Introduction Examination of Higher Functions Higher functions, Examination of cranial nerves, Sensory system, Motor system, Reflexes and spine. 1.Level of consciousness: 2. Ask any history of suffering from hallucination or delusion or illusions. 3. Look for the appearance :

1. Clinical examination of Higher
Function Test
Pandian M
Dept of Physiology
DYPMCKOP

2. SLO
• Introduction
• Examination of Higher Functions
1. Higher functions,
2. Examination of cranial nerves,
3. Sensory system,
4. Motor system,
5. Reflexes and
6. spine.
1.Level of consciousness:
2. Ask any history of suffering from hallucination or delusion or
illusions.
3. Look for the appearance :

3. Introduction
• Examination of central nervous system is a
complex procedure in which attention is to be
given to all components of CNS.
• For e.g.
1. Higher functions,
2. Examination of cranial nerves,
3. Sensory system,
4. Motor system,
5. Reflexes and
6. spine.

4. Examination of Higher Functions
• Its mainly based upon the proper history
taking and systemic questionnaire
Mental state is examined under the following
headings:
1.Level of consciousness:
2. Ask any history of suffering from
hallucination or delusion or illusions.
3. Look for the appearance :

5. I. Level of consciousness:
- Level of consciousness is judged by
responsiveness of patient to the painful
stimulus

6. The various levels of consciousness are:
a) Somnolence: Pt’s are drowsy, but we can be aroused
them by various stimuli and will then make
appropriate motor and verbal responses.
b) Stupor: Pt’s aroused by repeated and painful stimulus
and may be the response last for short period &
simple commands.
c) Semicoma: Painful & repeated stimulus cause
withdrawal or other adaptive movements. If stimulus
is removed Pt’s reverts to original state.
d) Coma: Pt’s deeply unconscious, there is either no
response or only slight response to very painful
stimulus.

8. II. Ask any history of suffering from hallucination or
delusions or illusions.
III. Look for the appearance : posture, gait, bearing ,
cloths, hair, nails, grooming, signs of anxiety like
moist hands, perspiring forehead.

10. IV. Ask for history of sleep- duration, disturbed
sleep or undisturbed, nature of sleep.
V. Memory :
for recent events- simple qtn’s, phone
number, admission date, etc.
for past events- place, DOB, about school,
habits, etc.

11. • Intelligence: several objective tests are used
here
• Mood state: depressed or euphoria

12. Abnormalities of behavior
• Most difficult to note. Here, help of any near
relatives of the subject.

13. • Orientation :
– Time , Place, Person
• Examination of speech and articulation:

14. • Two basic types of disorders:
1. Sensory aphasia
2. Dysarthria
Aphasia:-
disorder of speech results due to injury to higher
centers.
There are two types of aphasia:
1. sensory aphasia:
inability to understand the spoken words or
written words and neologism damaged to Wernicke’s
(Area 22)

15. Cont…
a) Word blindness:- inability to understand
written word (lesion in visual association area
)

16. b) Word deafness:-
inability to understand heard words (lesion in
auditory association area)

17. A Specialized integration of Area and location

18. 2.Motor association area:
The person is able to understand the meaning of
written or spoken words but he can’t able to express
ones own thoughts to others through talking or
writing – lesion to Broca’s area (44, 45).
3. Agraphia : selective loss of writing ability either
spontaneous or dictation.

19. Applied aspects

20. Dysarthria
• Dysarthria is a motor speech disorder.
• Dysarthria affects the movement of the individual
speech muscles and in coordination in the muscles
of vocalization.
• It can vary from mild slurring to completely
unintelligible speech

21. Global Aphasia
• This condition is produced as a result of loss of
both Wernicke’s(area 22) & Broca’s area(44).
• As a result all the functions of speech are
involved.

22. References
• Text book of Medical Physiology
– Guyton & Hall
• Hutchinson Clinical Methods
• Practical Physiology Manual
– A.K. Jain, C.L. Ghai, G.K. Pal
• Net source for pictures

23. THANK YOU . . .