1.6 Flashcards
Paralysis vs. paresis
Paralysis - complete loss of muscular action
Paresis - muscle weakness or partial paralysis
3 sets of muscle groups regulated by motor regulation
- Distal musculature
- fingers and toes - Proximal musculature
- elbow and shoulder and lower extremity equivalent - Axial musculature
- spine
CNS area involved in planning
cerebral cortex
CNS area involved in command
motor cortex (motor strip)
CNS area involved in organizing muscle groups
basal nuclei
CNS area involved in adjustment
cerebellum
CNS area involved in associations
brainstem
CNS area involved in pathways
spinal cord
CNS area involved in final transmission
peripheral nerves
7 aspects of motor exam
- Muscle inspection and palpation
- Passive movement
- Rapid fine movement
- Muscle strength
- Deep tendon reflexes
- Coordination
- Balance and gait
Spasticity vs. rigidity
Spasticity: velocity related increase in tone
- hypereflexia
Rigidity: increased constant resistance to passive movement
- normal reflexes
Somatosensory modalities: 2 major sensory modalities
- Vibration, proprioception, fine touch (discriminative touch)
- Pain and temperature
Higher mental function neurological exam
- Mental status
- Executive function
- Attention
- Language
- Memory
- Visuospatial function
- Emotionality
3 questions of neurologic exam
- Is this a neurologic problem?
- organic vs. psychogenic - Where is the lesion?
- What is the pathophysiology? What is the etiology?
Tools for recording the neurologic H & P
History matrix
Localization matrix
Motor scales, strength, and DTRs
History matrix
Symptom timeline
Collateral factors/descriptors
Localization matrix
Enter a circle (◯) if the structure could be involved
Localization tips: muscle
weakness, atrophy
Localization tips: NMJ
weakness increases with exam
Localization tips: peripheral nerve
multiple modalities in area of one nerve
Localization tips: spinal cord
regional symptoms/signs (s/s), fit the distribution of a tract
Localization tips: brainstem
cranial nerve, consciousness, motor + sensory signs
Localization tips: deep white matter and lateral thalamus
hemimotor/hemisensory s/s
Localization tips: cortical lesions
complex processing
Localization tips: cerebellum
balance and coordination
Localization tips: basal nuclei
hemibody or bilateral, postural or voluntary control impaired
Fail safe
makes sure certain diagnoses are rules out
Muscle power grading scale
Grade 5 - normal strength
Grade 4 - relative to normal, but reduced muscle strength against resistance
Grade 3 - difficulty contracting against resistance
Grade 2 - visible movement gravity minimized
Grade 1 - visible muscle contraction but no movement
Grade 0 - no muscle contraction
Reflex response grading system
0+ no reflex
1+ decreased reflex
2+ normal reflex
3+ increased reflex
4+ abnormally brisk reflex with sustain clonus
The text uses the term “organic basis.” This means there is an identifiable anatomic or functional reason for the patient’s complaints. What are the features that would make a clinician suspect that there is no organic basis for the symptoms?
The features that would make one suspect that the symptoms are not organically based would be neurological symptoms, which, as the history taking progresses, shift from side to side, and a lack of consistent hard neurological findings.
