Module 10 Part 2

Question 1

what is the fourth portion of the neurologic assessment

Answer 1

proprioception and cerebellar function

Question 2

sensation of position and muscular activity origination from within the body which provides awareness of posture, movement, and changes in equilibrium

Answer 2

proprioception

Question 3

what do you test proprioception for

Answer 3

coordination and fine motor skills and balance

Question 4

how do you test Rapid rhythmic alternating movements

Answer 4

Have seated person alternately pronate and supinate hands, patting knees, and gradually increasing speed OR
Have person touch thumb to each finger on the same hand sequentially from index to little finger and back, gradually increasing speed

Question 5

how do you test Accuracy of movement

Answer 5

Finger-to-finger test with person’s eyes open
Finger to nose test with person’s eyes closed
Heel-to-shin with person supine, sitting, or standing

Question 6

how do you test for balance equilibrium

Answer 6

Romberg test, balance on one foot, hop in place

Question 7

how do you perform the Romberg test

Answer 7

Have person stand with arms at side and feet together
Have person perform initially with eyes open and then with eyes closed
Stand close to prevent falls
Person should maintain position with eyes open or closed for 20 seconds with only minimal swaying

Question 8

If the Romberg is positive (i.e. there is significant swaying or the person has to take a step to maintain/regain balance)

Answer 8

do not do other tests of balance

Question 9

what is the fifth portion of the neurologic assessment

Answer 9

sensory function

Question 10

how do you perform the primary sensory function test

Answer 10

Always with the person’s eyes closed

Question 11

what are the sites of the primary sensory function test

Answer 11

Vision, hearing, smell, taste  and facial sensations
Hands
Lower arms
Abdomen
Feet
Lower legs

Question 12

how do you test superficial touch

Answer 12

Use a cotton wisp

Have the person point to the area touched

Question 13

how do you test superficial pain

Answer 13

Sharp and dull sensations

Allow 2 seconds between each stimulus

Question 14

these are ONLY TESTED when superficial pain sensation is not intact

Answer 14

temperature and deep pressure

Question 15

superficial touch and superficial pain are lost first

Answer 15

neuropathies

Question 16

Ability to identify a familiar object by touch and manipulation

Answer 16

Stereognosis

Question 17

With a blunt pen, draw a letter or number on the palm

Should be readily recognized

Answer 17

Graphesthesia

Question 18

Touch an area of the body and ask the person to point to where you have touched

Answer 18

point location

Question 19

Simultaneously touch one or both sides of the body

Ask the person to point to where you have touched

Answer 19

extinction phenomenon

Question 20

what is the sixth portion of the neurological assessment

Answer 20

reflex function

Question 21

what are the three types of superficial reflexes

Answer 21

abdominal, cremasteric, plantar

Question 22

Stroke lateral side of foot from heel to the ball, then across to the medial side

Answer 22

plantar reflex

Question 23

what is a normal plantar reflex

Answer 23

Normal response is a positive plantar reflex

Plantar flexion of all toes

Question 24

Dorsiflexion of the great toe with or without fanning of the other toes

Answer 24

Babinski’s sign (abnormal if greater than 2 yoa)

Question 25

When the reflexes are absent try eliciting it

Answer 25

after re-enforcing (Jendrassik maneuver), by asking the person to interlock and pull flexed fingers

Question 26

how do you check deep tendon reflex of bicep

Answer 26

With the arm gently flexed at the elbow, find the biceps tendon with your thumb.
Press firmly on the tendon
Strike your own thumb with the hammer
Response – contraction of biceps muscle causing flexion of the elbow

Question 27

1-2 inches above the wrist
Support the relaxed arm either on the lap or semipronated on your forearm
Strike above the styloid process a few centimeters above the wrist on the thumb side
Response – flexion and supination of the forearm

Answer 27

brachioradialis deep tendon reflex

Question 28

how do you check deep tendon reflex of tricep

Answer 28

Back of elbow
With the elbow in flexion, tap the triceps tendon, just proximal to the elbow, with a reflex hammer.
The arm could also be abducted at the shoulder for this maneuver
Response – contraction of the triceps muscle with extension of elbow

Question 29

how do you check deep tendon reflex of patellar

Answer 29

Knee jerk”
Slightly lift up the leg under the knee, and tap the patellar tendon with a reflex hammer
If performed in a sitting position, have the legs dangle over the edge of the chair or table
Response – contraction of the quadriceps muscle with extension of lower leg

Question 30

how do you check deep tendon reflex of achilles

Answer 30

At level of ankle
Slightly externally rotate at the hip
Gently dorsiflex the foot
Tap the Achilles tendon with a reflex hammer
Response – contraction of the gastrocnemius muscle with plantar flexion of foot

Question 31

how do you check for clonus

Answer 31

Test if reflexes are hyperactive
Sharply dorsiflex the foot and maintain in that position
Clonus is when the foot continues to tap
Sustained clonus may represent neoropathy or hyperreflexia