How to do a neurological exam
Other platforms explain it with text and video. In VMS you practice it on the patient.
The neuro exam has many parts, but it is always the same order and always left against right. A difference between sides is the finding that matters most.
Step by step
Prepare
Clean your hands, introduce yourself, get consent and explain each part before doing it. [1]
Mental status
Level of consciousness, orientation, attention and speech. [1]
Cranial nerves
Pupils, eye movements, face, hearing, palate and tongue (see the cranial nerve guide). [1]
Motor
Look for wasting and twitching, check tone, test strength 0 to 5 in each muscle group and look for pronator drift. [1]
Reflexes
Biceps, triceps, knee and ankle, graded 0 to 4+, and the plantar response. [1]
Sensation
Light touch, pinprick, vibration and position sense, from the hands and feet upward. [1]
Coordination
Finger to nose, heel to shin and rapid alternating movements. [1]
Gait and Romberg
Normal walk, heel-to-toe walk, then Romberg: feet together, eyes closed, stay close to catch the patient. [1]
Record
Write findings by part and compare sides. [1]
Common errors
- Not comparing left and right.
- Standing too far during the Romberg test.
- Skipping the plantar response.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
- NBOME COMLEX-USA clinical presentations
Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Facts and steps also follow NBOME COMLEX-USA clinical presentations. VMS is not affiliated with these organizations. Updated: 2026-10-11.