Week 4 - Neurological Assessment Flashcards
(88 cards)
1
Q
Central Nervous System (CNS)
A
brain and spinal cord
2
Q
Meninges
A
protective layer over the CNS
3
Q
Cerebrospinal fluid
A
clear fluid around brain and spinal cord (for cushioning protection)
4
Q
Peripheral Nervous System (PNS)
A
12 cranial nerves, 31 spinal nerves and branches
Consists of:
- Sensory (afferent) messages to CNS
- Motor (efferent) messages from CNS
5
Q
Cerebral Cortex
A
CNS
Outer-layer of nerve bodies and cells, divided into right and left hemispheres (and 4 lobes)
Area of highest functioning (memory, reasoning, sensations, voluntary movement)
6
Q
Basal Ganglia
A
CNS
- Deep in hemispheres, associated with motor system
- Automatic, involuntary movements (e.g., arm swing when walking)
7
Q
Thalamus
A
CNS
- “relay station”
- Relays sensory information from the body to the cortex
8
Q
Hypothalamus
A
CNS
- “command centre”
- Controls temp, HR, BP, regulates sleep
- Houses pituitary gland producing many directive hormones
- Under autonomic control (unconscious bodily functions)
9
Q
Cerebellum (6)
A
CNS
- At base of brain
- Motor coordination of voluntary movement
- Equilibrium
- Muscle tone
- Operates on unconscious level
- Adjusts/corrects voluntary movements to coordinate and smooth them
10
Q
Brain stem (in central core)
A
CNS
Consists of:
- Midbrain
- Pons
- Medulla
- Many fibre tracks relaying -information to-from brain
- Plays a role in autonomic control as well
11
Q
Spinal Cord
A
CNS
- Continuous from brain stem into L1-L2
- Major pathway for all ascending/descending tracts
12
Q
4 Lobes of the Cerebral Cortex
A
- Frontal Lobe
- Temporal Lobe
- Parietal Lobe
- Occipital Lobe
13
Q
Frontal Lobe
A
Personality, behaviour, emotional, intellectual functioning
- Location of Broca’s Area (motor speech)
14
Q
Temportal Lobe
A
Auditory, taste, smell
- Location of Wernicke’s Area (language comprehension)
15
Q
Parietal Lobe
A
Primary sensory area
16
Q
Occipital Lobe
A
Visual
17
Q
Broca’s Area
A
- In Frontal Lobe
- Regulates motor component of speech
- If damaged, results in “expressive aphasia”
18
Q
Wernicke’s Area
A
- In Temporal Lobe
- Processes language comprehension
- damaged, causes “receptive aphasia”
19
Q
Expressive Aphasia
A
Motor component of talking is impaired, can’t say what they want to say
20
Q
Receptive Aphasia
A
Can hear but not understand language
21
Q
Sensory Pathways of the CNS
A
Ascending (send info to the brain)
- Spinothalamic tract
- Posterior (dorsal) column
22
Q
Spinothalamic tract
A
Ascending sensory pathway of CNS
Responsible for:
- Pain
- Temperature
- Light (crude) touch
23
Q
Posterior (dorsal) column
A
Ascending sensory pathway of CNS
Responsible for:
- Proprioception
- Vibration
- Stereognosis (ability to identify an object without looking)
24
Q
Motor Pathways of CNS
A
Descending (sending info from brain to periphery)
- Corticospinal (Pyramidal) Tract
- Extrapyramidal Tract
- Cerebellar System
25
Corticospinal (Pyramidal) Tract
Descending sensory pathway of CNS
Responsible for:
- Skilled, purposeful voluntary movement
26
Extrapyramidal Tract
Descending sensory pathway of CNS
Responsible for:
- Muscle tone
- Gross body movements
27
Cerebellar System
Descending sensory pathway of CNS
