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Neuro Clinic > Examination > Flashcards

Examination Flashcards

1
Q

what to include in a history??

A

medical history: include location of lesion

social history: employment?

living environment: where do they live? type of dwelling. stairs? railings? anyone live with them? are they able to assist in their care? do they work? do they have a support system? who are they (family and services)? working?

Prior level of function (PLOF): did they use an AD? are they a community ambulatory? driving?

Medications: prescription and OTC

Chief complaint: *** where to start! motivation for patient

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2
Q

patient goals

A

what are their goals for therapy?
if appropriate, what are the family’s goals for therapy?
can also ask caregiver

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3
Q

what are the 5 review of systems?

A

cardiovascular/pulmonary

integumentary

musculoskeletal

neuromuscular

communication/affect, cognition, and language system (motor learning, retention of skills)

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4
Q

tests and measures:

A 
aerobic capacity/endurance
anthropometric characteristics (ht, wt, gender)
arousal, attention, cognition
assistive/adaptive devices
circulation
cranial &peripheral nerve integrity
environmental, home and work barriers
gait locomotion and balance
integumentary integrity
joint integrity and mobility
motor function (motor control & learning)
muscle performance
neuromotor development and sensory integration
orthotic, protective, &supportive devices
pain
posture
ROM/ muscle length
reflex integrity
self care & home management (ADL, IADL)
sensory integrity
ventilation & respiration/gas exchange
work, community & leisure integration
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5
Q

what is tone?

A

=tension of a muscle which can be altered either consciously or automatically, centrally or peripherally

examine tone first bc changes in position and movement will change or influence tone

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6
Q

what are the 4 types/categories of tone?

A

1- flaccidity= absence of tone (“deadweight”, physically have to hold the limb up- no ms. activation)

2- hypotonia= decreased tone (LMNL)

3- normal

4- hypertonia = increased tone (UMNL)

  • spasticity
  • rigidity
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7
Q

what is hypotonia? how is it produced?

A

flaccidity/hypotonia can be produced by injury to a number of CNS loci involved in the cerebellar cortical connections. These include the dentate nucleus of the cerebellum, the ventrolateral nucleus of the thalamus and the premotor cortex.

hypotonia is also seen with lesions of the medullary pyramids

LMNL (a few with UMNL (>90% of UMNL are hypertonia)

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8
Q

what is hypertonia? how do you test for it?

A

hypertonia= increased tone
need to test whether it is spastic or rigid

test tonic stretch reflex and the phasic stretch reflex

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9
Q

what is the tonic stretch reflex?

A

tonic stretch reflex of hypertonicity= resistance to passive movement

increase in tone with speed (feel a catch-increase in resistance) but no difference when moving slow= SPASTICITY- velocity dependent

not velocity dependent- constant= RIGIDITY

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10
Q

what is the phasic stretch reflex?

A

AKA monosynaptic reflex, myotonic reflex, DTR

SPASTICITY= increased DTR

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11
Q

what is spasticity?

how is it graded?

A

=increase in tonic stretch reflexes (velocity dependent) and increase in phase stretch reflex (DTR)

graded by the Modified Ashworth Scale (measures tonic stretch reflex)

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12
Q

what are the grades for the Modified Ashworth Scale?

A

0 = no increase in muscle tone (absent)

1= slight increase in muscle tone (catch and release or min resistance at end range) (minimal)

1+ = slight increase in muscle tone through less than 1/2 range

2 = more marked increase muscle tone through must ROM, but affected part moves easily (moderate)

3= considerable increase in muscle tone, passive movement difficult (maximal)

4= affected part(s) rigid in flexion or extension

**tone is constantly changing (weather, mood) so it is important not to get caught up in scoring

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13
Q

what are the types of spasticity?

A

clasp knife phenomenon

decerebrate posturing

decorticate posturing

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14
Q

what is clasp knife phenomenon?

A

spasticity in which there is an initial resistance during passive stretch followed by a sudden melting of that resistance

tends to be extensors

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15
Q

what is decerebrate posturing?

A

hyperactive state associated with extension of upper and lower extremities

(worst)

velocity dependent-spastic

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16
Q

what is decorticate posturing?

