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NMS > Clinical Examination of Proprioception > Flashcards

Clinical Examination of Proprioception Flashcards

1
Q

Specific modalities of sensation are carried in the ______________ of the cord.

A

Posterior columns

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2
Q

Specific modalities carried in the posterior columns of the cord

A
  • Position sense
  • Vibration
  • Pressure
  • Texture movement
  • Localization of touch
  • 2 point discrimination
  • Weight
  • Ability to decipher letters or numbers written on the skin
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3
Q

Best tool used to evaluate vibration sense

A

128 or 256 Hz tuning fork

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4
Q

How to test vibration sense in a patient.

A
  • Have patient close their eyes and instruct them that you are going to place the tuning fork on their angle and to describe what they feel
  • Patient should report a “buzzing” or “vibration feel”
  • Should they report nothing, move to the knees.
  • Should they still feel nothing, move to the hip
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5
Q

Loss of vibratory sensation

A

Pallanesthesia

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6
Q

Romberg Test

A
  • Patient stands erect , looking straight ahead, first with eyes open
  • Patients feet are approximated
  • Doctor stands near the patient
  • Patient then closes his or her eyes and stands erect
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7
Q

Normal and abnormal findings for Romberg Test

A 
Normal = patient maintains posture and has little or no swaying
Abnormal = patient takes a step to maintain posture or the patient falls.
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8
Q

If a patient falls during the Romberg test with their eyes open, what does that indicate?

A

Cerebellar defect and/or Vestibular Mechanism Defect

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9
Q

If a patient falls during the Romberg test with their eyes closed, what does that indicate?

A

Dorsal column pathology

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10
Q

Test requires intact function of the nervous system. The long motor and sensory tracts, cerebellum, basal ganglia, and peripheral nerves.

A

Hopping on one foot

Squatting on one foot

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11
Q

Hopping on one foot test

A

Patient hops on one leg with eyes open and closed and then hops on the other leg with eyes open and closed

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12
Q

Normal and abnormal findings for Hopping on one foot test

A 
Normal = patient maintains posture with eyes open and closed
Abnormal = patient takes a step to maintain posture of the patient falls
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13
Q

If a patient has an abnormal findings with the Hopping on one foot test with their eyes open and closed, what does this indicate?

A

Cerebellar defect and/or Vestibular Mechanism Deficit

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14
Q

If a patient has an abnormal finding with the Hopping on one foot test with their eyes closed only, what does this indicate?

A

Dorsal column pathology

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15
Q

Good test to find minor weakness in the lower extremities

A

Squatting on one foot

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16
Q

Squatting on one foot

A

Patient squats on one leg with eyes open and closed and then squats on the other leg with eyes open and closed

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17
Q

Normal and abnormal findings for squatting on one foot

A 
Normal = Patient maintains posture with eyes open and closed
Abnormal = Patient takes a step to maintain posture or the patient falls
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18
Q

If a patient fails Squatting on one foot with their eyes open and closed, it indicates a :

A

Cerebellar deficit or Vestibular mechanism deficit

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19
Q

If a patient fails Squatting on one foot with eyes closed only, this indicates a:

A

Dorsal column pathology

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20
Q

Finger to Nose test

A

Patient has his or her arms straight out to the side and attempts to touch the tip of his or her finger bilaterally with eyes open and closed.

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21
Q

Normal and abnormal findings for Finger to Nose test

A 
Normal = Should see smooth and accurate movement
Abnormal = Uncoordinated movement and/or inaccuracy in measuring distance
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22
Q

Uncoordinated movement

A

Dyssynergia

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23
Q

Inaccuracy in measuring distance

A

Dysmetria

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24
Q

Finger to Finger Test

A

Patient has his or her arms straight out to his or her side and attempts to touch the tips of their index fingers together, straight out in front of them, with eyes open and closed

25
Q

Normal and abnormal findings for Finger-to Finger test

A 
Normal = Should see smooth and accurate movement 
Abnormal = Dyssynergia and/or Dysmetria
26
Q

Only proprioceptive test done with only the eyes open

A

Finger to Nose to Finger Test

27
Q

Finger to Nose to Finger Test

A

The Dr. stands with his finger about 2 feet from the patient and has the patient alternate touching his or her finger from his or her nose to the doctor’s finger with the doctor changing finger positions constantly

28
Q

Normal and abnormal findings for Finger to Nose to Finger test

A 
Normal = should see smooth and accurate movement
Abnormal = Dyssynergia only
29
Q

Heel to Shin test

A

Patient attempts to run his heel from one side down the anterior shin from the knee to the ankle of the opposite leg. This is performed bilaterally with eyes open and closed.