Responsible for:
- Coordinates movement
- Maintains equilibrium
- Posture
28
Upper Motor Neurons
- Are Descending neurons
- Located in CNS
- Influence Lower Motor Neurons (LMN)
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Lower Motor Neurons (LMN)
- Located in Peripheral Nervous System (PNS)
| - Final pathway
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Example of Upper Motor Neuron Disorder
Stroke
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Example of Lower Motor Neuron Disorder
Spinal lesion
32
Peripheral Nervous System (PNS)
Peripheral nerves are both afferent and efferent, and carry input to the CNS
PNS consists of:
- 12 Cranial Nerves
- 31 pairs of spinal nerves
- Dermatomes
- Reflex arcs
- Autonomic Nervous System
33
12 Cranial Nerves
```
I: Olfactory
II: Optic
III: Oculomotor
IV: Throclear
V: Trigeminal
VI: Abducens
VII: Facial
VIII: Acoustic
IX: Glossopharyngeal
X: Vagus
XI: Spinal Accessory
XII: Hypoglossal
```
3 Sensory
4 Motor
5 Mixed
34
Olfactory Nerve
CN: I
Type: Sensory
Function: Smell
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Optic Nerve
CN: II
Type: Sensory
Function: Vision
36
Oculomotor Nerve
CN: III
Type: Mixed
Functions:
- Motor: Extra-ocular movement (e.g., eyelids)
- Sensory: pupil constriction, lens shape
37
Trochlear Nerve
CN: IV
Type: Motor
Function: Down and inward movement of the eye
38
Trigeminal Nere
CN: V
Type: Mixed
Functions:
- Motor: muscles of mastication
- Sensory: sensation of face, scalp, cornea, mucous membranes of mouth/nose
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Abducens Nerve
CN: VI
Type: Motor
Function: Later movement of the eye
40
Facial Nerve
CN: VII
Type: Mixed
Functions:
- Motor: facial muscles, closing eyes, labial speech, closing mouth
- Sensory: taste on anterior two-thirds of the tongue
- Parasympathetic: saliva and tear secretion
41
Acoustic Nerve
CN: VIII
Type: Sensory
Function: Hearing and equilibrium
42
Glossopharyngeal Nerve
CN: IX
Type: Mixed
Functions:
- Motor: pharynx (phonation and swallowing)
- Sensory: taste on posterior 1/3 of tongue, pharynx (i.e., gag reflex)
- Parasympathetic: parotid gland, carotid reflex
43
Vagus Nerve
CN: X
Type: Mixed
Functions:
- Motor: pharynx and larynx (talking and swallowing)
- Sensory: general sensation from carotid body, carotid sinus, pharynx, viscera
- Parasympathetic: carotid reflex
44
Spinal accessory nerve
CN: XI
Type: Motor
Function: Movement of trapezius and sternomastoid muscles
45
Hypoglossal nerve
CN: XII
Type: Motor
Function: Movement of tongue
46
4 types of reflexes
1. Deep Tendon Reflexes (DTR)
2. Superficial Reflexes
3. Visceral Reflexes
4. Pathologic Reflexes
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Example of Deep Tendon Reflex
Reflex hammer
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Example of Superficial Reflex
Corneal Reflex
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Example of Visceral Reflex
Pupillary response to light
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Example of Pathalogic reflexes
Unexpected reflexes with underlying nervous damage
51
Reflex Arc
Afferent signal and motor response. Body reacts prior to cognition as a way of preventing injury.
