SS stuff Flashcards
What do we assess during mental status screening?
- Take a thorough history
- Observe physical appearance and behavior
- Investigate cognitive functioning
- Observe speech and language
- Evaluate emotional stability
What tools are used to screen for cognitive function?
- Mini-Cog (give 3 words, draw clock, then ask to recall words; abnormal clock or inability to recall = impaired)
- 6CIT – 6 item Cognitive Impairment Test
- MMSE - Mini Mental State Examination
- SLUMS – St. Louis University Mental Status Examination
- Montreal Cognitive Assessment
When testing a myotome, how many seconds does the patient have to hold the position?
5 seconds
How should you test for spasticity?
Passive motion and speed up as you go
- If testing a muscle that primarily flexes a joint, place the joint in a maximally flexed position and move to a position of maximal extension over one second (count “one thousand one”)
- Compare right/left and upper/lower
What would a 0 on the modified ash worth scale indicate?
No increase in muscle tone
What would a 1 on the modified ash worth scale indicate?
Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension
What would a 1+ on the modified ash worth scale indicate?
Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
What would a 2 on the modified ash worth scale indicate?
More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
What would a 3 on the modified ash worth scale indicate?
Considerable increase in muscle tone, passive movement difficult
What would a 4 on the modified ash worth scale indicate?
Affected part(s) rigid in flexion or extension
How do you test for coordination?
- Rapid rhythmic alternating movements
- Alternate turning palms up/down on lap or alternate PF/DF
- Alternative test: touch thumb to each finger and back on the same hand
- Increase speed gradually - Accuracy of movement
- Finger-to-nose test or alternate finger-to-nose test
- Alternative test: heel-to-shin test - Impairments may indicate cerebellar disease
How do you test for balance?
- Equilibrium
- Romberg test
- 4 Stage Balance test - Gait
- Observe the expected gait sequence, noting simultaneous arm movements and upright posture
- Heel-toe walking
What is the 4 stage balance test?
- stand with feet side by side
- place instep of one foot so it is touching the big toe of the other foot
- place one foot in front of the other, heel touching toe
- stand on one foot
(5. hopping of one foot)\
- first three should be able to be done for 10s to be normal
- last should be done for at least 5s
What is the Romberg test
Standing with feet side by side with eyes closed
- slight sway is normal
- points to loss of vestibular function or proprioception
- cerebellar will be unsteady with eyes open
What are the superficial sensations to be tested?
- Light Touch
- Pain (sharp/dull)
- Temp
- Pressure
What are the deep sensations to be tested?
- Position sense
- Kinestesia
- Vibration
How do you test position sense?
- Move a distal joint up/down/in/out
2. Ask patient to describe the position at end range
How do you test kinesthesia?
- Move a distal joint up/down/in/out very slowly
- Pt recognizes while your moving - Ask patient to describe the position while you are moving
What are the combined (cortical) sensations to be tested?
- Stereognosis
- Two point discrimination
- Extinction phenomenon
- Graphesthesia
- Tactile localization (often tested with light touch)
How do you test extinction phenomenon?
- Simultaneously touch 2 areas on each side of the body
2. Ask patient to tell how many stimuli are felt
How should interpretation of monofilament testing be interpreted?
- 17 monofilament = 1 gram pressure = decreased sensation
- 07 monofilament = 10 grams pressure = loss of protective sensation
- 10 monofilament = 75 grams of pressure = absent sensation
How do you test CN III, IV, and VI?
Oculomotor, Trochlear, Abducens
- opening of eyelids
- pupillary reflex - pupil constricts in response to light
- consensual reflex - pupil constricts in response to light in other eye
- accommodation-convergence reflex - pt follows finger as it is brought toward nose (pupils should constrict)
- extraocular movement testing - letter ‘H’
How do you test CN V?
Trigeminal
- Light touch sensation to the entire face with pts eyes closed
- pt bites down hard and palpate master muscle
- Corneal reflex
How do you test CN VII?
Facial
- Crease up the forehead
- Keep eyes closed against resistance
- Reveal the teeth
- Puff out cheeks
