Chapter 15: Neurological Flashcards
Achilles
reflexive action that jerks the ankle when the achilles tendon is tapped with the foot dorsiflexed
Babinski
reflexive action of the big toe when the foot’s sole is stimulated
Brachioradialis Reflex
caused by striking the brachioradialis tendon at the base of the wrist into the radial styloid process
Biceps Reflex
reflex contraction of the biceps brachii used to assess the C5 and C6 reflex arcs
Clonus
neurological condition causing involuntary muscle contractions
Cranial Nerves I-XII
twelve nerves assessed in a neurological exam to ensure appropriate sensory and motor issues
Dermatome
skin area that is mainly supplied by a single spinal nerve
Dysphagia
difficulty in the oral or pharyngeal phases of swallowing
Dysphasia
partial or complete inability to communication, resulting from a brain injury
Gait
coordinated action of the neuromuscular system and musculoskeletal systems that allow walking
Gag Reflex
reflexive action causing a cough or gag when each side of the back of the throat is touched
Graphesthesia
ability to recognize writing on the skin by onlu touch
Moro
protective response to a quick disruption of body balance; tested in infants by pulling up on the arms of an infant in the supine position
Palmar Grasp
grasp pattern in infants when pronated hand on an object causes the fingers to curl around the object
Patellar Reflex
kicking reflex caused when the knee joint is stimulated
Plantar Grasp
reflex action in some newborns; a stroke beneath the toe bed and pressured applied causing a curling reflex
Reflexes
automatic muscle reaction when stimulus is applied
Rooting
involuntary reflex where infant turns head when the corner of the mouth is stimulated
Romberg Test
test of balance and ability to maintain upright posture
Stereognosis
ability to identify the shape of a 3D object by only tactile manipulation
Sucking
reflexive action when a finger or nipple is placed near an infant’s mouth
Triceps Reflex
automatic contraction of the triceps brachii muscle when stimulated
Cranial Nerve I
Olfactory nerve (sensory)
- sense of smell
Cranial Nerve II
Optic nerve (sensory)
- ability to see
Cranial Nerve III
Oculomotor Nerve (motor)
- ability to move and blink your eyes
Cranial Nerve IV
Trochlear Nerve (motor)
- controls superior oblique muscle
- moves eye down, or back and forth (side to side)
Cranial Nerve V
Trigeminal Nerve (sensory and motor)
- Ophthalmic: sends sensory info to upper face (forehead, scalp)
- Maxillary: sends sensory info to middle of face (cheeks, upper lip, nasal cavity)
- Mandibular: (both motor and sensory) sends sensory info to lower face and moves jaw and ear
- Sensations in your face and cheeks, taste and jaw movements
Cranial Nerve VI
Abducens Nerve (motor nerve)
- controls the lateral rectus muscle
- ability to move your eyes
Cranial Nerve VII
Facial nerve (sensory and motor)
- facial expressions and sense of taste
Cranial Nerve VIII
Auditory/Vestibular Nerve (sensory)
- sense of hearing and balance and coordination
Cranial Nerve IX
Glossopharyngeal nerve (sensory and motor)
- ability to taste and swallow
Cranial Nerve X
Vagus Nerve (sensory and motor)
- Digestion and heart rate
Cranial Nerve XI
Accessory Nerve (motor)
- shoulder and neck muscle movement
Cranial Nerve XII
Hypoglossal Nerve (motor)
- Ability to move your tongue
What is mental status ?
the degree of competence that a person shows in intellectual, emotional, psychological and personality functioning
What questions do we ask to ensure the patient is alert and oriented ?
- For client’s name (last orientation to be lost)
- Where he or she is (second orientation to be lost)
- Ask the date (first orientation to be lost)
- what is happening (situation)
Lethargic
aroused by saying their name and touching them
- once aroused they respond appropriately but return to “sleep” once stimuli cease
Obtunded
require louder verbal stimuli and vigorous shaking to prompt a response
- they carry out requests while awake but return to “sleep” when stimuli ceases
Stuporous
require painful stimuli to respond
- response is usually withdrawal from pain
Semicomatose
require painful stimuli and respond with abnormal flexion or extention
Comatose
does not respond to any stimuli, even central pain
What is the test we perform for balance ?
Romberg test
What determines consciousness ?
awareness, arousal, and cognition
What is the scale of the Deep Tendon Reflexes ?
0: no response
1+: sluggish or diminished
2+: active or expected response (normal)
3+: more brisk than expected, slightly hyperactive
4+: brisk, hyperactive, with intermittent or transient clonus
What is clonus ?
involuntary, rhythmic muscular contractions and relaxations
What are some reasons for hyperactive reflexes ?
