Module 11 - Neurological Assessment Flashcards
1
Q
Structure of the Neurological System
A
- CNS
- PNS
- Meninges
- Cerebrospinal Fluid
2
Q
Central Nervous system Structure
A
- Cerebral Cortex
- Frontal lobe
- Parietal lobe
- Occipital lobe
- Temporal lobe
3
Q
Function of Neurological System
A
- Sensory
- Motor
- Integration
4
Q
Function of Thalamus
A
Main relay station for the nervous system
5
Q
Hypothalamus
A
- Major control centre
- Controls temperature, heart rate and blood pressure
- Regulates sleep
- Endocrine function from anterior/posterior pituitary
- Co-ordination of autonomic activity and emotions
6
Q
Cerebellum
A
- Balance
- Equilibrium
- Coordination
- Muscle tone
7
Q
Midbrain
A
Motor neurons
8
Q
Pons
A
Relay station containing ascending and descending tracts
9
Q
Medulla Oblongata
A
- Respiratory
- Cardiac
- GI
- Nuclei for cranial nerves VIII through XII
10
Q
What is a dermatome?
A
A circumscribed skin area that is supplied mainly from one spinal cord segment through a spinal nerve
- Overlap if one nerve is severed most sensations will continue
11
Q
Dermatome Landmarks
A
- Thumb, middle finger and fifth finger are connected to C6, C7 and C8
- The axilla is at level T1
- The nipple is at T4
- The umbilicus is at T10
- The groin is at L1
- The knee is at L4
12
Q
Health History Questions
A
1) Headaches
2) Head Injury
3) Dizziness/Injury
4) Seizures
5) Tremors
6) Weakness
7) In-coordination
8) Numbness
9) Dysphagia
10) Difficulty speaking
11) Significant past history
12) Environmental and Occupational hazards
13
Q
Components of the Glasgow coma scale
A
- Assessment of comatose patients and is important in critical care
- Used to assess functional state of the brain
- Standard assessment that defines LOC
14
Q
Scoring areas of Glasgow Coma Scale
A
1) Best Eye opening response
2) Best Verbal responses
3) Best Motor responses
- 15 points is best response
- 8 or less is comatose
- 3 is totally unresponsive
15
Q
Assessment of Gait
A
- Observe the client walking 3-6 m and then turn and return to starting point
- Smooth gait
- Rhythmic
- Effortless
- Equal arm coordination
- Turns are smooth
- Client should be walking in a straight line
16
Q
Gait - Abormalities
A
- Stiff immobile posture
- Lack of arm swing or rigid arms
- Unequal rhythm of steps
- Crooked line
- Widening base
- Staggering balance
- Muscle weakness
- Swaying, falling
- Positive Romberg
- Loss of proprioception
- Loss of vestibular function
17
Q
Romberg Assessement
A
- Test for balance/equilibrium
- A positive test is loss of balance
1) Ask patient to stand up with feet together and arms at the sides and to close their eyes and hold the position
2) Wait 20 seconds
3) Some swaying will occur - normal
4) Perform a shallow knee bend or hop in place - both legs
18
Q
What are the neuro vital signs?
A
- All vitals (BP, HR, Temp) Co-ordination/Skilled Movements: - Grip strength - Finger to Finger - Finger to nose - Heel to shin
19
Q
Cranial 1 – Olfactory Nerve
A
- Normal sense of smell
- Test one nostril at a time
20
Q
Cranial 1 – Olfactory Nerve - Abnormalities
A
- Blocked passages
- Anosmia
- Neurogenic Anosmia (nasal disease)
21
Q
Cranial Nerve II – Optic
A
- Test vision and visual fields
22
Q
Cranial Nerve II – Optic
A
Vision lost
23
Q
Cranial III, IV and VI – Oculomotor, Trochlear and Abducens
A
PERRLA:
- Pupils’ size
- Regulatory
- Equality
- Direct and consensual light reactions
- Accommodation
- Position of gaze
- Movement
24
Q
Cranial III, IV and VI – Oculomotor, Trochlear and Abducens - Abnormal
A
- Myasthenia gravis
- Dysfunction of the nerves
- Intracranial pressure causes unilateral dilation and non-reactivity of the pupil
- Limited movement
- Disease
- Poor accomodation
- Stigma
25
Cranial Nerve V – Trigeminal Nerve - Motor
- Equally strong bilaterally
| - Clenching teeth
26
Cranial Nerve V – Trigeminal Nerve - Motor Abnormal
- Decreased strength on one or both sides
- Asymmetry
- Pain
27
Cranial Nerve V – Trigeminal Nerve - Sensory
- Sensation is felt using cotton bud
| - Test 3 division: ophthalmic, maxillary and mandibular
28
Cranial Nerve V – Trigeminal Nerve - Sensory Abnormalities
