To test a patient's nervous system, it's helpful to assess cranial nerve function. There are 12 cranial nerves and each is responsible for muscle movement, sensory processing or organ or gland function. An abnormality in a cranial nerve is a sign a doctor needs to investigate further. Cranial nerve assessment can be part of a routine exam or done because the patient has a neurological complaint.

Step1

Ask the patient to close his eyes and press gently on one of his nostrils. Offer cinnamon, coffee, cloves or other substances with a strong smell. The patient should be able to identify them. Test the other nostril too.

Step2

Place a Snellen chart about 20 feet from the patient and have her read the smallest line of letters she can. Then stand about 2 feet away and ask her to look at your nose. Spreading your hands about 2 feet apart, slowly move your fingers in towards your patient's line of vision. The patient needs to tell you when she first sees your fingers.

Step3

Test a patient's eye movements by having him hold his head still. Raising your finger about 1 foot from his face at his field of vision, slowly move it to the right, up, down and left.

Step4

Have the patient clench her teeth. Feel the jaw to make sure muscles are symmetrical. Touch the patient's face with a piece of cotton (dull sensation) and a safety pin (pain sensation).

Step5

Offer the patient sweet and salty water on the tip of his tongue to check for taste function. Assess the patient's facial expressions by asking him to smile, frown, puff his cheeks out and pucker his lips.

Step6

Stand 1 to 2 feet away from the patient and whisper a two-syllable word like "football" or "baseball" into one ear while the patient covers the other. She should have no trouble making out what word you said. Test balance by asking the patient to stand with eyes closed and feet close together.

Step7

Request the patient say "ah" while you observe the uvula and palate, which should be symmetrical. Warn her about the gag reflex test, where you'll place a tongue depressor or swab at the back of the throat. Give the patient water and watch how she swallows.

Step8

Place your hands on the patient's shoulders. Ask him to shrug and press down slightly while he's doing this. With your hand on his jaw, have him move his head towards that side while you give a little resistance with your hand. Muscles on both sides should be symmetrical.

Step9

Assess cranial nerve XII by telling the patient to stick out her tongue and move it from side to side. Also ask her to push her tongue against her cheek while you press lightly on that cheek.