FROM MY PT SCHOOL NOTES · NEUROLOGY · UNIT 2 · CHAPTER 05
What belongs in a focused neurologic history?
A well-chosen history narrows the examination more efficiently than performing every test on every patient. The first question is whether the presentation is safe and appropriate for a PT assessment.
Build a useful clinical decision
Begin with function and change over time
Clarify the patient’s priorities, prior level of activity, current activity restrictions, participation goals and the setting where difficulty occurs. Ask about onset (sudden or gradual), progression, fluctuation, injury or illness, associated symptoms and prior evaluation.
Compare current function with baseline. A person who previously walked independently but now needs help standing may need a different level of examination, supervision and urgency than someone with long-standing stable limitations.
Focused history sequence
| 1. Patient priority | What activity changed, and why does it matter? |
| 2. Onset and course | When did it start, and is it new, stable or progressing? |
| 3. Safety screen | Are there acute changes or signs requiring immediate referral? |
| 4. Targeted examination | What finding would change the plan or next referral? |
Review the systems that may alter the plan
Ask about relevant diagnoses, surgeries, medications and their potential effects on alertness, blood pressure, sensation or coordination. Screen communication, cognition and vision; cardiopulmonary tolerance; skin and pressure risk; falls; pain; bladder and bowel change when clinically relevant; and available support.
The history should be responsive rather than endless. A reported change in sensation or movement may lead to targeted questions about neurological distribution, time course, severity and associated changes.
Escalate the history that changes safety
Sudden weakness or facial asymmetry, new speech difficulty, acute severe headache with other neurological concerns, rapidly progressive deficits, new bowel/bladder dysfunction with saddle sensory change, or reduced responsiveness may require emergency pathways. Do not delay emergency care to complete an assessment.
Other concerns, such as worsening falls, new progressive weakness, unexplained symptoms or medication side effects, warrant timely coordination with the appropriate treating team. The actual urgency depends on the combination of findings and local protocols.
Apply it to physical therapy
An effective introduction might be: ‘What were you able to do before this changed, and what is hardest now?’ Follow it with ‘When did this start, and has anything else changed?’ These answers help you choose the next focused tests and determine whether the visit should proceed.
Practice the decision
A patient scheduled for a balance evaluation reports sudden new left-arm weakness and slurred speech that began an hour earlier. Is the next step to complete Romberg testing?
Reasoning: No. Activate emergency response immediately for possible acute stroke; do not use outpatient balance tests to reassure or delay evaluation.
Check your understanding
What three history details most strongly change your decision to continue with a routine examination or refer?
Original lecture sources: 2 Exam & Eval.pdf; 11 Screening and Examination Lab Handout.pdf; Neurological Examination Form.pdf; Systems Screening.pdf.. Independently reorganized for educational review; official test protocols and figures should be accessed from their original sources. Not an individual evaluation, diagnosis or treatment plan.