Decreased sensation
29
Cranial Nerve V – Trigeminal Nerve - Corneal Reflex
Test blinking reflex
30
Cranial Nerve V – Trigeminal Nerve - Corneal Reflex Abnormalities
No blinking occurs
31
Cranial Nerve VII: Facial Nerve
- Smiling
- Frown
- Lift eyebrows
- Shows teeth
- Puffs cheek
32
Cranial Nerve VII: Facial Nerve Abnormalities
- Muscle weakness
- Loss of movement
- Asymmetry
33
Cranial Nerve VIII: Acoustic Nerve
- Hearing
| - Identifying sounds
34
Cranial Nerve IX and X: Glossopharyngeal and Vagus Nerve
Phalageal movement
35
Cranial Nerve IX and X: Glossopharyngeal and Vagus Nerve - Abnormalities
- Absence or asymmetry
- Deviation
- Asymmetry of tonsillar pillar
- Hoarseness or brassy voice
36
Cranial Nerve XI: Spinal Accessory
- Resistance is equal
- Equal movement
- Shrug against resistance
- Side to side resistance
37
Cranial Nerve XI: Spinal Accessory Abnormalities
- Atrophy
- Muscle weakness
- Paralysis
38
Cranial Nerve XII: Hypoglossal Nerve
- Speech
| - Smooth/even tone tongue
39
Cranial Nerve XII: Hypoglossal Nerve Abnormalities
- Atrophy
- Tongue deviation
- Paralysis
40
Hypoalgesia
Decreased pain sensation
41
Analgesia
Absence of pain sensation
42
Hyperglesia
Increased pain sensation
43
Assessment of Sensory System
- Testing intactness of the spinal nerve, sensory tracts and higher cortical discrimination
- Do not need to test entire skin surface
- Detect localized pain, numbness and tingling
- Note decreases sensation areas
44
Hypoesthesia
Decreased touch sensation
45
Anaesthesia
Absent of touch sensation
46
Hyperasthesia
Increased touch sensation
47
Clonus
Rapid rhythmic contractions
48
Hyper-reflexes
Exaggerated reflexes
| - Motor lesions
49
Hyporeflexia
Reduced function of reflex
50
Paralysis
Decrease in motor power caused by a problem with motor nerve or motor fibre
- Trauma
- Spinal Cord injury
- CVA
- MS
- Muscular Dystrophy
51
Fasciculation
Rapid continuous twitching of resting muscle
- Atrophy
- Fatigue
52
Tic
Involuntary compulsive repetitive twitching of muscle group
| - Neurological issue (Tourettes)
53
Myoclonus
Rapid sudden jerk or short series of jerks at regular intervals
- Tonic Clonic Seizures
54
Rest Tremor
- Coarse and slow
| - Disappearing voluntary movement
55
Intention tremor
Rate varies but worsens with voluntary movement
| -Seen in MS and alcoholism
56
Chorea
- Sudden rapid jerky and purposeful movement involving the limbs, trunk or face
- Accentuated voluntary acts
- No rhythm or repetitive movement
- Disappears with sleep
57
Athetosis
Slow, twisting, writhing continuous movement resembling a snake or a worm
- Cerebral palsy
58
Spastic Hemiparesis
Arm is immobile against the body
- CVA
- Trauma
59
Cerebellar Ataxia
Patient is staggering, wide based gait
| - Alcoholism
60
Parkinsonian (Festinating)
- Posture is stooped, trunk forward
- Elbow, hips and knees are flexed
- Hesitant to start walking
61
Scissors
Knees cross or are in contact
62
Steppage or Foot drop
Appears if patient is walking up stairs where there are no stairs
63
Waddling
- Weak hip muscles
| - Opposite hip drop
64
Short Leg
Leg length discrepancy
65
Diseases of Motor System
1) Cerebral Palsy - Damage to cerebral cortex - developmental defect
2) Muscular Dystrophy - Wasting of skeletal muscle structures
3) Hemiplegia - Lower muscle paralysis
4) Parkinson Disease - Destruction of neurons producing dopamine
5) Cerebellar - A lesion in one hemisphere (will affect opposite side)
6) Paraplegia - Spinal injury - no movement below the lesion
7) Multiple Sclerosis - Destruction of Myelin of the neurons - both sensory/motor dysfunction
66
Sensory - Peripheral Neuropathy
Loss of sensation involves all modalities
| - Diabetes
67
Sensory - Individual Nerves or Roots
Decrease in or loss of all sensory
68
Sensory - Spinal cord Hemisection
Loss of pain and temperature sensation starting one to two segments below the level of the lesion
69
Sensory - Complete Transection of the Spinal Cord
Complete loss of ALL sensory modalities below the level of the lesion
70
Sensory Loss - Thalamus
Loss of ALL sensory modalities
71
Sensory Loss - Cortex
Loss of discrimination of sensation
| - Lesions