A

hypertonic state associated with flexed upper extremities and extension in lower extremities

(better- red nucleus is functioning)

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17
Q

what is rigidity?

A

hypertonia characterized by increased responsiveness of tonic stretch reflexes which is velocity independent and which occurs in the absence of heightened phasic stretch reflex

most rigidity is mobile but patients complain of “stiff and tight”

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18
Q

what are 3 types of rigidity?

A

cogwheel

lead pipe

Genghalten

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19
Q

what is cogwheel rigidity?

A

represents a catch and release of the muscle tension throughout the range of passive movement

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20
Q

what is lead pipe rigidity?

A

associated with a stiff “plastic” or “lead pipe” type of increased resistance to passive movement, which is independent of extent or rapidity of movement

21
Q

what is Genghalten rigidity?

A

heightened resistance to passive movement is elicited by contact or holding. usually assume normal postures at rest and muscles are visibly slack. Tension is not increased by active movement but by handling.

frontal lobe lesion- these patients are very functional, don’t feel stiff/tight- but the moment you touch them they stiffen up

22
Q

what are 3 things to test for sensory integrity?

A

recognition

interpretation

attention

23
Q

types of sensory testing:

A

sharp/dull discrimination

vibration

temperature

light touch

proprioception

kinesthesia

stereognosis: tactile recognition of objects
graphesthenia: ability to recognize writing on skin

double simultaneous stimulation

peripheral impairments

spinal cord impairments

brain impairments: sensory neglect& hypersensitivity

24
Q

motor function/muscle performance:

A

MMT is indicated ONLY when the spasticity is NOT present– pt. can’t isolate movement = invalid test

the motor inspection begins as soon as you meet the patient:

  • study every activity: how the pt. sits, walks, gestures; posture; general level of activity
  • unobtrusive observation of the pt’s spontaneous activity often discloses more than formal tests, particularly for infants and mentally ill patients
25
Q

motor assessment:

A

identify what they move and how the accomplish each movement

  • isometric
  • eccentric
  • concentric

assess movement, posture and where the movement is initiated from

ways to test:

  • MMT
  • movement in planes
  • placing and holding
  • Brunstrom/ Fugl-Meyer staging
  • motor development sequence
26
Q

what is Brunstrom Staging?

A

stage I = flaccidity, central shock

stage II = associated movements, little tone, general hypotonic- “overflow” (effort = >associated movements)

stage III: flexion synergy pattern/ extension synergy pattern

stage IV-V: basic movements of synergy patterns

stage VI: full isolated movement (MMT)

27
Q

what are 4 things to look at for motor developmental sequence?

what are standardized tests for motor developmental sequence?

A

1-mobility- ability to assume position
2-stability- ability to maintain position
3- controlled mobility- weight shifting in position
4- skilled- can do a functional activity in the position

standardized tests:

  • Fugl myer
  • Motor assessment scale
28
Q

what is balance?

A

control movement of the COM relative to stability limits in order to maintain equilibrium or stability

29
Q

what are limits of stability?

A

area in which the COM can be moved safely without changing the BOS

Mechanical: area of stability determined by the biomechanics of the individual, environment and task

Perceived: area of stability in which individuals perceive themselves to be stable (what you are testing)

30
Q

how do you score balance?

A

Absent

Poor = (document amount of assistance required)

Fair- = can sit/stand w/ UE support mat/walker

Fair = can sit/stand consistently w/out UE support or assistance

Good- = 1/4 active weight shifting

Good = 1/2 active weight shifting

Good+ = 3/4 active weight shifting

Normal = full active weight shifting

31
Q

what are balance strategies?

A

motor strategy: automatic (latency response 100 ms, too long for simple stretch reflex but too short for voluntary)

  • ankle strategy
  • hip strategy
  • stepping response

sensory strategy: (vestibular, visual, proprioception)
the way in which the CNS combines and “weighs” sensory info from vision, vestibular and somatosensory sources (foam and dome/balance master)

can use Romberg - knocks out visual & uses proprioception

CTSIB test= clinical test of sensory integration of balance
“foam and dome”– separates the 3 systems

32
Q

what are 3 balance responses?

