EXAMINATION 35
EXAMINING THE
NERVOUS SYSTEM
Sometimes physical disability
results from problems in the
muscles, bones, or joints
themselves. But often it comes
from a problem in, or damage to,
the nervous system.
Depending on what part of
the nervous system is affected,
the disability will have different
patterns.
For example, polio affects only
certain action nerves at points
in the spinal cord (or brain stem).
It therefore affects movement.
It never affects sensory nerves,
so sight, hearing, and feeling stay
normal. (See Chapter 7.)
THE NERVOUS SYSTEM
The nervous system
is the body’s
communication system.
The ‘central switchboard’
is the brain, from
which electrical
messages run back
and forth, to all parts
of the body, through
‘wires’ called nerves.
Sensory nerves bring
messages from parts
of the body about
what the body sees
(eyes), hears (ears),
smells (nose), and
feels (skin).
Action nerves (motor
nerves) carry messages
to parts of the body,
telling muscles to move.
The brain
is the main
control center
of the nervous
system.
The ‘trunk
line’ of the
nerves is the
spinal cord. It
runs from the
brain down
the middle of
the spine.
Nerves come
out from
between
each back
bone and
communicate
to a part
lower down
in the body.
A spinal-cord injury, however, can damage or cut both the sensory and action
nerves, so that both movement and feeling are lost. (See Chapter 23.)
Unlike polio and spinal-cord injury, which come from damage to nerves in the spine,
cerebral palsy comes from damage to the brain itself. Because any part or parts of
the brain may be damaged, any or all parts of the body may be affected: movement,
sense of balance, seeing, hearing, speech, and mental ability. (See Chapter 9.)
Therefore, how completely you examine the workings of the nervous system will
depend partly on what disability the child appears to have. If it is fairly clear the disability
comes from polio, little examination of the nervous system is needed. But sometimes
polio and cerebral palsy can be confused. If you have any suspicion that the disability
might be caused by brain damage, you will want to do a fairly complete exam of nervous
system function. Damage to the brain or nervous system can cause problems in any
of these areas:
• seeing (See Chapter 30.) • hearing (See Chapter 31.)
• eye movement
or position (See
pages 40 and 301.)
• use of mouth and
tongue, and speech
(See pages 313 to 315.)
• seizures (epilepsy)
(See Chapter 29.)
• balance, coordination,
and sense of position
(See pages 90 and 105.)
• mental ability;
level of development
(See pages 278 and 288.)
• feeling
(pain and touch)
(See pages 39 and 216.)
• unusual or strange behaviors;
signs of self-damage (See page 364.)
• muscle tone (patterns of unusual
floppiness, tightness, spasms, or
movements).
(See Chapter 9.)
• reflexes; muscle jerks
(See pages 40 and 88.)
• urine and bowel control
(See Chapter 25.)
Methods for testing some of these things are included on the next few pages and on the
RECORD SHEETS 2, 3, and 4. Other tests that you will need less often, we include with
specific disabilities. Refer to the page numbers listed above.
disabled village children