The Complete Clinical Guide to Screening Adult Neurologic Populations

The Screen Is Not the Point. The Decision Is.

Administration is the easy half. Any manual can show you where to place your hands and what to write in the box. What decides the outcome is the part that comes after — whether to proceed, refer, or stop, and how to tell a real deficit from a confound that made a healthy nervous system look impaired. A patient who passes every bedside screen and then leaves a burner lit did not defeat your technique. The screen ceilinged, the conditions were never recorded, and nothing in the note explained why.

This handbook closes that gap. Written in the voice of a clinician who screens adult neurologic patients every week, it moves domain by domain — cognition, awareness, vision and neglect, sensation, tone, strength, range, coordination, balance, and all twelve cranial nerves — and treats every finding as a decision rather than a data point. Each technique is specified to the level of grip, velocity, position, and timing, because those details are the finding. Discrimination tables separate weakness from apraxia from neglect, spasticity from contracture, cerebellar dysmetria from sensory ataxia. Fully labeled clinical figures show exactly what a positive sign looks like. Escalation pathways tell you what to do in the four seconds after you notice one pupil is larger than the other.

What this handbook equips you to do

• Run a defensible screen in twenty minutes by selecting the two or three domains that actually bear on this patient's discharge question, instead of working through an undifferentiated battery that answers nothing.
• Separate a true deficit from an artifact — hearing loss masquerading as comprehension failure, medication timing recorded as cognitive decline, fatigue reported as executive dysfunction, a flat hearing-aid battery producing a diagnosis.
• Recognize the findings that cannot wait, including declining arousal within a session, a new dilated pupil, a wet voice after intake, and progressive range loss with local warmth — each with the exact wording that gets a physician moving.
• Tell apart the four reasons a limb goes unused using manipulations that take under a minute, so a strengthening program is never prescribed for a neglect problem.
• Protect what the deficit exposes — the insensate eye that will ulcerate overnight, the flaccid shoulder injured during a single transfer, the splint applied to a limb that cannot report pressure.
• Translate every finding into a supervision level, an environmental change, or a piece of equipment, with the reasoning written so that nursing, families, and receiving teams act on it.
• Write the note that survives an audit — conditions, comparison point, and action with a named recipient and time — and the referral that comes back answered instead of ignored.
• Carry a complete implementation toolkit of quick-reference cards, documentation templates, patient handouts, workflow checklists, and decision algorithms designed to be printed, laminated, and used tomorrow.

Buy now and stop guessing at the bedside — put decision-grade screening in your hands before your next evaluation slot.

The therapists who improve across a career are not the ones with better technique. They are the ones who know which findings matter, which are artifacts, and who to tell before they leave the room.

Written for practicing occupational therapists, students, and rehabilitation colleagues who need more than a procedure list. Clear technique, honest reasoning, and the judgment to know when a clean result deserves more scrutiny than an abnormal one.