight-leg raise, asterixis, winging of scapula S Y/N
Adequate exposure was obtained for all inspection steps. C
Adequate draping was maintained for all steps. C
Evaluation: #Y = #C =
min. = 57/71 min. = 3
Comments on quality of performance: Needs remediation?

Y / N

Student: Evaluator: Date:

Developed by Albany Medical College, Center for Physician Assistant Studies | Bickley: Bates’ Guide to Physical Examination
and History Taking, Twelfth Edition. Copyright © 2017 Wolters Kluwer Health