Cranial Nerve Testing for Pediatric Physical Therapists

Andrew J. Opett, PT, DPT, OCS

Nerve Classification Skull exit Function and testing

Sense of smell. Have patient close eyes and

I. Olfactory Sensory Cribriform plate of ethmoid
identify familiar odor (coffee, fruit).
Sense of vision. Have patient read from eye
chart or book page, identify pictures or shapes.
II. Optic Sensory Optic canal Test peripheral vision as patient looks straight
ahead. Test pupillary light response (CN II carries
afferent arm of this response).
Motor to muscles of eyeball (superior/ inferior/
medial rectus muscles, inferior oblique muscle,
levator palpabrae superioris and pupillary
sphincter. Test visual tracking in all directions to
test III, IV, and VI simultaneously. Test pupillary
III. Oculomotor Motor Superior orbital fissure
light response (CN III carries efferent arm of
this response). CN III opens the eye (lavator
palpabrase superioris muscle), so ptosis or
drooping of the upper eyelid can be seen with
dysfunction of this nerve.
Motor to superior oblique muscle of eyeball. .
IV. Trochlear Motor Superior orbital fissure Test visual tracking in all directions to test III, IV,
VI simultaneously.
VI (Ophthalmic division) and V2 (maxillary
division) sensory to the face. V3 sensory to face
V1 superior orbital fissure
V1, V2, sensory, and motor to muscles of mastication. Test light
V. Trigeminal V2 foramen rotundum
V3 mixed touch sensation to the face in the forehead (V1),
V3 foramen ovale
over cheekbone adjacent to nose (V2), and over
the mandible (V3).
Motor to the lateral rectus muscle the eyeball.
VI. Abducens Motor Superior orbital fissure Test visual tracking in all directions to test III, IV,
VI simultaneously.
Motor to muscles of facial expression, posterior
digastric, stylohyoid, and stapedius muscles.
Sense of taste from anterior 2/3 of tongue.
Internal acoustic meatus Parasympathetics to lacrimal, submandibular,
VII. Facial Mixed through stylomastoid sublingual glands. Test muscles of facial
foramen expression (smile, frown, raise eyebrows, purse
lips, etc). Note CN VII closes the eye, dysfunction
of CN VII results in inability to close the eye
(orbicularis oculi muscle).
Sense of sound, rotation, gravity. Test ability for
patient to hear a finger rub at approximately 12
VIII. Vestibulocochlear Sensory Internal acoustic meatus
inches from ear. If available, use tuning fork to
perform Rinne and Weber tests.

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 Nerve Classification Skull exit Function and testing

Sense of taste from posterior 1/3 of tongue;

secremotor innervation to parotid gland; motor
to stylopharyngeus muscle. CN IX and X usually
tested together: observe patient swallow, have
IX. Glossopharyngeal Mixed Jugular foramen
patient say “ah” and observe for symmetrical
movement of soft palate, lightly touch posterior
pharynx to elicit gag reflex on each side, observe
for hoarseness of voice.
Parasympathetic (visceral motor) to most
thoracic and abdominal viscera; motor to
X. Vagus Mixed Jugular foramen
muscles of pharynx and larynx. See testing for
CN IX above.
Motor to sternocleidomastoid and trapezius
XI. Spinal accessory Motor Jugular foramen muscles. Perform manual muscle test of
these muscles.
Motor to the tongue. Have patient move tongue
XII. Hypoglossal Motor Hypoglossal canal
in all directions. Observe for fluency of speech.

References

Bhatoe CH. Trauma to the cranial nerves. Indian Journal of Neurotrauma. 2007;4(2):89-100.

Boatman DF, Miglioretti DL, Eberwein C, Alidoost M, Reich SG. How accurate are bedside hearing tests? Neurology
2007;68:1311-14.

Butskiy O, Ng D, Hodgson M, Nunez DA. Rinne test: does the tuning fork position affect sound amplitude at the ear? Journal
of Otolaryngology-Head & Neck Surgery 2016;45(1):21.

Moore KL, Dalley AF. Clinically Oriented Anatomy 5th Edition. Philadelphia, PA: Lippincott Williams Wilkins; 2006:675-682.

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