Week 1 Flashcards
(44 cards)
FOGS
-Assessing pt. cognitive status –> should be assessed at beginning to drive the rest of the eval
F = Family report of memory loss
O = Orientation to person, place, time
G = General info recall
S = Spelling (WORLD forward and backward, or counting task)
Components of the Neuromuscular Assessment
- cognitive assessment
- communication assessment
- cranial nerve assessment
- sensory assessment
- motor control assessment
- functional assessment
- coordination assessment
Aphasia
Impairment in Broca’s area (expressive language) or Wernicke’s area (receptive language)
-difficulty with spoken language, reading, writing, hand gestures/sign language
Dysarthria
Problems with the motor component of speech
-can’t articulate well, makes their speech slurred
Why assess cranial nerves?
- Allows examiner to localize brainstem dysfunctions
- May be affected by a wide range of conditions including trauma, infection, CVA, tumor, intracranial inflammation
- Dysfunction in certain CN may help to rule in or rule out certain diagnoses
- CN assessment is not necessary for all patients
3 Primary roles of sensation in movement
- Guide selection of motor responses for effective interaction with the environment via feedforward info
- Adapt movements and shape motor programs through feedback for corrective action
- Protect the organism from injury
- Assessment of sensation aids us in diff-dx as well as looking at sensory integrity
Deficits in sensory integrity result it..
poor motor planning, organization, and performance
Indications for sensory assessment
-Impaired locomotion
-Impaired joint mobility or integrity
-Impaired motor control/motor function
-Impaired muscle performance
-Impaired neuromotor development
-Impaired reflex integrity
-Impaired posture
-Impaired ventilation, respiration, circulation
Pain
What do we assess during sensory assessment?
- Afferent inputs
- Peripheral sensory processing –> superficial sensation, deep sensation, combined cortical
- Cortical sensory processing –> DCML and ALS
Combined cortical
- stereognosis: object recognition
- tactile localization
- two-point discrmination
- barognosis (recognition of weight)
- graphesthesia (identification of traced figure)
ALS
- crude touch: pain, temperature, tickle, itch, sexual sensation
- activated primarily by mechanoreceptors, thermoreceptors, nocioreceptors
- small, slow afferent fibers
- crosses over almost immediately in spinal cord
DCML
- discriminative, finely graded sensation, precise location
- large, rapidly conducting fibers
- ascends ipsilaterally to medulla, synapses, then crosses over
Deep Tendon Reflexes
- involuntary, predictable, specific
- ‘2’ is ‘normal’
- hyperreflexia may indicate UMN lesion
- hyporeflexia may indicate LMN lesion
DTR Grading Scale
0 = absent; no reflex response 1 = minimal response 2 = moderate response 3 = brisk, strong response 4 = clonus *grades of 1-3 are considered WNL for some patient, combined with other findings may indicate something more specific
Muscle tone
Resistance of a resting muscle to passive elongation or stretch
-3 main categories: hypotonicity, hypertonicity, and dystonia
Factors that contribute to normal muscle tone:
- physical inertia
- intrinsic mechanical-elastic stiffness of mm. and connective tissue
- active muscle contraction
Hypotonicity
- decrease in tone below resting level
- indicative of LMN lesion (could be in anterior horn, spinal nerves, peripheral nerves, or NMJ)
- flaccidity
- diminished DTRs
- fibrillations on EMG
- hyperextensibility or “floppy” limbs and joints
Hypertonicity
Increase in tone above resting levels
- 2 types: spasticity (clonus, clasp-knife); rigidity (cogwheel, lead pipe)
- indicative of UMN lesion (pyramidal pathways, cerebellum, or basal ganglia)
- abnormal timing
- paresis or plegia
- brisk DTRs, +Babinski
- dysynergic patterns of movement
Dystonia
Hyperkinesis due to CNS injury; Impaired or disordered tone that fluctuates in an unpredictable pattern
- repetitive involuntary movements: usually twisting or writhing
- periods of dystonic posturing (sustained abnormal postures caused by contractures of muscles that may last minutes, hours, or permanently
Coordination of movement
Ability to execute smooth, accurate, controlled motor responses
-requires coordinated effort of all the components of the motor system
Intralimb coordination
Using one UE to to brush the hair requires coordination at the shoulder, elbow, wrist, and fingers
Interlimb coordination
Integrated performance of two or more limbs working together- LEs/UEs during walking
Visual motor coordination
Integration of visual and motor activities with the environment to accomplish a goal (writing a letter, driving a vehicle)
-eye-hand coordination
Nonequilibrium coordination tests
address both static & mobile and gross & fine motor components of movement with the subject not attempting to maintain balance
