The Neurological Exam: What do they do and what are they looking for?

Merely Me Health Guide February 04, 2009
  • So what does happen when you go to see a neurologist and they do an exam?  I do think the procedure differs from doctor to doctor and depending upon what they are looking for.  When I see my neurologist, the exam does not take that long.  But for someone undergoing an extensive diagnostic exam, the procedure may take well over an hour.  There are far too many tests to discuss in one post so I am going to limit my discussion to the more popular techniques that my personal neurologist performs when I go to see her.  This way I can relate my personal first hand experience.


    1. They Check Your Reflexes: 

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    One test they may do is to test what is known as your plantar response.  The doctor will scrape the sole of your foot with a pointed instrument, beginning at your heel and moving towards the toes.  The normal response will cause the toes to curl downward.  However, if the toes fan upward and especially the big toe shoots up, then this is called the "Babinski response" which indicates neurological damage.  Before my official diagnosis of MS, my general practitioner did this test on me and my response was normal.  But I still have MS.  So just goes to show you that just because you have MS doesn't mean you will necessarily flunk all the neurological tests.


    Your neurologist or doctor will undoubtedly also check your deep tendon reflexes.  Everyone has had this done to them, with the little hammer.  Your muscles and tendons stretch out when tapped and what they are looking for is whether or not there is symmetry on both sides.  Do your reflexes look the same on both sides of your body.  Is there a lack of reflex or alternatively do you have exaggerated or rapid fire reflexes which shoot out too quickly?  Asymmetry or abnormal reflexes can also be a sign of neurological damage.


    2.  They Check Your Coordination:


    When the docs check your coordination they are also checking to see if there are problems with your cerebellum as this is the part of the brain which controls voluntary movement and motor coordination.  And in doing so they are also seeing if you have any type of ataxia, which is a general term used to describe abnormal movements and incoordination.


    Here are the tests that my neurologist consistently performs to test my coordination:


    a.  Rapid back and forth movements of palm up and palm down on my leg.  For some folks they may have to slow down and the rhythm may become chaotic.  I have always done well on this test thus far.


    b.  Precision finger taps:  This reminds me of part of the chicken dance.  You simply take your index and middle finger and tap your thumb rapidly.  They check for speed and fluidity of movement.  I have also had no problem with this particular test.


    c.  Finger-nose-finger:  This is where you rapidly touch your nose and then touch the doc's finger.  They may suddenly move their finger's position to see if you can still touch it or will you shoot over the mark.  I sometimes have trouble with this one.


    d.  Heel to shin:  This is where the doctor asks you to take the heel of your foot and run it up and down the length of your shin.  There are times when I am not able to do this one so well and my foot falls off from my attempts.


    3.  They Check Your Gait:


    If you have MS it is very likely that your gait will be affected.  These are the tests that I consistently fail.  Your gait is a very complex and intricate physiological process which is influenced by a number of nervous system reflexes.  By testing our gait, the neurologist can gain many clues as to what is going on with us neurologically.

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    a.  They will have you walk normally up and down the hall.  The thing which can happen with MS is that you can walk fine for a couple of yards and then symptoms kick in like foot drop (when the toes won't pick up and the foot drags behind you), or leaning to one side, or having your knees buckle, or any number of *fun* MS gait issues.  I am destined to have a somewhat abnormal gait.


    b.  They may have you walk on your toes and then your heels back and forth.  I seemingly do better at walking on my heels than my toes for some reason. 


    c.  The doctor may have you do the heel-to-toe walk which seems exactly like a sobriety test.  I flunk this test every time and eventually fall down and usually to my right side. 


    4.  They Check Your Balance:


    I have a particularly hard time maintaining my balance.  My son got the Wii Fit game for Christmas so my whole family tried it.  They have a good portion of the exercise program devoted to balance.  You are supposed to do a preliminary test for balance before they tell you which exercises to do.  I am 44 years old and this program told me that I have the balance and coordination of a 60 year old and then they tell me that I must fall down a lot!  Thanks Wii Fit!  Had no idea how bad off I was until I tried the game. 


    At any rate the main test for your balance is the Romberg's Test which essentially means that you stand with feet together, eyes open and hands to your side, and see if you keep your balance.  The real fun begins when you close your eyes and the doctor examines you for a minute.  Well it only takes me about twenty to thirty seconds before I am on the floor.  Your balance is dependent upon various neurological systems working in tandem together.  Vision is one of them.  When you take vision away, will your proprioceptive function (your awareness of your body in space) or vestibular functions (responsible for our spatial orientation and sense of balance) need to compensate.  Thus my vestibular and proprioceptive systems are not working so well. 


    Other signs that the balance centers of the brain may be affected by your MS include experiencing dizziness or vertigo or even nystagmus which are jittery eye movements.


    There are many other neurological tests including ones to test vision, cognition, mood, and sensory awareness. 


    I am going to share two excellent links with you on this topic of neurological exams.  Both of these sites have videos of what the tests look like.  And the second link includes videos of abnormal responses.  Remember that only a qualified doctor or neurologist can adequately perform these tests and give you a professional interpretation. 


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     *  NeuroLogic Exam: