Neuro Flashcards
(28 cards)
Cranial Nerves: Sensory/Motor/Both
“Some Say Marry Money But My Brother Says Big Boobs Matter More”
I. Sensory II. Sensory III. Motor IV. Motor V. Both VI. Motor VII. Both VIII. Sensory IX. Both X. Both XI. Motor XII. Motor
Cranial Nerves: Testing
Name the cranial nerve and how it’s tested.
I. Olfactory
Test: Smelling odors
II. Optic
Test: Visual field (eye chart test)
III. Oculomotor
Test: Up, Down, Medial gaze
IV. Trochlear
Test: Down, Lateral gaze
V. Trigeminal
Test: Face sensation (sharp? or dull?); move mandible lat. deviation, protrusion/retrusion
VI. Abducens
Test: Lateral gaze
VII. Facial
Test: Taste (sweet? or salty?); mimic facial expression
VIII. Vestibulocochlear
Test: Hearing Test
IX. Glossopharyngeal
Test: Gag reflex; Distinguishing between tastes (bitter/sour - this is the skittles test)
X. Vagus
Test: Gag reflex
XI. Accessory
Test: Resisted shoulder shrug
XII. Hypoglossal
Test: Tongue protrusion :0P
(does the tongue deviate to one side?)
LEFT and RIGHT Hemisphere Specialization
LEFT HEMISPHERE
3 L's: Love, Logic, Language
Math calculations
Positive emotions (love/happiness)
Analytical
Written and verbal communication
Sequence and perform movements.
RIGHT HEMISPHERE
Artistic Ability (you totally have this! :0P Hehe)
Spatial relationships
Hand-eye coordination
Kinesthetic awareness
Express negative emotions
Nonverbal processing
Brunstrom Stages of Recovery
Stages 1-7
- Stage 1: No voluntary movement initiated. (Flaccidity)
- Stage 2: Beginning of spasticity w/ the appearance of limb synergy.
- Stage 3: Spasticity increases & the synergies are performed voluntarily.
- Stage 4: Spasticity starts to decrease. Movements are not dictated solely by the synergy.
- Stage 5: Spasticity further decreases & the movements become independent of the synergy. (movement synergies are less dominant).
- Stage 6: Joint movements are preformed with coordination. (isolated and combination movements are evident. Coordination deficits are present w/ rapid movements).
Stage 7: Normal motor function.
Think of hiking a peak, as you hike up it is getting harder the steeper it gets. Then you reach the peak, and it gets easier as you come down. Stage 4 is the middle of the stages or “top of the peak” where you have reached the climax of spasticity and now decreasing
pg 165 scorebuilders
pg 305 neuro book
Asymmetric Tonic Neck Reflex
Description?
Normal Age of Response?
What does it interfere with?
*ATNR (Asymmetrical Tonic Neck Reflex) Asymmetric-w/o symmetry. Head is turned to one side R/L. Arm & leg on face side are extended, arm & leg on scalp side are flexed & spine curved w/ convexity toward face side.
(BIRTH - 6 MONTHS).
Interferes with:
Feeding, visual tracking, midline of hands, bilat hand use, rolling, development of crawling, leading to skeletal deformity (scoliosis, hip subluxation, hips dislocation)
Symmetric Tonic Neck Reflex
Description?
Normal Age of Response?
What does it interfere with?
*STNR (Symmetrical Tonic Neck Reflex) Symmetric - w/ symmetry. Head position, flexed or extended. When head is flexed, arms are flexed, & legs extended. When head is extended arms are extended, & legs flexed.
(6 - 8 MONTHS).
Interferes with:
Ability to prop on arms in prone, attaining and maintaining hands-and-knees position, crawling reciprocally, sitting balance when looking around, use of hands when looking at an object in hands in sitting
Tonic Labyrinthine Reflex
Description?
Normal Age of Response?
What does it interfere with?
*TLR (Tonic Labyrinthine Reflex) Position of labyrinth in inner ear- reflected in head position. Supine position = body and extremities are held in extension. Prone position = body and extremities are held in flexion.
(BIRTH - 6 MONTHS)
Interferes with:
Ability to initiate rolling, ability to prop on elbow with extended hips when prone, ability to flex trunk and hips to come to sitting position from supine, often causes full body extension which interferes with balance in sitting/standing
Galant Reflex
Description?
Normal Age of Response?
What does it interfere with?
Touch to skin along spine from shoulders to hip.
Lateral flexion of trunk to side of stimulus.