52
NS Developmental Considerations for Infants (5)
- Brain and NS are immature at birth, not fully developed
- Dramatic growth and development of neurological system during 1st year of life
- Initially, movements directed primarily by primitive reflexes
- As cerebral cortex develops more, these more primitive reflexes become inhibited
- If these reflexes persisted beyond a particular length of time, there would be concern about an underlying neurological disorder
53
Sensory and Motor System development in infants
Develops during process of myelinization of the neuron:
- Cephalocaudal (head to toe) and proximal to distal (middle of body to periphery) order
E.g., first head and neck, then trunk, then control of extremities to crawl and walk
- Develops from simple to complex to coordinated
54
NS Developmental Considerations for Older Adults (4)
1. General atrophy/loss of neurons in brain and spinal cord (15% decrease by age 90)
2. Decrease in velocity of conduction in cranial/spinal nerves due to 10% decreased myelin)
3. Motor systems atrophy (slowing down of movement and reaction times)
4. Slowing of processing times, but cognitive function remains the same in the absence of neurodegenerative disorders
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Complications of neural atrophy in older adults
- Loss of neurons in brain stem, cerebellum, cerebral cortex = impaired fine coordination and agility, correction, and balance.
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Complications of decreased cranial/spinal nerve conduction in older adults
- Slows reaction time in some individuals due to delay in synapse time
- Sensory changes (decreased taste, smell, pain perception)
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Complications of motor system atrophy in older adults
- Result of progressive decreased cerebral blood flow and oxygenation
- May cause dizziness, loss of balance
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Components of subjective neurological assessment
PQRSTU-AAA:
1. Headache
2. Head injury
3. Dizziness and vertigo
4. Seizures
5. Tremors
6. Weakness
7. Coordination/balance
8. Numbness or tingling
9. Difficulty swallowing
10. Difficulty speaking
11. Significant past history/family history
12. Environmental and occupational hazards
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Objective vertigo
Sensation that room is spinning but person is still
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Subjective vertigo
Sensation that person is spinning but room is still
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Dysphagia
Difficulty swallowing
62
Paraesthesia
numbness/tingling
63
Dysarthria
Difficulty forming words, muscles used for speech are weakened
(complication in Broca's Area)
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Dysphasia
Difficulty with language comprehension or expression
| complication in Wernicke's Area
65
Examples of significant neurological past and family history (5)
- Stroke
- Alzheimer's, dementia
- spinal cord injury
- concussion
- meningitis
66
Examples of occupational hazards affecting neuro health (4)
- Chemical exposures, like lead
- Alcohol, drug, substance use
- Inadequate sleep or nutrition
- New medications
67
Components of Physical Examination/Objective Assessment Sequence of completion (4)
1. Cranial nerves (group together as much as possible)
2. Motor system
3. Sensory system
4. Reflexes
68
Assessment of Olfactory Nerve
CN I - Sensory
Assess:
1. Patency:
- Ask patient to occlude a nostril, sniff, and repeat on the other side.
2. Sense of smell:
- Close eyes, occlude nostril, present smell, ask them to say when they smell something and tell us what the smell is
69
Assessment of Optic Nerve
CN II - Sensory
Assess:
1. Visual Acuity: Snellen Chart
2. Visual fields (peripheral vision): Confrontation test
3. Fundus
70
Assessment of Oculomotor, Trochlear, and Abducens nerves
CN II, IV, VI - Mixed, Motor, Motor
Assess:
1. Palpebral fissures (eyelids)
- Symmetry
- Ptosis (drooping)
2. Pupils
- PERRLA: Pupils Equally Round Reactive to Light Accommodation
3. Eye Movements
- "Extra-occular movement" = unexpected
- Nystagmus (oscillating of the eye, wiggling in place… injury to cerebellum and brain stem)
71