- spinal cord injuries
- calcium and magnesium deficits
- hyperthyroidism
What are some reasons for diminished reflexes ?
- calcium or magnesium excesses
- hypothyroidism
- spina bifida
- guillain barre syndrome
What does a positive babinski look like ?
the big toes bends up and the other toes fan out
- normal in kids younger than 2 yrs old
Aphasia
defective, or absent, language function
Dysphagia
difficulty swallowing
Receptive/Fluent Aphasia
inability to comprehend the speech of others, spoken words are logical
- Wernicke’s Asphasia: temporal lobe
Expressive/Non-Fluent Aphasia
inability to communicate or express ideas as meaningful speech
Dysphasia
speech impairment
What does a normal/negative babinski look like ?
toes curl down (flex)
- normal in kids older than 2 yrs old
What is the expected age range for the Moro Reflex ?
- birth to 1-4 months
Tonic Neck Reflex
- birth/6 wks to 4-6 months
- move head to side with arm/leg extended
- they will extend on the side where their head is turned and the opposite side is flexed
What are abnormal findings in toddlers and children ?
- spasticity
- paralysis
- impaired vision, speech or hearing
- inattention, motor restlessness and easy distractibility may indicate ADHD
What are expected findings in older adults ?
- slowed responses
- move more slowly
- decline in function
- deviation of gait from midline
- difficulty with rapidly alternating movements
- some loss of reflexes and sensation
What are abnormal findings in older adults ?
- resting tremor of the hands that is reduced with purposeful movement
- dizziness or vertigo
- hemiparesis of upper or lower extremities (weakness/mild loss of strength)
What is Multiple Sclerosis ?
progressive demyelination of nerve fibers of brain and spinal cord
- typical onset between 20-50 yrs; higher risk among women
- clinical findings depend on the area of affected CNS
Symptoms:
- fatigue
- depression
- paresthesia
- ocular changes
- gait instability
- bowel/bladder dysfunction
What are Spinal Cord Injuries (SCI) ?
caused by traumatic disruption of spinal cord
- Cervical SCI: quadriplegia, tetraplegia
- Thoracic and Lumbar SCI: paraplegia
- Clinical Findings: complete SCI vs incomplete SCI
What are Head Injuries ?
in injury or trauma to the scalp, skull, or brain
- Open Head Injury: d/t fractures or penetrating wounds
- Closed Head Injury: d/t blunt trauma (concussion or confusion)
- Clinical Findings: depend on severity of the trauma and areas of brain involved
What is Parkinson Disease ?
a chronic, progressive movement disorder
- results from degeneration of dopamine-producing neurons
What is a Cerebrovascular Accident (Stroke) ?
occurs when brain cells die from ischemia
- results from thrombus, embolus, or hemorrhage
- clinical findings vary depending on area of the brain involved and extend of ischemic area
Symptoms:
- motor impairments
- bowel and bladder dysfunction
- speech and swallowing difficulties
What is the acronym for Cerebrovascular Accident (stroke) ?
ACT FAST
- facial drooping
- arm weakness
- speech difficulty
- time to call 911
What is one of the earliest and most sensitive indictors in alternations in cerebral function ?
change in LOC
What is 2-point discrimination ?
touch with 2 points; patient states if 1 or two pokes felt at the same time
What is extinction ?
impairs ability to percieve multiple stimuli at the same type simultaneously
- touch both sides of the boy with paperclip at same time
- patient states how many touches were felt
What can a compression of the nerve cause ?
absence of sensation
What is consciousness ?
awareness, arousal and cognition
Which people are at most risk for skin breakage like pressure ulcers ?
people with diminished/loss of sensation
- like older adults
When is the expected age for the Palmar Grasp ?
birth to 3-4 months
- can reemerge after a brain injury and sometimes it can cause the family of the patient to think they are doing it voluntarily and that means they’ll be okay but instead it’s a reflexive action
What does the frontal lobe do ?
- motor decision making (impulse control)
- personality
What does the temporal lobe do ?
- hearing
What does the parietal lobe do ?
sensory
- touch, shape, and taste
What does the cerebellum do ?
balance and coordination
What is Wernicke’s area and in which lobe is it in ?
concerned with comprehension of language
- in temporal lobe
- damage to this area causes you to speech fluently but can’t understand or use basic nouns
What is Broca’s area and in which lobe is it in ?
concerned with speech and language production
- frontal lobe
What assessment test can we perform to assess for peripheral nervous sensory function ?
light touch sensation
What is the function of the occipital lobe ?
vision
