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late, after the patient’s level of consciousness has begun to deteriorate. Call for medical assistance as soon as it is evident that there is a deterioration in the patient’s level of consciousness (Scherer 1986, R5; Tortora and Derrickson 2009, R5).

16 Ask the patient to close the eyes and hold the arms straight out in front, with palms upwards, for 20–30 seconds. The weaker limb will ‘fall away’. To show weakness and difference in limbs (Carlson 2002a, R5).

17 Stand in front of the patient and extend your hands. Ask the patient to push and pull against your hands. Ask the patient to lie on their back in bed. Place the patient’s leg with knee flexed and foot resting on the bed. Instruct the patient to keep the foot down as you attempt to extend the leg. Then instruct the patient to straighten the leg while you offer resistance. To test arm strength. If one arm drifts downwards or turns inwards, it may indicate hemiparesis. To test flexion and extension strength in the patient’s extremities by having the patient push and pull against your resistance (Carlson 2002a, R5).

18 Flex and extend all the patient’s limbs. Note how well the movements are resisted. To test muscle tone (Carlson 2002a, R5).

19 Ask the patient to pat the thigh as fast as possible. Note whether the movements seem slow or clumsy. Ask the patient to turn the hand over and back several times in succession. Evaluate coordination. Ask the patient to touch the back of the fingers with the thumb in sequence rapidly. To assess hand and arm coordination. The dominant hand should perform better (Carlson 2002a, R5).

20 Extend one of your hands towards the patient. Ask the patient to touch your index finger, then their nose, several times in succession. Repeat the test with the patient’s eyes closed. To assess hand and arm coordination/cerebellar function (Carlson 2002a, R5).

21 Ask the patient to place a heel on the opposite knee and slide it down the shin to the foot. Check each leg separately. To assess leg coordination (Fuller 2004, R5).

22 Ask the patient to look up or hold the eyelid open. With your hand, approach the eye unexpectedly or touch the eyelashes. To test the corneal (blink) reflex (Fuller 2004, R5).

23 Ask the patient to open the mouth, and hold down the tongue with a tongue depressor. Touch the back of the pharynx, on each side, with a lowlinting swab. To test the gag reflex (Fuller 2004, R5).

24 Ask the patient to lie on their back in bed. Place your hand under the knee, raise and flex it. Tap the patellar tendon. Note whether the leg responds. To assess the deep tendon kneejerk reflex (Fuller 2004, R5).

25 Stroke the lateral aspect of the sole of the patient’s foot. If the response is abnormal (Babinski’s response), the big toe will dorsiflex and the remaining toes will fan out. To assess for upper motor neurone lesion (Fuller 2004, R5).

26 Ask the patient to read something aloud. Check each eye separately. If vision is so poor that the patient is unable to read, ask the patient to count your upraised fingers or distinguish light from dark. To test for visual acuity (Fuller 2004, R5).

27 Occlude one ear with a lowlinting swab. Stand a short way from the patient. Whisper numbers into the open ear. Ask for feedback. Repeat for the other ear. To test hearing and comprehension (Fuller 2004, R5).

28 Ask the patient to close the eyes. Using the point of a Neuro tip (sharp instrument for applying pressure), stroke the skin. Use the blunt end occasionally. Ask patient to tell you what is felt. See if the patient can distinguish between sharp and dull sensations. To test superficial sensations to pain (Fuller 2004, R5).

29 Ask the patient to close the eyes. Fill two test tubes with water: one warm, one cold. Touch the patient’s skin with each test tube and ask patient to distinguish between them. To test superficial sensations to temperature (Fuller 2004, R5).

30 Stroke a lowlinting swab lightly over the patient’s skin. Ask the patient to say what they feel. To test superficial sensations to touch (Fuller 2004, R5).

31 Ask the patient