Neuromuscular: Examination: History, Systems Review

Question 1

Orientation

Answer 1

• Person
• Place
• Time

Question 2

Consciousness

Answer 2

• Screen for patients level of conscious arousal which can range from alert to coma.

Question 3

Memory

Answer 3

• Examine for different types of recall
• Immediate (Brief i.e. 5 minutes)
• Recent (short term recall of recent events, can be same day event)
• Remote (Long term recall, typically past events)

Question 4

Attention

Answer 4

• Length of attention span
• Sustained attention=ability to attend to a task without redirection.
• Divided Attention=ability to shift attention between tasks
• Focused attention=ability to stay on task in presence of distractors
• Ability to follow commands, single or multiple step

Question 5

Emotional Response

Answer 5

• Examine for behavior of patient

Question 6

Higher Level Cognitive Reasoning

Answer 6

• Judgement
• Problem solving
• General Knowledge
• Calculation
• Sequencing

Question 7

Expressive Function

Answer 7

• Examine for fluency of speech, speech production
• Typically associated with damage to Broca’s area
• NEED TO KNOW DYSARTHRIAS
• NEED TO KNOW NEUROMUSCULAR FOUNDATIONAL DEFINITIONS FOR SPEECH DISORDERS

Question 8

Receptive Function

Answer 8

• Examine comprehension
• Typically associated with damage to Wernicke’s area
• NEED TO KNOW DYSARTHRIAS
• NEED TO KNOW NEUROMUSCULAR FOUNDATIONAL DEFINITIONS FOR SPEECH DISORDERS

Question 9

Non-verbal Communication

Answer 9

• Examine ability to read, and write

- Use of gestures, symbols, pictographs

Question 10

Vital Signs

Answer 10

• Irregularities in pulse
• Increase or decrease in BP
• Changes in response to activity
• O2 SAT SHOULD BE GREATER THAN 94 FOR PATIENTS WITH CENTRAL NERVOUS SYSTEM DAMAGE AND IDEALLY BETWEEN 97-100% AS PER THE AMERICAN HEART AND STROKE ASSOCIATIONS

Question 11

Examine Respiration

Answer 11

• Examine RR
• Cheyne-Stokes: Period of apnea lasting 10-60 second accompanied by gradually increasing depth and frequency of respiration.
• Hyperventilation: Increased rate and depth of respiration.
• Apneustic Breathing: Prolonged inspiration

Question 12

Meningeal Irritation/Brain Infection

Answer 12

• IMPAIRMENT TO NECK MOBILITY WITH STIFFNESS AND PAIN WITH LIMITATION AND GUARDING TO NECK FLEXION.
• KERNIG’S SIGN
• BRUDZINSKI’S SIGN
• IRRITABILITY AND DISCOMFORT WITH BRIGHT LIGHT
• Altered consciousness

Question 13

Intracranial Pressure/Cerebral Edema/Brain Herniation

Answer 13

• Progressively decreasing levels of consciousness.
• Altered vital signs especially to BP and respiration.
• Headache
• Vomiting
• PUPILLARY CHANGES: IPSILATERAL DILATION, SLOWED REACTION TO LIGHT, PROGRESSION TO FIXED DILATED PUPILS (A poor prognostic sign).
• Progressive impairment to motor function.
• Seizure

Question 14

Spatial Relations: Figure Ground Discrimination

Answer 14

• Pick one item out from an array of items.

Question 15

Spatial Relations: Form Constancy

Answer 15

• Have patient pick out an item from an array of similarly shaped items but different sized sized objects.

Question 16

Spatial Relations: Spatial Relations

Answer 16

• Patient duplicates a pattern of two or three blocks.

Question 17

Spatial Relations: Position in space

Answer 17

• Have patient demonstrate different limb positions

Question 18

Spatial Relations: Topographical Disorientation

Answer 18

• Determine if the patient can navigate a familiar route on his or her own.

