Examination: Neurology Flashcards
What is important to do to ensure tikanga is followed?
Clearly explain reason for exam
Gain permission for exam
Different coloured linen for head (white linen) vs rest of body (other colour) = keeps tapu and noa separate
Correct tone and manner (respectful)
Thank patient
NB: always check especially when touching head and face
WIPER
Wash hands Introduction - full name, role, permission, explanation of procedure Position patient Expose as necessary Examine from patient's RIGHT
Check for pain before starting
Communicate with patient about progress and check on comfort throughout and gain permission throughout
Assess expression for any pain/discomfort
Thank patient and let them know exam is complete
Allow them to put on clothes
Wash hands
General obs of a neurological presentation.
Alert?
Look well?
Distressed/pain?
Body weight?
What are they doing when you first see them?
Mobile/gait abnormalities/mobility aids?
Posture?
Facial symmetry/wasting?
Eyes - ptosis, strabismus, nystagmus, squint?
Speech - quality (nasal/hoarse), articulation (clearness of speech)
Hearing
Muscle wasting: arms/legs
Abnormal movements (tremor/fasciculation)?
What is the testing of balance called?
Romberg’s Test
Which three inputs combine to achieve balance?
Visual input from eyes
Proprioceptive from joints and muscles
Vestibular input from vestibular system
What do we examine for gait and balance?
WIPER
Any pain or discomfort to start
Gait - walk 2/3m away, turn and come back. Walk heel-to-toe, walk on toes followed by walking on heels, squat and stand up (or rise from chair)
What do we look at for gait?
Initiation: assess for apraxia
Phases of gait: swing and stance
Turn: stable/smooth/extra steps
Heel-to-toe: ataxic gait
Walk on heels/toes: balance, distal muscle strength
Squat and stand up: assess for proximal myopathy
How do we assess balance?
Ask for issues with balance before starting
Ask px to stand upright, feet together
Close eyes for up to a minute
Compare steadiness with eyes open/closed
Positive test: patient had to open eyes in order to not fall/lose balance
When would it be appropriate to ask the orientation questions?
If px seems confused when you talk to them
Some else has reported the px seems confused/forgetful
Clinical situation suggest cognition is affected e.g. acute illness, fall, collapse, head injury
List the components of the motor system examination.
Look: inspect
Feel: muscle tone
Move: muscle power
Special tests: coordination and deep tendon reflexes
List components of inspect of the motor system.
Assess symmetry - compare both sides Scars and other skin lesions Muscle hypertrophy Muscle wasting Use of limb - function Posture (decorticate, decerebral, hemiplegic posture with flexion of the upper limb and extension of the lower limb) Gait Abnormal involuntary movements - fasciculations/tremor
What is a tremor?
Oscillatory movement about a joint or group of joints resulting from alternating contraction and relaxation of muscles.
Postural tremor
A fine fast tremor that becomes worse with intentional movement
e.g. physiological tremor - nervous/too much caffeine or benign essential tremor
Pin rolling tremor
Slow, coarse tremor in PD
Worst at rest, improves with movement
More common in upper limbs, asymmetrical
How do we describe tremor?
Speed (fast/slow)
Amplitude (fine/course)
Maximal at rest or maintaining a posture/ carrying out a movement
