LESSON 10 NEUROLOGICAL ASSESSMENT Flashcards
(123 cards)
1
Q
2 REGION OF NERVOUS SYSTEM
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Central Nervous System (CNS)
Peripheral Nervous System (PNS)
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Q
Cerebrum consist of what ?
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right and left hemispheres, frontal, parietal, occipital & temporal lobes
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Q
(thalamus and hypothalamus) body temp, sleep
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Diancephalon
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position sense, posture & equilibrium/balance
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Cerebellum
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(medulla oblongata, pons & midbrain) resp. & cardiac regulation, sneezing
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Brain stem
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Q
somatic sensory center
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Parietal
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higher intellect, speech production, personality, behavior, emotions, voluntary movement
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Frontal
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hearing, memory, speech perception and translation
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Temporal
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Q
Vision
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Occipital
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Q
Consist of Cervical, thoracic, lumbar nerves
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Spinal roots
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Q
Responsible for motor roots
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anterior
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Q
responsible for sensory roots
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posterior
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Q
damage to posterior roots
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loss of sensation
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Q
damage to anterior roots
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flaccid paralysis
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Q
External environmental information received and transmitted through?
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Peripheral nervous system
16
Q
number of spinal nerves in
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
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cervical 8 pairs C1-C8
Thoracic 12 pairs T1-T12
Lumbar 5 pairs L1-L5
Sacral 5 pairs S1-S5
Coccygeal 1 pair Coccyx
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Q
-Rapid involuntary predictable motor response to a stimulus.
-Reflex arc, is not dependent on the brain.
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Reflex
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Q
Skeletal muscle contraction
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Somatic
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Q
Cardiac, smooth muscle and glands
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autonomic
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Q
Three basic types of neurologic examination
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Screening neurologic exam
Complete neurologic exam – neurologic concerns
Neurologic recheck exam
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Q
consideration for assessment
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Assess mental status first
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Q
Equipment
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Eye charts, tuning fork, pen light, reflex hammer, key, buttons, coin, big safety pin
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Q
eye opening (GCS)
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SPONTANEOUS 4
TO SOUND 3
TO PAIN 2
NEVER 1
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Q
motor response (GCS)
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obeys command 6
localizes pain 5
normal flexion (withdrawal) 4
abnormal flexion 3
extension 2
none 1
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verbal response
oriented 5
confused conversations 4
inappropriate words 3
incomprehensible sound 2
none 1
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GCS is used to evaluate patients with
traumatic brain injury
altered mental status
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GCS measures what categories
eye opening (e)
motor response (m)
verbal response (V)
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formula for GCS score
e + v + m
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GCS SCORE INTERPRETATION
13-15 MILD HEAD INJURY
12-9 MODERATE HEAD INJURY
BELOW 8 SEVERE HEAD INJURY
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(mental status) Physical appearance, dress, grooming, hygiene
Appropriate for age, sex, culture, season, setting
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(mental status) Behavior and affect, facial expression
Depressed, hostile, euphoric, fearful, flat/dull
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third type of mental status
Assess thought content/process
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speech language
Quality
Rate
Volume
Fluency – Abnormal patterns
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difficulty/discomfort in talking (laryngeal disease)
aphonia/dysphonia
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distorted speech sounds, may sound unintelligible, basic language intact
cerebellar dysarthria
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a language disorder that affects how you communicate. It's caused by damage in the area of the brain that controls language expression and comprehension.
Aphasia
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can understand but can't speak
Broca's aphasia
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absent/reduced speech and comprehension
global aphasia (expressive)
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can't understand but can speak
Wernicke's aphasia (receptive)
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Producing speech are of the brain (broca's area)
frontal lobe
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understanding and processing speech are of the brain (wernicke's area)
temporal lobe
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Perceptions
Illusions/delusions
Hallucinations
Ability to make a decision/judgment
Insight
Though process and perception
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Ask to repeat 3-4 unrelated words (cognitivge abilities and mentation)
immediate memory
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Ask who “I” am, last meal, last visitor (cognitive abilities and mentation)
recent memory
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Ask the birthday, anniversary, last President, favorite President (cognitive abilities and mentation)
remote memory
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Meaning of a proverb, simple math (cognitive abilities and mentation)
abstract reasoning and skills
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Visual, auditory, tactile
interpretation of stimuli
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cranial nerves type
ssmmbmbbsbbmm
some say marry money, but my big brother say big brain matter most
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(abnormal flexion) Comatose posturing
Decorticate Rigidity
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cranial nerves
OOOTTAFAGVAH
OFLACTORY, OPTIC, OCULOMOTOR, TROCHLEAR, TRIGEMINAL, ABDUCEN, FACIAL, ACOUSTIC (VESTIBULOCOCHLEAR), VAGUS, SPINAL ACCESSORY, HYPOGLOSSAL
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(abnormal extension) Comatose posturing
Decerebrate Rigidity
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(nonfunctional brain stem) Comatose posturing
Flaccid Quadriplegia
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(meningeal irritation) Comatose posturing
Opisthotonos
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is a term for a group of disorders that affect coordination, balance and speech. Any part of the body can be affected, but people with ataxia often have difficulties with: balance, walking, speaking.