Assessment of Trigeminal nerve
CN V - Mixed
Sensory:
1. Assess light touch; assess corneal reflex only if necessary
2. Ophthalmic, maxillary, mandibular areas
3. Ask pt to tell you when they feel a piece of cotton
4. If unable to feel, then test corneal reflex (blink)
Motor:
1. Assess temporal and masseter muscles, lower jaw movement
2. Palpate muscles of mastication below the ears; assess for equal strength on both sides
72
Assessment of Facial nerve
CN VII - Mixed
Motor:
1. Assess mobility & symmetry with facial expressions
2. Ask client to smile, show teeth, squeeze eyes tight, puff cheeks - Look for symmetry
Sensory:
1. Assess anterior 2/3 of tongue sense of taste (when suspect injury to CN VII)
Parasympathetic:
1. Saliva and tear secretion
73
Assessment of Acoustic nerve
CN VIII - Sensory
1. Assess hearing acuity
- ability to hear regular conversation
- Whispered voice test: Occulde one ear, stand 2ft behind, whisper simple sentence and ask them to repeat it
74
Assessment of Glossopharyngeal and Vagus nerves
CN IX and X - Mixed
Motor:
1. Assess movement of pharynx
- Tongue blade, say "ahh", watch soft pallet and uvula move upward in midline
2. Assess for gag reflex (not routine)
- Stick tongue depressor into back of throat
Sensory:
- Difficult to assess posterior 1/3 of tongue sense of taste
75
Assessment of Spinal Accessory nerve
CN XI - Motor
Assess:
1. Neck muscles for size and strength
2. Movement of trapezial and sternal mastoid muscles
3. Turn face against resistance of your hand
4. Same with shoulders with equal strength on both sides
76
Assessment of Hypoglossal nerve
CN XII - Motor
1. Assess movement of the tongue (should be on midline) - “light, tight, dynamite”
2. Assessing strength of voice, enunciation
77
Components of Motor System Assessment (2)
1. Muscles
| 2. Cerebellar function
78
Assessment of muscles (4)
Part of the Motor System Assessment
Based on observation:
1. Move head-to-toe and assess major muscle groups
2. Assess for symmetry of size, strength, tone (passive ROM, move limb/joint for pt and note rigidity/resistance
3. Look for involuntary movement (ticks, tremors, twitches)
4 . Look for atrophy of muscle groups
79
Assessment of cerebellar function
Part of the Motor System Assessment
Balance tests:
1. Gait
2. Tandem walking (heel-to-toe)
3. Romberg test (stand with feet together and close eyes for 20s)
Coordination and Skilled Movements:
1. Rapid-alternating movements
2. Finger-to-finger test
3. Finger-to-nose test
4. Heel-to-shin test
80
Ataxia
uncoordinated/unsteady gait
81
Components of Sensory System Assessment (2)
1. Spinothalamic Tract
| 2. Posterior Column Tract
82
Assessment of Spinothalamic Tract (3)
Part of Sensory System Assessment
1. Pain: random sites irregularly on body, poke with sharp and blunt tongue blade and to discriminate
2. Temperature
3. Light touch: cotton ball and ask them to tell us when they feel it
83
Assessment of Posterior Column Tract (3)
Part of Sensory System Assessment
1. Vibration: use tuning fork and place vibrating end on bony prominence on pt, ask them to tell us when they feel vibration and when it stops
2. Position (kinesthesia):
3. Fine touch (tactile discrimination)
- Stereognosis: recognition of objects when eyes are closed (pen, paper clip)
- Graphesthesia: ask pt to close eyes, draw letter or number on hand
- 2-point discrimination: ability to decipher two simultaneous pinpricks on the skin and the ability to determine if it's two or one point (use paperclip)
84
Stereognosis
Recognition of objects when eyes are closed (pen, paper clip)
Part of fine-touch, assessment of posterior column tract
85
Graphesthesia
Ask pt to close eyes, draw letter or number on hand
Part of fine-touch, assessment of posterior column tract
86
Deep Tendon Reflex Testing
Test the reflex arc at a specific spinal level
- Biceps (C5-C6)
- Triceps (C7-C8)
- Brachioradialis (C5-C8)
- Quadriceps (patellar, knee jerk) (L2-L4),
- Achilles (L5-S2)
87
Superficial Reflex Testing
Sensory receptors in the skin rather than muscles
88
Deep Tendon Reflex grade
```
+4 = Very brisk, hyperactive with clonus (rapid, rhythmic contraction of muscle)
+3 = Brisker than average
+2 = Average, normal
+1 = Diminished, low normal
0 = No response
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