30
Q

Normal and abnormal findings of Heel to Shin test

A 
Normal = Should see smooth and accurate movement
Abnormal = Dyssynergia and Dysmetria
31
Q

Testing for the ability to perform rapid alternating movements

A

Patting knees rapidly, tapping forefinger to thumb, pronation/supination of the hands performed with eyes open and closed

32
Q

Normal and abnormal findings for Testing the ability to perform rapid alternating movements

A 
Normal = performing actions properly 
Abnormal = Inability to perform actions properly
33
Q

Performing actions properly

A

Diadochokinesia

34
Q

Performing actions improperly

A

Dysdiadochokinesia

35
Q

What does Dysdiadochokinesia indicate?

A

Possible cerebellar dysfunction

36
Q

Holmes Rebound Phenomenon

A

Patient contracts the flexors of the forearm against resistance by the doctor. The doctor releases the arm quickly. This is performed with eyes open and closed

37
Q

Normal and Abnormal findings of the Holmes Rebound Phenomenon

A 
Normal = should see a "check reflex"
Abnormal = Dyssnergia and/or Dysmetria
38
Q

Tandem Gait

A

Person walk along a straight line on the floor by placing one heel directly in front of the opposite toe with the eyes open and closed

39
Q

Normal and abnormal findings for Tandem Gait

A 
Normal = Patient is able to perform both tasks with eyes open and closed
Abnormal = dyssynergia and/pr dysmetria
40
Q

Joint Position Test

A

Dr. examines one digit of the patients hand or foot by stabilizing the hand and/or foot and grabbing a single digit from the sides and flex or extend that digit without placing any pressure on the top or bottom of the digit. Ask the patient to inform you whether you are moving the toe or finger up or down. This is performed with eyes closed

41
Q

Abnormal findings of the Joint Position Test

A

Patient cannot determine accurately whether his finger or toe is being moved up or down

42
Q

What would an abnormal finding on the Joint Position Test indicate?

A

Possible posterior column disease

43
Q

Abadie’s sign

A

Pinching the Achilles tendon

44
Q

Pitres’ sign

A

Pinching the testicles

45
Q

Biernacki sign

A

Pinching or striking the ulnar nerve

46
Q

Besides the Achilles tendon, testicles, and ulnar nerve, where can deep pain also be tested by placing pressure on?

A

Eyeballs

47
Q

When any of the signs (Abadie’s, Pitres’, Bernacki, or eyeball pressure) are diminished, this indicates what pathology?

A

Posterior column disease (Tabes dorsalis is the classic example)

48
Q

Combination of both superficial and deep sensations which are then subject to integration with higher cortical functions and memory.

A

Multimodal sensations

49
Q

Examples of multimodal sensations

A 
Stereognosis
Barognosis 
Topognosis
Graphognosis 
2-point discrimination
50
Q

May be assessed by placing a common object (pin, cap, key, button, etc.) in the patients hands with their eyes closed. Patient should be able to identify the object within a few seconds without switching hands

A

Stereognosis

51
Q

Patient assesses the relative weight of similarly sized and shaped objects that have different weights

A

Barognosis

52
Q

Touch the patient somewhere on the skin and have him or her point to the area just touched

A

Topognosis

53
Q

Test the patient by writing a letter or number on their chest, back or palm of the hand and have them identify it

A

Graphognosis

54
Q

Is determining at which point a patient can determine 2 objects separate from one another

A

2 point discrimination

55
Q

2 point discrimination varies depending on the location on the body. For example, normal ranges for the finger tips are _____mm while the dorsum of the fingers are ____mm, the palm of the hands ____ mm, and the dorsum of the hand up to ____mm

A

Tips = 2-4 mm
Dorsum fingers = 4-6 mm
Palm = 8-12 mm
Dorsum hand = 20-30 mm

56
Q

This is the ability for the patient to know a body part is his own body part.

A

Somatognosis

57
Q

Test for Somatognosis

A

Placing your arm next to the patient’s arm and askin him to “touch your arm with your finger”

58
Q

The ability for the patient to know that he is ill

A

Nosognosis

59
Q

Test for Nosognosis

A

In light of overwhelming and obvious evidence of neurological disease such a hemiplegia, the patient will deny that there is a problem

NMS (16 decks)

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