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Flashcards in Neurological Assessments Deck (15):
0

What are you assessing in motor system?

Muscles - size, strength, tone - should be symmetrical bilaterally; involuntary movements (normally none, but if present note location, frequency, rate and amplitude)
Cerebellar function - balance, coordination and skilled movements;

1

How to assess cerebellar function?
(balance test - gait)

Have patient walk 3-6m, turn, and return to starting point; normally will move with sense of freedom, gait is smooth, rhythmic and effortless; coordinated arm swing; turns are smooth; step length is approximately 30 cm from heel to heel
-ask patient to walk a straight line in a heel-to-toe (tandem) manner - decreases base of support and accentuates any problem with coordination- normally a person can walk straight and stay balanced

2

How to assess cerebellar function?
(balance tests - the romberg test)

Ask patient to stand with feet together and arms at the sides. Once he or she is in a stable position, ask the patient to close he eyes and to hold the position; wait approximately 20 seconds
- normally a person can maintain posture and balance even with the visual orienting information blocked, although slight swaying may occur
Stand close to catch the patient in case he or she falls**

3

How to assess cerebellar function - balance?

Gait
Romberg Test
Ask patient to perform shallow knee bend or to hop in place, first on one leg, then the other; this demonstrates normal position sense, muscle strength, and cerebellar function.

4

How to assess cerebellar function?
(Coordination and skilled movements)

Rapid alternating movements
Finger-to-finger test
Finger-to-nose test
Heel-to-shin test

5

How to assess cerebellar function?
(rapid alternating movements)

Ask the patient to pat the knees with both hands, lift up and turn over the hands, and pat the knees with the back of the hands; then ask patient to do this faster - normally this is done with equal turning and a quick rhythmic pace
Alternate - ask patient to touch thumb to each finger on the same hand, and then reverse direction; normally can be done quickly and accurately

6

How to assess cerebellar function?
(finger-to-finger test)

With the patient's eyes open, ask that he or she use the index finger to touch your finger and then his or her own nose. After a few times, move your finger to a different spot. The patient's movement should be smooth and accurate

7

How to assess cerebellar function?
(Finger-to-nose test)

Ask the patient to close their eyes and to stretch out their arms. Ask the patient to touch the tip of his or her nose with each index finger, alternating hands and increasing speed. Normally, this movement is accurate and smooth

8

How to assess cerebellar function?
(Heel-to-shin test)

Test lower extremity coordination by asking the patient to assume a supine position, to place the heel on the opposite knee, and run it down the shin from the knee to the ankle; normally, a person moves the heel in a straight line down the shin

9

What are you assessing in the sensory system?

Spinothalamic tract - pain, temperature, light touch
Posterior column tract - vibration, position (kinaesthesia), tactile discrimination, stereognosis, graphaesthesia, two-point discrimination

10

How to assess spinothalamic tract - pain?

tested by patient's ability to perceive a pinprick; break a tongue blade lengthwise, forming a sharp point at the fractured end and a dull spot at the rounded end
-lightly apply the sharp point or the dull end to the patient's body in a random, unpredictable order, asking the patient to say dull or sharp depending on the sensation felt; let at least 2 seconds elapse after each stimulus, to avoid summation; with summation, frequent consecutive stimuli are perceived as one strong stimulus

11

How to assess spinothalamic tract - temperature?

-test temperature sensation only when pain sensation is abnormal; otherwise, you may omit it because the fibre tracts are much the same
Fill 2 test tubes - one with hot water, one with cold water and apply the bottom ends to the patient's skin in a random order
-Ask the patient to say which temperature is felt

12

How to assess spinothalamic tract - light touch?

-apply a wisp of cotton to the skin; stretch a cotton ball to lengthen it and brush it over the skin in a random order of sites and at irregular intervals - this prevents the patient from responding just from repetition
include the arms, forearms, hands, chest, thighs, and legs - ask the patient to say "now" or "yes" when touch is felt; compare symmetrical points

13

How to assess posterior column tract - vibration?

Test patient's ability to feel vibrations of a tuning fork over bony prominences; strike the tuning fork with the heel of your hand and hold the base on a bony surface of the patient's fingers and great toe; ask the patient to indicate when the vibration starts and stops
-if the patient feels the normal vibration or buzzing sensation on these distal areas, you may assume that the proximal spots are normal too and proceed no further; if no vibrations are felt, move proximally and test ulnar processes, ankles, patellae, and iliac crests; compare responses on the right side with those on the left side;

14

How to assess posterior column tract - position (kinaesthesia)?

Test the patient's ability to perceive passive movements of the extremities; move a finger or toe up and down and ask the patient to tell you which way it moved
this test is done with the patients eyes closed, but to be sure it is understood, have the patient watch a few trials first
Vary the order of the movement up or down; hold the digit by the sides, because upward or downward pressure on the skin may provide a clue as to how it has been moved; normally a person can detect movement of a few millimetres