Nerves in Order Olfactory Optic Oculomotor

Modality Special Sensory Special Sensory Somatic Motor

Function Smell Vision Levator palpebrae, superioris, superior, medial & inferior recti muscles

Trochlear

Visceral Motor Somatic Motor Branchial Motor General Sensory Somatic Motor Branchial Motor Visceral Motor General Sensory

Parasympathetic to ciliary & pupillary constrictor muscles Superior oblique muscle Muscles of mastication Sensory for head/neck, sinuses, meninges, & external surface of tympanic membrane Lateral rectus muscle Muscles of facial expression Parasympathetic to all glands of head except the parotid Sensory for ear and tympanic membrane Taste anterior two-thirds of tongue

Trigeminal

Abducens Facial

Special Sensory Special Vestibulocochlear Sensory Branchial Motor Visceral Motor Glossopharyngeal Visceral Sensory General Sensory

Hearing and Balance Stylopharyngeus muscle Parotid Gland Carotid Body Sensation posterior one-third tongue & internal surface of tympanic membrane.

Taste posterior one-third tongue

Special Sensory Branchial Motor Muscles pharynx & larynx Visceral Motor Vagus Visceral Sensory Special Sensory Branchial Spinal Accessory Motor Somatic Hypoglossal Motor Sensory from pharynx, larynx & viscera Sensory from external ear Parasympathetic to neck, thorax, & abdomen

Trapezius & sternocleidomastoid muscles Tongue muscles except palatoglossal

VIII. Cerebellar Function The cerebellum is responsible for balance and coordination. Coordination of movement is a complex process involving both sensory afferent information regarding proprioception and muscle efferent stimuli. The Romberg test evaluates proprioception and cerebellar function. Ataxia can be assessed using the finger-to-nose (FTN) test, while coordination in the lower extremities is assessed using the heel-to-shin (HTS) test. Assessment Techniques a. Romberg test 1. ask the patient to stand, feet together with eyes closed and arms at sides 2. (+) Romberg-only positive if loss of balance occurs b. FTN test 1. ask the patient to alternately point from his or her nose to the examiners finger 2. the examiner will typically move his or her finger to different locations c. HTS test 1. ask the patient to run the heel of one foot along the shin of the opposite leg 2. the patient then does the same procedure on the opposite side IX. Reflex Function Evaluation of deep tendon reflexes (DTRs) examines the spinal reflex arc. DTRs are usually tested by tapping on a tendon with fingers or a reflex hammer. This causes a stretching of certain muscles and results in contraction. When damage occurs to higher centers (upper motor neurons), the spinal reflex arc is uninhibited and the DTRs are hyperactive. When damage occurs to the peripheral nerve or dorsal roots (lower motor neurons), the reflex arc is interrupted and the DTRs are decreased. The rapidity and strength of the reflexes should be symmetrical when comparing one side with the other. The reflexes most often tested are the biceps, brachioradialis (wrist), triceps, patellar (knee), and Achilles (ankle). The plantar reflexes refer to the reflex motion of the great toe after a noxious stimuli is applied to the bottom of the foot. An upgoing great toe and fanning of the other toes is a positive response. This is called Babinskis Sign and is suggestive of an upper motor neuron lesion. A normal response is a downgoing toe. Assessment Techniques

Reflexes are graded on a scale of 0 to 4. A stick figure typically appears in the chart to designate the elicited reflexes. 0 ............Not present 1+ ..........Present but diminished 2+.......... Normal 3+ ..........Hyperactive, may have clonus but not sustained 4+...........Hyperactive with sustained clonus