This page is designed for the average diver (non-medical professional). It gives you basic information to help you perform a quick neurological examination if you suspect someone may be suffering from the bends (decompression sickness), air embolism, or other medical problems following diving.
This neurological examination, when conducted on a person with a history of diving, is used to determine the presence or absence of symptoms of decompression sickness and/or air embolism involving the central nervous system. Prior to performing the neurological exam, ensure that the diver is conscious & stable (and is breathing oxygen if available). Remember, it is essential for you to activate your local Emergency Medical Services as soon as signs and symptoms are detected.
Rapid Neurological Exam Video
The above video shows one way to perform an initial Rapid Neurological Exam. This basic examination does not require any medical training and can be done by anyone (the simplest way to report the various results of a neurological exam are "normal" or "abnormal"). This examination can provide a baseline of neurological findings (or no findings) which can be compared to subsequent neurological examinations conducted by emergency medical personnel and physicians. This baseline can help determine if the patient's symptoms are worsening, lessening, or staying the same. In some cases initial neurological symptoms may be gone by the time the patient arrives at a treatment facility and the only indication of neurological dysfunction may be the notes from this initial Rapid Neurological Exam.
More information and tutorials on neurological examinations can be found at:
If there is a lesion (damaged area) in the Spinal Cord the Motor/Strength and Sensory exam can be used to determine where the damaged area may be. The simplest way to report the various results of a neurological exam are Normal or Abnormal. When testing muscle strength, if the muscle feels weak it can be reported as Abnormal. A more comprehensive method for reporting muscle strength is the following scale from 0 to 5:
5/5 - Normal strength
4/5 - Weakness against resistance
3/5 - Able to move against gravity, but not against resistance
2/5 - Able to move with gravity eliminated (perpendicular to gravity)
1/5 - Unable to move but flicker or trace of muscle contraction present
0/5 - No sign of muscle contraction
Acknowledgement:
We would like to thank Steve Barsky and Hammerhead Video for the donation of the time and effort required to produce this video. Image Source:The Why Files
Cranial Nerves
The neurological exam performs many tests at the head of the patient. These are to test if Cranial Nerve function is intact. The exam tests the twelve Cranial Nerves:
I - Olfactory / Smell
II - Optic / Vision
III - Oculomotor / Eye Movement & Pupil Size
IV - Trochlear / Eye Movement
V - Trigeminal / Facial Sensation
VI - Abducens / Eye Movement
VII - Facial / Facial Motor - Expressions
VIII - Acoustic / Hearing - Balance
IX - Glossopharyngeal / Swallowing
X - Vagus / Swallowing - Heart Rate
XI - Spinal Accessory / Shoulder & Neck Movement
XII - Hypoglossal / Tongue Movement
If you would like a larger version (640x480 - 93Mb) of this video, send a blank 700 Mb CD-R disk with a self addressed stamped disk mailer to:
USC Catalina Hyperbaric Chamber
P.O. Box 5069
Avalon, CA 90704
Or if you have a high speed/ broadband connection you can download the following zipped file with the larger version of the video: Neuro.zip
Image Source:
Clinical Neurophysiology on the Internet
Sources
The Standard Neurological Examination - Gordon Boivin
A Broad Outline of the Neurological Exam - Dr. Jeff Sipsey