(30 WEEKS GESTATION - 2 MONTHS)
Interferes with:
Development of sitting balance, can lead to scoliosis
Palmar Grasp
Description?
Normal Age of Response?
What does it interfere with?
Pressure in palm on ulnar side of hand.
Flexion of fingers causing strong grip.
(BIRTH TO 4 MONTHS)
Interferes with:
Ability to grasp and release objects voluntarily, weight bearing on open hand for propping, crawling, protective responses
Plantar Grasp
Description?
Normal Age of Response?
What does it interfere with?
Pressure to base of toes.
Toe flexion.
(28 WEEKS GESTATION - 9 MONTHS)
Interferes with:
Ability to stand with feet flat on surface, balance reactions and weight shifting in standing
Rooting Reflex
Description?
Normal Age of Response?
What does it interfere with?
Touch on cheek.
Turning head to same side with mouth open
(28 WEEKS GESTATION - 3 MONTHS)
Interferes with:
Oral-motor development, development of midline control of head, optical righting, visual tracking, and social interaction
Moro Reflex
Description?
Normal Age of Response?
What does it interfere with?
Head dropping into extension suddenly for a few inches.
Arms ABD with fingers open, then cross trunk into ADD; cry
(28 WEEKS GESTATION - 5 MONTHS)
Interferes with:
Balance reactions in sitting, protective responses in sitting, eye-hand coordination, visual tracking
Startle Reflex
Description?
Normal Age of Response?
What does it interfere with?
Loud, sudden noise.
Similar to moro response but elbows remain flexed and hands closed.
(28 WEEKS GESTATION - 5 MONTHS)
Interferes with:
Sitting balance, protective responses in sitting, eye-hand coordination, visual tracking, social interaction, attention
Positive Support Reflex
Description?
Normal Age of Response?
What does it interfere with?
Weight placed on balls of feet when upright.
Stiffening of legs and trunk into extension
(35 WEEKS GESTATION - 2 MONTHS)
Interferes with:
Standing and walking, balance reactions and weight shifting in standing, can lead to contractors of ankles into plantar flexion
Walking/Stepping Reflex
Description?
Normal Age of Response?
What does it interfere with?
Supported upright position with soles of feet on firm surface.
Reciprocal flexion/extension of legs
(38 WEEKS GESTATION - 2 MONTHS)
Interferes with:
Standing and walking, balance reactions and weight shifting in standing, development of smooth, coordinated reciprocal movements of LE’s
Glasgow Coma Scale
What is it used for?
What does the scoring telling us?
(concussion/TBI)
Neuro assessment tool used initially after injury to determine arousal and cerebral cortex function.
Coma Score (E + M + V) = 3 to 15
* 8 or less: Severe Brain Injury and coma * 9-12: Moderate Brain Injury * 13-15: Mild Brain Injury
Some extra info just to be familiar...
E: Eye Opening
4 - Spontaneous
3 - To Speech
2 - To Pain
1 - Nil
M: Best Motor Response
6 - Obeys commands
5 - Localizes pain
4 - Withdraws
3 - Abnormal Flexion
2 - Extensor response
1 - Nil
V: Verbal Response
5 - Oriented
4 - Confused conversational
3 - Inappropriate words
2 - Incomprehensible sounds
1 – Nil
4 Stages or Motor Control
Pg 36 in neuro book
- Mobility = when movement is initiated. (random movements LACKING PURPOSE w/in the 1st 3 months of development. Mobility is present before stability.
- Stability = the ability to maintain a steady position in a WB, antigravity posture. Also known as static postural control. 2 types…
- 1- tonic holding = isometric contraction @ end of short range
- 2- cocontraction = static contraction of antagonistic mm around a jt to provide stability.
- Controlled Mobility = superimposed movement on perviously developed postural stability by wt shifting w/in a posture. (Proximal mobility is combined w distal stability). Also known as Dynamic Postural Control.
- Skill = most mature type of movement and usually mastered after controlled mobility. (Proximal segments stabilize while distal segments are free for movement). Skilled movements involve manipulation & exploration of the environment.
Rancho Los Amigos Levels of Cognitive Functioning
LEVELS I - VIII
I. NO RESPONSE:
Pt appears to be in a deep sleep & is completely unresponsive to any stimuli.
II. GENERALIZED RESPONSE:
Pt reacts but in an inconsistent & non-purposeful manner. Responses are limited and often the same response regardless the stimulus presented. Responses my include physiological changes, gross body movements, and/or vocalization.
III. LOCALIZED RESPONSE:
Pt reacts specifically but inconsistently to stimuli. Responses directly related to type of stimulus. May follow simple commands - closing eyes or squeezing hand in an inconsistent, delayed manner.
