Exam 1: Examination (Lab) Flashcards
What components should you consider during a functional assessment?
Movement quality, components, and alignment
Ability to initiate, sustain, and terminate movement
Stages of motor control
How would you assess bed mobility?
Left, right, up, down, rolling, coming to sit
What should you consider when assessing ambulation?
Physical assistance, assistive device use, distance, speed, quality, stairs, ramps, curbs, indoors, outdoors
What are the primary superficial sensation tests?
Light touch, touch localization, pain, temperature
What are the deep, proprioceptive sensation tests?
Vibration, pain, position sense or static proprioceptive, passive movement sense or kinesthesia
How do you assess light touch sensation?
Materials: cotton ball
Explain the test and introduce the stimulus on an area with intact sensation and have the patient say “touch”. Have the patient close their eyes and touch areas of their extremities in a random order while varying speed
How do you assess touch localization?
Materials: cotton ball
Explain the test and introduce the stimulus on an area with intact sensation and have the patient point to where you touched them. Have the patient close their eyes and repeat the process having them open their eyes after every touch to identify the location
How do you assess superficial pain?
Materials: tongue depressor split in half
Explain the rest and introduce stimulus on an area with intact sensation and have the patient identify if it is sharp or dull. Have the patient close their eyes and touch their extremity with the dull and sharp side in a random order varying speed
How do you assess temperature sensation?
Materials: warm and cold test tubes
Explain the test and introduce warm and cold sensation on area with intact sensation and have patient identify if it is warm or cold. Have the patient close their eyes and touch their extremity with the warm and cold test tubes in a random order with varying speed
What is the ideal temperature for a cold stimulus?
41-50 F
What is the ideal temperature for a warm stimulus?
104-113 F
How do you assess vibration sensation?
Materials: tuning fork
Explain the test and introduce stimulus by hitting tuning fork and placing on bony prominence. Have patient close their eyes, and have them identify when the vibration either stops, or manually stop the tuning fork and have them say when they no longer feel the sensation
How long can a patient normally sense vibration when testing at the hand?
15-20 seconds
How long can a patient normally sense vibration when testing at the tibia?
7-10 seconds
How do you assess deep, proprioceptive pain?
Explain the test but do not tell the patient that you are looking for a negative response. Have the patient close their eyes and squeeze the muscle belly firmly
How do you assess position sense or static proprioception
Position the patient by making sure they have access to their entire ROM. Assess PROM of the involved extremity. Explain the purpose of the test and show the patient what the “up” and “down” position will be. Have the patient close their eyes and passively move their limb randomly and have the patient identify the stopping location. You need to assess all joints within the extremity.
How do you assess passive movement sense or kinesthesia?
Position the patient by making sure they have access to their entire ROM. Assess PROM of the involved extremity. Explain the purpose of the test and manually move the patient through random motions and have them mirror on the other side. Have the patient close their eyes and begin the assessment. The test limb is the one you are passively moving
What cortical and discriminatory sensations do we test?
Two-point discrimination, point localization, stereognosis, graphestheia, extinction phenomenon
How do you assess stereognosis?
Materials: variety of identifiable small objects
Explain the test and have the patient identify verbally the objects with their eyes open. Have the patient close their eyes and place the objects in their hand one at a time in a random order. Have the patient feel the object and identify it
How do document stereognosis?
Astereognosis or stereognosis intact
How do you assess graphesthesia?
Use your finger to write shapes, letters, or numbers in the patient’s hand. Begin with their eyes open to insure understanding, then administer the test with their eyes closed. Make sure to “erase” the surface between symbols
How do you assess extinction phenomenon?
Position patient in position where you are able to fully access their extremities. Explain the test and practice with their eyes open. Touch the extremity either on the same side or opposite sides with either one or two fingers and have the patient identify either one or two. Then perform the assessment with their eyes closed
What is hypometria?
Undershooting a target
What is hypermetria?
Overshooting a target
How to you assess dysmetria in the UE?
Finger to nose, finger to finger, finger to examiner’s finger, opposition. Perform each task first with eyes open then eyes closed. Increase speed as patient goes on
How do you assess dysmetria in the LE?
Great toe to examiner’s finger or target on floor, shin slide, heel to target. Perform each task first with eyes open then eyes closed
How do you assess diadokokinesia in the UE?
Supination and pronation
Wrist flexion and extension
Hand opening and closing
Start with movement at the same time and progress to alternating, then with eyes closed
How do you assess diadokokinesia in the LE?