A

Righting: baby- if you turn their head their body follows
(opposite direction of weight shift)

Equilibrium

Protective: same direction of weight shift

33
Q

standardized balance tests:

A

balance and mobility assessment

Berg balance test

Functional reach

Balance master

Get up and go

Mini BEST

34
Q

what is coordination?

A

smooth, accurate purposeful movement brought about by the integrated action of many muscles, superimposed upon a basis of efficient postural activity, monitored primarily by sensory input

Gross motor coordination

Fine motor coordination

35
Q

what is gross motor coordination?

A

includes evaluation of body posture, balance and extremity movements involving large muscle groups

36
Q

what is fine motor coordination?

A

evaluation of extremity movements concerned with small muscle groups (manipulation of objects with hands or finger dexterity which involves skillful, controlled manipulation of small objects)

37
Q

what are 5 components of movement?

A 
speed
control
steadiness
response orientation
reaction time
38
Q

what is the normal response of speed?

A

increased speed of performance does not affect level (quality) of motor performance

39
Q

what is the normal response of control?

A

continuous and appropriate motor adjustments can be made if speed and direction are changed (the ability to correctly judge movement and diastase as in following a target). movements are direct, accurate and easily reversed, initiated and ceased

40
Q

what is the normal response of steadiness?

A

maintenance of position or posture or body or specific extremities, without swaying, tremors or extra movements

41
Q

what is the normal response of response orientation?

A

correct movement occurs in response to stimulus, usually verbal (involves memory, cognition, and motor planning)

42
Q

what is the normal response of reaction time?

A

movement occurs within a reasonable or normal amount of time (may involve initiation)

43
Q

cerebellar testing: nonequilibrium coordination test:

what terms are used for lost or impaired ability?

A

alternate or reciprocal motion- the ability to quickly reverse movement from agonist to antagonist

adiadochokinesia= loss of ability
dysdiadochokinesia= impaired ability
finger to nose
finger to finger
alternate finger to nose, finger to finger
finger opposition
alternate supination/pronation
patting (hand)
tapping (foot)
heel to knee to toe (shin slides)
44
Q

what is composition? how do you test it?

what terms are used for lost or impaired ability?

A

synergy of movement- ability to perform movement achieved by muscle groups acting together

asynergia= loss of ability 
dyssynergia= impaired ability
finger to nose
finger to finger
heel to knee to toe
pointing
past pointing
throwing a ball
kicking a ball 
walking
45
Q

what is movement accuracy? how do you test it?

what terms are used for lost or impaired ability?

A

=ability to judge distances and speeds of movement

ametria = loss of ability
dysmetria = impaired ability
finger to nose
finger to finger
heel to knee to toe
pointing
past pointing
toe to examiner's finger
drawing a circle
making a figure eight with foot
46
Q

what is fixation or holding posture?

A

= ability to hold a posture of individual parts of the body

UE: patient holds both arms horizontally in front of him (first with eyes open and then with eyes closed)

LE:
supine- patient raises one leg at a time, holds and lowers slowly (guard patient for possible loss of control.
sitting- patient holds knee extended

47
Q

equilibrium coordination test:

A

note any swaying or unsteadiness of posture during the following activities:

  • rising from a supine position to a sitting position w/o the use of one’s hands
  • rising from a sitting position to a standing position
  • standing, laterally flexing the trunk to each side
  • standing, bending forward and returning to the upright position
  • standing, slightly extending the head and trunk
  • walking, placing the heel or one foot directly in front of the toe of the opposite foot
  • walking along a straight line
  • walking sideways (braiding)
  • stopping and starting abruptly while walking
  • climbing stairs
  • Mexican hat dance

assess activities for unilateral, ipsilateral, contralateral, bilateral, symmetrical, bilateral asymmetrical, bilateral unrelated (UE’s and LE’s performing dissimilar activities simultaneously), and 4 limb activities

48
Q

functional abilities:

A

analysis functional capabilities, amount of assistance required:

  • supine to sit
  • sit to supine
  • sit to stand
  • transfers
  • wheelchair mobility
  • ADL’s
  • ambulation
  • stairclimbing
  • ADL’s
49
Q

what are 4 basic functional abilities to look at?

A

bed mobility
transfers
ambulation
w/c mobility and management

Neuro Clinic (14 decks)

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