Neuro 2 Flashcards Preview

Clinical Assess 3 > Neuro 2 > Flashcards

Flashcards in Neuro 2 Deck (46):
1

Joints have _________

 

range of motion

It is not proper to say the that the patient is strong at the elbow or has good range of motion of the biceps.

2

Muscles have ________

strength

It is not proper to say the that the patient is strong at the elbow or has good range of motion of the biceps.

3

What is wrong with this statement?

the patient is strong at the elbow

Joints have range of motion

Muscles have strength

4

What is wrong with this statement?

the patient has good range of motion of the biceps.

Joints have range of motion

Muscles have strength

5

•muscular twitching involving the simultaneous contraction of contiguous groups of muscle fibers

fasciculation

6

residual muscle tension present in the muscle at rest

TONE

7

How do you test for muscle TONE?

  1. Assessed by feeling for resistance to passive stretch
  2. Move the joints through Passive Range of Motion & feel for resistance

8

Assessing muscle tone

INCREASED; Variable, worse at extremes of PROM

Spacticity

9

Assessing muscle tone

INCREASED; Continuous throughout PROM

Lead pipe rigidity

10

Assessing muscle tone

INCREASED; Intermittent/rachet like

Cogwheeling

11

Assessing muscle tone

DECREASED

  • hypotonia
  • flacidity

12

Abnormal Involuntary Movements

•most common cause is Parkinson’s Disease.  This tremor is often called a “pill rolling” tremor for its characteristic movement.

Resting Tremor-

13

Abnormal Involuntary Movements

•a tremor of  movement.  Does not exist at rest.  Usually is caused by brainstem or cerebellar disease.

Intention Tremor-

14

Abnormal Involuntary Movements

tremors and dyskinesias

15

Abnormal Involuntary Movements

Two types of tremors/Dyskinesia

•Tremor at rest (pill rolling)

•Intention tremor (best seen on finger-to-nose)

16

Abnormal Involuntary Movements

What is the best way to spot an ​Intention tremor?

•(best seen on finger-to-nose)

17

Abnormal Involuntary Movements

Identify:

  • a tremor of sustained posture.  Is usually normal variant. 

  • Postural Tremor
  • May be familial, or be caused or enhanced by medications, anxiety, sleep deprivation, caffeine, or hyperthyroidism

18

Abnormal Involuntary Movements

Identify the causes:

  • Postural Tremor

  • Postural Tremor
  • May be familial, or be caused or enhanced by medications, anxiety, sleep deprivation, caffeine, or hyperthyroidism

  • a tremor of sustained posture.  Is usually normal variant. 

19

Abnormal Involuntary Movements

Tics worsen with ______ and disappear during _______.

  • Tics
  • Tics worsen with stress and disappear during sleep.

  • Sudden, quick, coordinated movements that may be easily imitated. 

  • Occurs repeatedly and can be voluntarily suppressed for a short time. 

20

Abnormal Involuntary Movements

Identify:

  • Sudden, quick, coordinated movements that may be easily imitated. 

  • Occurs repeatedly and can be voluntarily suppressed for a short time. 

  • Tics
  • Tics worsen with stress and disappear during sleep.

21

Abnormal Involuntary Movements

Identify:

  • –Unpredictable, brief, rapid, jerky movements

  • •Chorea
  • –Seen in Huntington’s Disease

A image thumb
22

Abnormal Involuntary Movements

Identify the cause:

  • Chorea

Q image thumb

  • •Chorea
  • –Seen in Huntington’s Disease

  • –Unpredictable, brief, rapid, jerky movements

A image thumb
23

Abnormal Involuntary Movements

Identify the cause:

  • •Athetosis

Q image thumb

  • Athetosis
  • –Seen in Cerebral Palsy

  • –Slow, twisting writhing movement

A image thumb
24

Abnormal Involuntary Movements

Identify:

  • –Slow, twisting writhing movement

  • Athetosis
  • –Seen in Cerebral Palsy

A image thumb
25

Strength examination is the act of....

