cerebrum - how to assess

Question 1

what are the catgeories of neurological assessments

Answer 1

1. mental status
2. language/communication
3. motor assessments
4. sensory assessments
5. special senses

Question 2

mental status - informal assesssment of alertness and orientation
when is it performed?
how many levels of alertness?
4 components of orientation?
how is this documented?

Answer 2

when is it performed?
- done while obtaining historical info from pt when a neuroloigcal problem is suspected
how many levels of alertness?
- 5 alert, lethartic, obtunded, comatose, stupor, somnolent
4 components of orientation?
- person, place, time, situation
how is this documented?
- A & O x #

Question 3

mental status - formal assessment

Answer 3

• retentive memory & immediate recall
• recent memory
• remote memory
• general knowledge
• higher functioning

common cognition otucome measures inlcude items assessing each of these different domains

Question 4

Montreal Cognitive Assessment (MoCA)

constructs assessed?

Answer 4

• visuospatial/executive function
• naming
• memory
• attention
• language
• abstraction
• delyaed recall
• orientation

Question 5

what is a normal score for the montreal cognitive assessment (MoCA)?

Answer 5

out of 30; normal ≥ 26

Question 6

Mini Mental State Exam (MMSE)

constructs assessed?

Answer 6

• orientation
• registration
• attention and calculation
• recall
• language
• copying

Question 7

what is the scoring for mini mental state exam (MMSE)

Answer 7

out of 30
- normal is 24-30
- mild cog impairment is 18-23
- severe cog impairment is 0-17

Question 8

MoCA and MMSE

what might we, the PT, do if our pt scores outside of the normal range? how does this info impact our PT sessions?

Answer 8

communicate prior to the test and then follow up with honesty –> so this is what we are going to do about the problem we found.
- tailor the communication based on deficits/tailor treatment
- refer out

Question 9

MoCA and MMSE

what does it mean if our patient scores within the normal range, but shows deficits in a single construct (like recall) on both MoCA and MMSE?

Answer 9

following the recall example:
- provide extra resources: videos, pictures
against its tailoring the session to what the patient needs

Question 10

language/communication

informal assessment

Answer 10

• assess hearing ability very early in the examination and at adjust yuor communication appropriately, if hearing deficits
• done while taking the history by ntoing pt’s abiolilty to hear questions and respond
• at minimum PT’s should report pt’s comprehension and ability to express himself verbally or nonverbally

Question 11

langugae/communication

informal assessment:

what questions are you asking/answering as you assess?

Answer 11

• can the client speak
• do they have word finding problems consistent with expressive aphasia or trouble enunciating consistent with dysarthria?
• note voice quality, is volume adequate
• does the individual understand language or show signs ofreceptive aphasia

Question 12

What is dysarthria

Answer 12

difficulty in articulating words, caused by impairments of the control of muscles used in speech

Question 13

what might we, the PT, do if our patient demonstrates impaired language or communication?

how does this info impact our PT sessions?

Answer 13

if its new and happens during session –> problematic, refer out

if known just depends on what their impairment is –> how have they been communicated with most effectively with others. bring in family memebers, whiteboad to write down thoughts, adjust your speaking langauge in order for them to understand you, usual visual aides if needed

Question 14

motor system assessments:

what to do

Answer 14

• muscle strength/force production
• active vs. passive ROM
  **- reflexes
• muscle tone
• fractionation**
• **synergistic movement patterns **
• motor control and coordination

Question 15

deep tendon reflexes

testing procedure?

Answer 15

1. patient needs to be completely relaxed, usually seated edge of mat
2. place muscle midway between shortest and longest lengths
   - need potial resting tension of muscle being tested
3. stimulus must be brief but strong
4. assess and compare bilat

Question 16

what is the deep tendon reflex scoring

Answer 16

Question 17

deep tendon reflexes

what score(s) would you expect with an uppper motor neuron lesion? why?

Answer 17

• possible light reflexes (babinski) hyperreflexia

this is because UMN do not directly synapse with skeletal muscles - they synapse with LMN. loss of descending inhibition to shut it off ends up with an excess movement

Question 18

deep tendon reflexes

what score(s) would you expect with a lower motor neuron lesion? why?

Answer 18

-hyporeflexia
the lower motor neuron actually synapses with the muscle itself

Question 19

clonus

Answer 19

• rhythmic oscillating stretch reflex tath is related to UMN lesions
• therefore conus is generally accompanied by hyperreflexia

Question 21

clonus is common in muscle with?

Answer 21

long conduction delays, such as the long reflex tracts found in distal muscle groups

Question 22

muscle tone

Answer 22

• the resistance of a muscle to stretch: the overall stiffness of the muscle

Question 23

muscle tone

skeletal muscle have what kind of resistance? what is the result?

Answer 23

• intrinsic resistance to stretch resulting from the elastic properites of tendions, connective tissue, and the muscle tissue itself

Question 24

muscle tone

when do you, the PT tetect the amoutn of tension/resistance ?

Answer 24

detect the amount of tension/resistance of a relaxed muscle during PASSIVE ROM

Question 25

# muscle tone tone can fluctuate over the course of the day, why?

Answer 25

due to many factors: - infections - stress - volitional effort - medicatin - temp

Question 26

muscle tone testing procedure

Answer 26

1. move slowly through the joints ROM 2. move quicly through each motion

Question 27

what is muscle tone general scoring?