Dorsiflexion and plantarflexion
Knee flexion and extension
Start with movement at the same time and progress to alternating, then with eyes closed
How do you assess rebound?
Have patient meet your resistance in midrange, then let go and observe response. Rebound is classified as an exaggerated response
What are the components of a motor system exam?
Tone, involuntary movements, strength, power, endurance
What are the differences between reflexive tone assessment and voluntary tone assessment?
Reflexive: DTR, MSR, PROM at variable speeds, clonus
Voluntary: AROM at variable speeds, damping, posture, movement control and coordination
How do you assess CN 1?
Have patient identify scents with their eyes closed
How do you assess CN 2?
Pupillary light response, Snellen chart, visual field assessment
How do you perform a visual field assessment?
Assess one eye at a time and have patient look straight ahead. Hold an object 12-18 inches away starting level with the patient’s eye. Move the object superior, inferior, left, right, and on each diagonal in the shape of a sphere making sure to pause back in the middle every time. Have patient identify when they can see the stimulus
How do you assess CN 3, 4, and 6?
Observation of ptosis, eyelid asymmetry, visual tracking
How do you perform a visual tracking assessment?
Looking for smooth pursuit and saccades. Have patient track an object while keeping their head straight. Move the object superior, inferior, left, right, and on all four diagonals, circular in both directions, the convergence
How do you assess CN 5?
Facial sensation and masseter strength by resisting mouth opening
How do you assess CN 7?
Observe for hemifacial weakness. Have patient smile, furrow forehead, scrunch nose, and assess taste of anterior 2/3 of the tongue
If stroke, weakness will be in bottom half of the face
How do you assess CN 8?
Hearing intact, nystagmus
How do you assess CN 9 and 10?
Visualize palate for equal elevation, gag reflex
How do you assess CN 11?
Strength of upper traps and SCM
How do you assess CN 12?
Have patient protrude tongue and move side to side. Will deviate toward the side with the deficit
What are the main components of a general cerebral function exam?
General observable behavior
Level of consciousness – arousal
Attention
Intellectual performance and memory
Emotion status
Thought content
What is arousal?
State or responsiveness to stimulation or action, physiological readiness
What are the four categories of arousal?
Comatose, stupor, lethargy, alertness
What is attention?
Selective awareness of the environment, selective responsiveness to stimuli
How do you assess attention?
Length of eye contact, ability to follow commands, vigilance, ability to maintain conversation
What is cortical sensory interpretation?
The ability to integrate thought processes with sensory input
What is agnosia?
Lack of knowledge, inability to recognize objects despite intact visual and tactile systems
What is astereognosis?
The inability to tactilely recognize a familiar object despite intact sensation
What is visual agnosia?
The inability to visually recognize familiar object
What is spatial agnosia?
The inability to find way around in a familiar setting
What is color agnosia?
The inability to understand colors as a quality of an object
What is apractognosia?
The inability to recognize a familiar task
What is anosognosia?
The unawareness or deep denial of the presence of neural deficits
What is prosopagnoisa?
The inability to recognize familiar human faces
What is autopagnosia?
The inability to recognize body parts and their relationships
What are the three components of assessing body image?
Neglect, body schema, right and left discrimination
What is neglect in terms of body image?
Unawareness of body parts, may be localized to an extremity or an entire side of the body
Assess by the patient’s ability to cross midline and degrees of stimulus needed to guide patient
What is a body schema?
Mental image of body, body part may be perceived disproportionally, absent, or located incorrectly anatomically
What is right and left discrimination?
Ability to differentiate left from right side. Requires higher level of intellect and perceptual function
What is apraxia?
Lack of action, relates to the inability to perform an action upon request even though the muscles requires are innervated
What is Ideomotor Apraxia?
Inability to carry out simple, one step task upon request
What is Ideational Apraxia?
Inability to perform dynamic, sequential skill upon request
What is receptive aphasia?
Inability to comprehend spoken language, written communication, or gestures. Related to sensory interpretations of speech
What is expressive aphasia?
Inability to produce spoken words, written communication, and occasionally gestures. Related to cortical loss of motor programs
What is global aphasia?
Both expressive and receptive language deficits
What is dysarthria?
Impairment of the mechanical coordination of speech. Related to the paresis or incoordination of the muscles for speech.
What pathological damage is dysarthria associated with?
Brainstem and cerebellar lesions due to the close proximity of the cranial nerves to the supra and infra hyoids
