Medical Neurological Assessment

Question 1

Pain complaint

Answer 1

Location
Quality
Severity
Duration
Precipitating factors
Associated symptoms
Exasperation/diminished pain
Onset

Use pain rating scales

Question 2

Headaches

Answer 2

Multiple causes, not good indicator of neuro trouble

Question 3

Vertigo

Answer 3

Sensation of moving around in space or objects moving around them.

Question 4

Assessing Cerebral Function

Answer 4

Mental status
Intellectual function
Thought content
Emotional status
Perception
Motor ability
Language ability

Question 5

Mental Status- Alert

Answer 5

Open eyes spontaneously, Responds appropriately, briskly, and is oriented

Question 6

Lethargic

Answer 6

Opens eyes to verbal stimuli, Slow to respond but appropriate, Short attention span, Obtunded (sleepy)

Question 7

Stupor

Answer 7

Responds to stimuli (usually physical) with moans and groans, Never fully awake, Confused, Conversation unclear.

Question 8

Semi-Comatose

Answer 8

Responds to painful stimuli, Conversation=none, Protective reflexes are present.

Question 9

Comatose

Answer 9

Unresponsive except to severe pain, protective reflexes absent, pupils fixes, no voluntary movement.

Question 10

Unconscious

Answer 10

Non-medical word, ranges from stupor to coma

Question 11

Persistent Vegetative state

Answer 11

No cognitive brain function, Wake sleep cycles, Very poor prognosis (3-6 months)

Question 12

Brain Dead

Answer 12

No brain function, Only reflexive movements

Question 13

Types of stimuli -> Response

Answer 13

Voice
Touch
Shaking
Voice + shaking
Noxious/painful stimuli (sternal rub)

Question 14

Nature of response

Answer 14

Eye opens,
Remove stimuli,
Abnormal posturing,
No response

Question 15

Glasgow Coma Scale- Eye opening

Answer 15

Spontaneous- 4
To speech- 3
To pain- 2
Nil- 1

Question 16

Glasgow Coma Scale- Best motor response

Answer 16

Obeys-6
Localizes- 5
Withdraws- 4
Abnormal flexion- 3
Extension response- 2
Nil- 1

Question 17

Glasgow Coma Scale- Verbal response

Answer 17

Oriented-5
Confused conversation- 4
Inappropriate words- 3
Incomprehensible sounds- 2
Nil- 1

Question 18

Glasgow Coma Scale scoring

Answer 18

13= mild brain injury
9-12= Moderate brain injury
<8= Severe brain injury (coma)

Question 19

General appearance

Answer 19

How do they look?

Grooming, dress, aids, eye deviation, skin

Question 20

Visual assessment

Answer 20

Signs of trauma, wounds, scrapes, ecchymosis, etc.

Question 21

Bruising over the mastoid

Answer 21

Suggests skull fractures

Question 22

Periorbital edema and bruising (raccoon’s eyes)

Answer 22

Suggests frontal-basal fracture

Question 23

Rhinorrhea

Answer 23

Drainage of CSF from the nose: suggests fracture of the cribiform with torn meninges

Question 24

Otorrhea

Answer 24

Drainage of CSF from the ear: suggests fracture of the temporal bone with torn meninges.

Question 25

Decorticate posturing

Answer 25

Flexed posturing= Flexed arm/elbow, Flexed wrists/fingers, adducted arms, legs with internal rotation, plantar flexed foot. Suggests damage to the cortico-spinal tract (more favorable than decerebrate posture)

Question 26

Decerebrate Posturing

Answer 26

Extension posturing= extended arm/elbow, flexed wrists/fingers, adducted arm, pronation of arm, foot is plantar flexed. Suggests severe injury to the brain at the level of the brainstem.

Question 27

Opisthotonos

Answer 27

Severe muscle spasm of the neck and back.

Question 28

Orientation

Answer 28

``` X4= Person Place Time Situation ```

Question 29

Bottom up

Answer 29

Measure component skills

Question 30

Top down

Answer 30

Performance in task

Question 31

Evaluation

Answer 31

``` Gathering data from: medical record/chart review Observation of client including with family, staff, other clients, Interviews with client and family, Quantitative assessment. ```

Question 32

OT Assessments

Answer 32

Sensation, ROM/MMT (deformity control)- head and neck -UE -Head and UW motor control Wrist and hand function Trunk control ADLs Vision/visual perception Cognition (thinking, memory, personality) Apraxia/Perception Endurance- assess ability to tolerate activity (bed, sitting EOB, Chair, standing) *not the type of activity, Resistance, and time tolerated.

Question 33

Psychosocial

Answer 33

``` Client's understanding of the situation Coping skills available Problem solving skills Ability to direct others Family involvement Discharge plans/options Motivation/Participation in goal setting ```

Question 34

Problem list

Answer 34

Identify strengths and deficit areas from evaluation Re-evaluate as patient improves, Apparent problems are combination of cognitive, sensory-perceptual, sensorimotor, and behavior deficits. -identify each deficit -Determine severity of deficit in relation to others.