Testing muscles against resistance

26

Strength scale

Identify:

  • No movement/flicker

Zero-0

_____________________

GRADED  0 – 5 scale:

0 = No movement / flicker

1 = Visible flicker of contraction

2 = Active movement with gravity eliminated

3 = Active movement against gravity (no   resistance at all)

4 = Active movement against gravity with some     resistance

5 = Active movement against gravity with full

       resistance

27

Strength scale

Identify:

  • Visible flicker of contraction

One-1

_____________________

GRADED  0 – 5 scale:

0 = No movement / flicker

1 = Visible flicker of contraction

2 = Active movement with gravity eliminated

3 = Active movement against gravity (no   resistance at all)

4 = Active movement against gravity with some     resistance

5 = Active movement against gravity with full

       resistance

28

Strength scale

Identify:

  • Active movement with gravity eliminated

Two-2

_____________________

GRADED  0 – 5 scale:

0 = No movement / flicker

1 = Visible flicker of contraction

2 = Active movement with gravity eliminated

3 = Active movement against gravity (no   resistance at all)

4 = Active movement against gravity with some     resistance

5 = Active movement against gravity with full

       resistance

29

Strength scale

Identify:

  • Active movement against gravity (no   resistance at all)

Three-3

_____________________

GRADED  0 – 5 scale:

0 = No movement / flicker

1 = Visible flicker of contraction

2 = Active movement with gravity eliminated

3 = Active movement against gravity (no   resistance at all)

4 = Active movement against gravity with some     resistance

5 = Active movement against gravity with full

       resistance

30

Strength scale

Identify:

  • Active movement against gravity with some     resistance

Four-4

_____________________

GRADED  0 – 5 scale:

0 = No movement / flicker

1 = Visible flicker of contraction

2 = Active movement with gravity eliminated

3 = Active movement against gravity (no   resistance at all)

4 = Active movement against gravity with some     resistance

5 = Active movement against gravity with full

       resistance

31

Strength scale

Identify:

  • Active movement against gravity with full resistance

Five-5

_____________________

GRADED  0 – 5 scale:

0 = No movement / flicker

1 = Visible flicker of contraction

2 = Active movement with gravity eliminated

3 = Active movement against gravity (no   resistance at all)

4 = Active movement against gravity with some     resistance

5 = Active movement against gravity with full

       resistance

32

Two rules for accurate strength testing

  1. Always test side to side! 
  2. Never test both sides at the same time!

33

Strength Testing

Need to immobilize the _____________ of the muscles you are testing

limb proximal to the joint

34

Strength Testing

Do the deltoids have a joint you need to immobilize?

No; therefore may test both at same time

35

Strength Testing

Which muscle?

“Make chicken wings and hold them up”

Deltoids

  • Nothing to immobilize

36

Strength Testing

Which muscle?

“Make a muscle and don’t let me move it”

Biceps or Elbow Flexion

  • Immobilize shoulder

37

Strength Testing

Which muscle?

“Push me away”

Triceps or Elbow Extension

  • Immobilize shoulder

38

Strength Testing

Which muscle?

“Curl your wrist down and don’t let me uncurl it”

Wrist Flexion

  • Immobilize arm so patient can't move at elbow

39

Strength Testing

Which muscle?

“Stick ‘em up and don’t let me move your wrist”

Wrist Extension

  • Immobilize arm so patient can't move at elbow

40

Strength Testing

Which muscle?

“Lift your leg straight up and don’t let me push it down ”

Hip Flexors

41

Strength Testing

Which muscle?

“Kick out against my hand”

Knee extension

  • Support thigh just above the knee

42

Strength Testing

Which muscle?

“Bend your knee and don’t let me straighten it”

Knee extension

  • Support thigh just above the knee

43

Strength Testing

Which muscle?

“Toes to the nose and don’t let me move them”

Ankle dorsiflexion

  • Support heel

44

Strength Testing

Which muscle?

“Step on the gas!”

Ankle plantarflexion

  • Support heel

45

Strength Testing

Which muscle?

“Big toe up like a thumbs up and hold it”

Toe extensors

46

Strength Testing

Which muscle?

“Curl your toes and don’t let me uncurl them”

Toe flexors