Question 19

Spatial Relations: Depth and Distance Imperceptions

Answer 19

• Determine if patient can judge depth and distance (i.e navigate stairs and sit down in chair)

Question 20

Spatial Relations: Vertical Disorientation

Answer 20

• Determine if patient can accurately identify when something is upright.

Question 21

Muscle Tone

Answer 21

• PROM to assess muscle stretch reflexes and responsiveness to passive elongation.
• Limited resistance=Low tone/Flaccid
• Excessive resistance=High tone/Spastic

Question 22

Muscle Tone: Flaccidity

Answer 22

• Absent tone

- Hypotonia: Decreased tone

Question 23

Muscle Tone: Flaccidity: LMN

Answer 23

• Low tone seen in segmental/LMN lesions to:

- Nerve roots and peripheral injury.

Question 24

Muscle Tone: Flaccidity: UMN

Answer 24

• Low tone seen in UMN lesion (spinal shock in SCI or cerebral shock in CVA).
• Characterized by decreased or or no resistance to PROM.

Question 25

Muscle Tone: Spasticity

Answer 25

- Seen in UMN lesions. - Check for varying resistance to PROM with varying speed (i.e velocity dependent tone) - Spasticity is distinguished from Rigidly via velocity dependent testing. If PROM resistance is velocity dependent it is classified as spastic, if not it is rigid.

Question 26

Muscle Tone: Rigidity

Answer 26

- Increased resistance to PROM that is independent of the velocity of movement. - Leadpipe=Uniform rigidity throughout the range of motion. - Cogwheel=Interrupted by a series of jerks.

Question 27

Muscle Tone: Opisthotonos

Answer 27

- Prolonged severe spasms causing head, neck, and heel to arch backwards. - Associated with meningitis, tetanus, epilepsy, and strychnine positioning.

Question 28

Muscle Testing: Myopathies and Neuropathies

Answer 28

- Myopathies=Typically proximal weakness | - Neuropathies=Typically see distal weakness of extremities

Question 29

Balance Testing: Sitting

Answer 29

- Maintaining a vertical posture with and without arm support.

Question 30

Balance Testing: Standing

Answer 30

- Feet apart, eyes open - Feet apart eyes closed - Feet together eyes open - Feet together eyes closed

Question 31

Balance Testing: Standing/Semi-Tandem

Answer 31

- Eyes open | - Eyes closed

Question 32

Balance Testing: Tandem Stance

Answer 32

- Eyes open | - Progress to eyes closed

Question 33

Single Leg Support

Answer 33

- Eyes open | - Eyes closed

Question 34

Balance Strategies: Ankle Strategy

Answer 34

- Ankle muscles and leg/foot proprioception used to maintain balance.

Question 35

Balance Strategies: Hip Strategy

Answer 35

- Hip and lower trunk muscles maintain balance by shifting center of mass/using hip motions.

Question 36

Balance Strategies: Stepping Strategy

Answer 36

- Rapid steps used to realign COM with BOS.

Question 37

Gait: Ataxia: Polyneuropathy

Answer 37

- Ataxic gait typically improved by looking down

Question 38

Gait: Ataxia: Cerebellar Disorder

Answer 38

- Ataxic gait associated with postural and limb intention tremor - NOT typically improved by looking down

Question 39

Gait: Ataxia: Cervical Myelopathy

Answer 39

- Ataxic gait if dorsal columns involved | - Patients may also demonstrate spasticity related deformities if corticospinal tracts are compressed.

Question 40

Gait: Hemiplegic

Answer 40

- Slow and asymmetrical - Decreased stance time - Decreased push off - Stroke affected UE and LE move as a unit instead of as a dissociated arm and leg swing

Question 41

Gait: Festinating/Parkinsonian

Answer 41

- Characterized by freezing with initiation/termination and short rapid steps once gait starts.

Question 42

Gait: Myopathic Gait

Answer 42

- Pelvic girdle and proximal muscle weakness results in hyper lordosis and compensated Trendelenberg on weight bearing limb.

Question 43

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Answer 43

Hemorrhagic Stroke