Answer 27

Question 28

# muscle tone what score(s) would you expect wiht an upper motor neuron lesion?

Answer 28

hypertonia - 3+,4+

Question 29

what score(s) would you expect with a lower motor neuron lesion?

Answer 29

hypotonia 0,1+

Question 30

# muscle tone - categories of hypertonicity rigidity

Answer 30

**not** velocity dependent or direction dependent these are different presentations: - cogwheel: tension that gives way in little jerks - lead pipe: smooth rigidity that continues through entire range | bidirectional ## Footnote you will feel it throughout regardless of how slow/fast or what direction its moved

Question 31

# muscle tone - categories of hypertonicity spasticity

Answer 31

volcity-dependent and direction-dependent - may be characterized by a "catch and release" - thought to be casue by imbalance of descending inhibitory and faciitatory influences on muscle stretch reflexes; hyper excitability of afferent pathways and dysfunctional processing of afferent peripheral nerve inputs by the spinal cord ## Footnote you may not feel it slow but you feel it fast. you may also only feel it going into extension not flexion - as an example

Question 32

modified ashworth scale ## Footnote clincial test for spasticity

Answer 32

0 is normal for this scale ## Footnote clinical test for SPASTICITY -velocity and direction dependent

Question 33

pendulum test procedures: equipemnt: scoring: ## Footnote clinical test of spasticity

Answer 33

procedures: - the patient sits on an exam table and PT holds. the patients foot with knee fully extension equipement: - typical equipment used is either elctro-goniometes, uni-lanar video or I2 motion analysis systems scoring: - using computer data for number of oscillations and amplitude, values of the relaxation index (R1 and R2) are calculated and compared to norms ## Footnote passive swinging assessment --> observe number of ossilactions

Question 34

in the ACUTE period immediately after UMN damage there is often hypotonia and areflexia... why?

Answer 34

this is true of any UMN injury --> why? - loss of descending corticospinal input - compromised of the SMA this is just FYI ## Footnote typical presentation of UMN is hyperreflexia and hypertonia in the chronic phase

Question 35

movement fractionation

Answer 35

fractionated movement reflects that pt's ability to actively move at one joint without moving at other joints ## Footnote like being able to isolate each finger to type

Question 36

movement fractionation testing procedure:

Answer 36

1. pt in a sitting position with back 2. check the PROM for each extremity and joint involved 3. ask the pt to perform isolated movements; instruction may be veral or visual 4. identify each movement as fractionated or unfractionated ## Footnote fully extending arm and asking to move just the shoulder joint into flexion is fractionation

Question 37

fractionated movement tips for assessing - support weight of limb only, do not guide this motion UE: LE:

Answer 37

UE: - when testing flexion at any joint strt with all joints in extension - when testing extension at any joint start with all joints in flexion LE: - when testing flexion at any joint start with all joints in extension/PF - when testing extension at any joint, start with all joints in flexion/DF

Question 38

movement fractionation - UE 1. shoulder flexion

Answer 38

fractionated: moves through shoulder ≥50% ROM without substitution

Question 39

movement fractionation - UE 2. flex and extend the elbow with neutral supination/pronation

Question 40

movement fractionation - UE 3. flex and extend the wrist against gravity

Question 41

movement fractionation - UE flex and extend the fingers agaisnt gravity

Question 42

movement fractionation - UE flex and extend the index finger with the other fingers fully flexed

Question 43

movement fractionation - LE flex hip in sagittal plane

Question 44

movement fractionation - LE extend knee in sagittal plane

Question 45

movement fractionation - Le dorsiflex ankle in sagittal plane

Question 46

synergistic movmenet patterns (synergies)

Answer 46

- multi-joint movmeents that occur simultaneously whe ntrying to move an isolated joint (finger, wrist, elbow, shoulder flexion when bringing the hand to the mouth to stifle a yawn)

Question 47

synergistic movement patterns is common to see in individuals that

Answer 47

have had an UMN lesion ## Footnote common

Question 48

UE: flexion syngery components

Answer 48

- scapular retraction and elevation - shoulda bduction, ext rot, elbow flexion, forearm supination - wrist/finger flexion

Question 49

LE: flexion syngery components

Answer 49

- hip flexion - abduction - ER - knee flexion - ankle DF - inverison - toe DF

Question 50

when do PT's assess synergistic movement patterns

Answer 50

- clinican watches the client while they perform AROM as well as funtional movmeents (grasping, walking) - the cinet can sachieve movment only through one rigid movement patterns, then they are said to be bound in synergy syngery is noted, the clinician should ask the client to move out of these patterns and observe whether the client can move out of the syngerygy pattern

Question 51

sensory system assessments include

Answer 51

- proprioception - kinesthesia - vibration testing - light touch - pain - temp

Question 52

talk through how a deep tendon stretch occurs

Answer 52

- tendon stretch - muscle spindle Ia afferent fiber --> cell body in dorsal root ganglion --> inhibitory interneuron --> extensor and flexor motor neurons --> ventral root --> one path inhibited the non working muscle while the other activates the muscle that tendon was stimulated