Neurological assessment
consciousness indicate dysfunction and alterations in the normal transmission and processing of sensory information in the CNS.
Neurological assessment should include assessment of consciousness, limb power assessment, pupillary assessment and vital signs. The Glasgow Coma Scale (GCS)
(Teasdale & Jennet 1974) is used internationally to assess consciousness. The individual score for each response is plotted on a graph, with the time of the assessment, and
then totalled. The minimum score of 3 would indicate a completely unconscious patient, whereas the maximum score of 15 would indicate a fully alert and orientated
patient.
The eye-opening response assesses mechanisms of arousal and control of the eyes. Arousal is governed by the RAS located in the brain stem; it is possible to be awake
but not necessarily aware. The verbal response assesses cerebral functioning; the patient’s ability to respond verbally assesses both the processing of information as well as comprehension and the capacity to articulate. The motor response assesses global brain function; the sensory and motor processes span both cerebral hemispheres
and are truly integrated within the brain. The upper limb response is assessed alone as lower limb responses may be due to spinal reflex.
Limb power assessment is also important as an alteration in power of one limb compared to another indicates focal injury to the brain. Due to decussation, changes in limb power usually occur on the opposite side to that of the injury. The power in all four limbs should be observed in this part of the assessment.
The nervous system
Susie Scott