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neurological exam to test for balance and coordination
romberg's test
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is a gait (method of walking or running) where the toes of the first foot touch the heel of the next one at each step. Neurologists sometimes ask patients to walk in a straight line using tandem gait as a test to help diagnose ataxia.
Tandem's gait
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stroke, immobile arm against body, stiff/extended leg, toe drag. it is a neuromuscular condition of spasticity that result in the muscle on one side of the body being in a constant state of contraction
spastic hemiparesis
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loss of position sense, staggering, alcohol (barbiturate). it is a sudden, uncoordinated muscle movement due to disease or injury in to the cerebellum.
cerebellar ataxia
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basal ganglia defects, stooped posture, trunk forward. it is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness and difficulty with balance and coordination
parkinsonian
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it is a type of spastic paraparetic gait in which the muscle tone in the adductors is marked. it is charac
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lower motor neuron defect. the inability to lift the foot while walking due to the weakness of muscles that cause dorsiflexion of the ankle joint. not a commonly seen condition
steppage/footdrop
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weakness in hip girdle and upper thigh muscle. to make up for the weakness, you sway from side to side and your hip drops with each step. also called as MYOPATHIC GAIT
WADDLING
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characterized by hypertonia and flexion in the legs, hips and pelvis accompanied by extreme adduction leading to the knees and thighs hitting, or sometimes even crossing, in a scissor-like movement
scissors
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Muscle size, strength, tone bilaterally
Tremor differentiation
motor system
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(also termed superficial sensation): receptors in skin and mucous membranes
Exteroceptive sensation
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(also termed deep sensation): receptors located in muscles, tendons, ligaments and joints
Proprioceptive sensation
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Client sitting
Eyes closed
“Say where you are touched.”
Compare bilaterally, and distally to proximally.
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interpretative sensory functions that require analysis of individual sensory modalities by the parietal lobes to provide discrimination. Individual sensory modalities must be intact to measure cortical sensation.
interpretative sensory functions that require analysis of individual sensory modalities by the parietal lobes to provide discrimination. Individual sensory modalities must be intact to measure cortical sensation.
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Close eyes
Place object in hand
“Identify object.”
Test bilaterally with different objects.
Note speed and accuracy
stereogenesis
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Strike fork & start on most distal bony prominence & work medially with neuropathy
Ask when do you feel the vibration start and when do you feel the vibration stop.
vibratory sensation
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inability to identify figure
agraphesthesia
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unable to identify object
astereogenesis
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Support the client’s forearm
Client’s arm flexed at 45-90 degree angle
Hold arm loosely
Strike tendon with a brisk wrist motion on top of your thumb
bicep reflex
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Close eyes
Draw letter or number on hand
“Identify figure.”
Test bilaterally
Note speed and accuracy
graphesthesia (parietal lobe)
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(reflex)
Grading scale 0-4+
Compare bilaterally
Biceps, brachioradialis, triceps, patellar, achilles
Deep tendon
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commonly with clonus
4+ - Hyperactive
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continued movement after stimulations removed
clonus
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(reflex)
Abdominal
Plantar (Negative Babinski)
Cremasteric
Superficial
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reflex charting
0 - absent
1- hypoactive
2-normal
3-active
4-hyperactive
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Relaxed arm required.
extension of the forearm.
triceps reflex
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is needed to conduct the impulses and the neurons of a newborn are not completely myelinated.
myelin
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Stroke up the lateral side of the sole & across the ball of the foot to just below the great toe.
plantar reflex
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Level of consciousness (LOC)
Motor function
Pupillary response
Vital signs
assess for increased intracranial pressure
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newborn consideration occurs with CNS damage.
High-pitched, shrill cry (cat-like screech)
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when something touches the baby's palate, he will try to suck it
sucking
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when infant is startled or feels like they are falling. infant will have a startled look and the arms will fling out sideways with the palms up and the thumbs flexed
moro
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this reflex starts when the corner of the baby's mouth is stroked or touched. the baby will turn or rotate his head and open his mouth to follow and root in the direction of the rooting
rooting
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stroking the hand of the baby, causes the baby to close his fingers in grasp
palmar grasp
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baby's head turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow
tonic neck
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occurs after the sole of the foot has been firmly stroked. the big toe then moves upward or toward the top surface of the foot
babinski
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