IV. CONFUSED-AGITATED:
Pt is in heightened state of activity, lacks short and long term recall, unable to cooperate with tx.
V. CONFUSED-INAPPROPRIATE:
Pt is able to respond to simple commands fairly consistently. W/ increased complexity or lack of any external structure, the pt responses are non-purposeful, random, or fragmented. Highly distractible & lacks ability to focus. Vocalization is inappropriate and memory severely impaired.
VI. CONFUSED-APPROPRIATE:
Pt shows goal directed behavior, but is dependent upon external input and direction. Follows simple commands and demonstrates carrryover for relearned tasks. Memory problems = wrong answers but appropriate for stimulus.
VII. AUTOMATIC-APPROPRIATE:
Pt is appropriate and oriented to setting. Demonstrates daily routine automatically (robot like manor). Minimal to no confusion. Judgement remains impaired.
VIII. PURPOSEFUL-APPROPRIATE:
Pt able to recall and integrate past & recent events. Aware & responsive to environment. Needs no supervision once activities are learned. May demonstrate decreased abilities, abstract reasoning, stress tolerance, & judgement with emergencies.
Pg 181-182 Scorebuilders (Neuro note cards show 10 levels)
Dermatomes
C2 -
Posterior head
C3 -
Posterior lateral neck
C4 -
Across the anterior surface of the calvicle.
C5 -
Anterior surface of the deltoid.
C6 -
Anatomical position @ the palmar surface of the thumb.
C7 -
Anatomical position @ palmar surface of the middle finger.
C8 -
Anatomical position @ the little finger and ulnar border of the hand.
T1 -
Medial surface of elbow/medial forearm.
L2 -
Proximal hip, anterior surface of the thigh.
L3 -
Middle 1/3 of anterior thigh.
L4 -
Patella and medial melleolus.
L5 -
Dorsal surface of the 3rd meta-tarsal.
S1 -
Lateral aspect of the foot, along the 5th meta-tarsal & plantar aspect of the foot.
S2 -
Medial aspect of the posterior thigh.
S3 - S5
Perianal area
Myotomes
Pg 132-133 Score builders
C2 - Longus colli, SCM, rectus capties
C3 - Trap, splenius capitis
C4 - Trap, levator scap
Test: Shoulder shrug
C5 - Supraspinatus, infraspinatus, deltoid, biceps
Test: Shoulder ABD
C6 - Biceps, supinator, wrist extensors
Test: Elbow flexion, wrist extension
C7 - Tricep
Test: Elbow extension, wrist flexion
C8 - Ulnar deviators, thumb extensors and adductors
Test: Finger Flexion
L2 - Psoas, hip adductors
Test: Hip flexion
L3 - Psoas, quads,
Test: Knee Extension
L4 - Tibialis Anterior, extensor hallucis
Test: Ankle Dorsiflexion
L5 - Extensor hallucis, peroneals, glut med, dorsiflexors, H/S
Test: Great toe ext, or knee flexion?
S1 - Calf and H/S, peroneals, plantar flexors, glut wasting
Test: Plantarflexion
ASIA Impairment Scale
(American Spinal Injury Association = ASIA)
(Spinal cord injury test/measure A-E)
A: Complete
- No S or M function preserved in S4-5
B: Sensory Incomplete
- S but no M function below neuro level and extends through S4-5
C: Motor Incomplete
- M function preserved below neuro level and most key muscles below neuro level have MMT grade LESS than 3
D: Motor Incomplete
- M function preserved below neuro level and most key muscles below neuro level have MMT grade GREATER than or equal to 3
E: Normal
- S and M functions normal
Complete SCI
usually flaccidity
Sensory and motor function will be absent below the level of injury AND the lowest sacral segments of S4 & S5.
*Most often the result of complete transection, spinal cord compression, or vascular impairment.
Incomplete SCI
Some spasticity, clonus, increased DTR, will usually be present
Partial preservation of some sensory & motor function (sacral sparing) below the level of injury and lowest sacral segments S4 & S5.
*B/C sacral tracts run most medially w/in the spinal cord, they are often salvaged.
Anterior cord syndrome
Anterior = in front, & we move extremities in front of our bodies = motor function
- results from a flexion injury to the C-spine, in-which a fracture or dislocation occurs to the C vertebrae.
- Pt loses motor, pain, & temperature sensations Bilaterally.
- Posterior dorsal column still intact, therefore the pt still able to sense position & vibration below the injury.
