Hands Off Exam Flashcards
Neurological patient - why should a full CE be performed?
Rule out systemic dx which can cause neuro signs
Neuro exam - must differentiate between what 3 postures?
Schiff-Sherrington syndrome
decerebrate rigidity
decerebellate rigidity.
Define ataxia
Lack of co-ordination
Define paresis
weakness or inability to generate movement voluntarily.
The aim of the neurological examination is firstly to establish the nature of the condition (neurological vs non-neurological) and then to establish the .
Neuro anatomical location
What questions might you want to ask when taking a history for a patient with a suspected spinal problem? (9)
- Previous health
- Vacc
- Worm
- Toxin
- Trauma
- Wellbeing
- Onset
- Progression
- Tx and response?
What are the 6 sections of a neuro clinical exam?
1 Mentation
2 Posture and Gait evaluation
3 Proprioceptive testing
4 Segmental spinal reflexes
5 Sensorium
6 Cranial nerve examination
Which aspects of the neuro exam are hands off?
Mentation
Posture and Gait evaluation
How can mentation be classified (5)
Normal
Obtunded
Disorientated
Stuporous
Comatose
It is important to differentiate three different postures, name them
1 Schiff-Sherrington syndrome
2 Decerebrate rigidity
3 Decerebellate rigidity
What does the patient look like with Schiff Sherrington syndrome and decerebrate rigidity and decerebellate rigidity?
recumbent with hyperextension of the thoracic limbs due to lack of inhibition of the thoracic limbs’ extensor tone.
With Schiff Serrington:
A) This is due to an interruption of the inhibitory pathway of what cells?
B) What spinal segment is this present in?
C) Where + what normally happens here?
A) Border cells
B) L1-L4
C) thoracolumbal intumescence where they normally inhibit the thoracic limb extensor tone
T or F
The Schiff-Sherrington posture is not a prognosis indicator for recovery.
True
What does Schiff Sherrington syndrome relate to?
An acute or peracute thoracolumbar spinal cord injury
What do decerebrate rigidity and decerebellate rigidity relate to?
Intracranial pathology
With Schiff-Sherrington syndrome, the patient is usually recumbent with hyperextension of the thoracic limbs due to lack of inhibition
Thoracic limb extensor tone
Decerebrate rigidity and decerebellate rigidity; what other sings do they often have?
opisthotonos
altered mentation
Define opisthotonos
Spasm of the muscles causing backward arching of the head, neck, and spine.
Decerebrate rigidity;
A) Mentation?
B) Pelvic limb position?
A) Stuporous or comatose
B) Hyperextension
Does decerebrate rigidity or decerebellate rigidity have better prognosis?
decerebellate rigitity
What are the 4 causes of ataxia?
afferent peripheral nerve
spinal cord lesion
, a vestibular disorder (vestibular ataxia)
cerebellar disorder (cerebellar ataxia)
How does vestibular ataxia present?
loss of balance reflected in a head tilt, and a tendency to lean, drift, fall or roll to one side.
General proprioceptive ataxia and upper motor neuron paresis are often associated in cases of a A) disorder that affects B) pathways.
A) a spinal cord disorder
B) Both
Cerebellar ataxia reflects the inability to modulate what and where resulting in abnormal and uncontrolled limb movements.
gait generating systems in the brain stem
What are excessive limb movements known as?
Hypermetria
What are the 3 types of ataxia?
Sensory
Vestibular
Cerebellar
What is sensory ataxia?
What is seen if brainstem/spine involved
Abnormal proprioception
paresis if brainstem or spinal.
Vestibular ataxia:
A) What proprioception?
Normal or abnormal
Cerebellar - proprioception?
Normal conscious proprioeption
What is difference between paresis vs plegia?
Paresis implies some voluntary movement, whereas plegia refers to complete loss of voluntary movement.
2 types of paresis?
upper motor neuron (UMN) and lower motor neuron (LMN)
LMN Paresis:
A) Posture
B) Gait
C) Motor function?
A) Difficultly supporting weight
B) Short strides/tendency
C) Flaccid
LMN paresis:
A) Segmental reflexes
B) Resting muscle tone
C) Muscle atrophy
A) Decreased - absent
B) Decreased - absent
C) Early and severe
UMN paresis:
A) Segmental reflexes
B) Resting muscle tone
C) Muscle atrophy
A) Normal to increased
B) Normal to increased
C) Late and disuse
UMN Paresis:
A) Posture
B) Gait/proprioception
C) Motor function?
A) Usually normal / abnormal limb position
B) Stiff and ataxic/delayed proprioception
C) Spastic
Where are UMN tracts? (2)
Spinal cord
Brainstem
Where do UMN tracts run?
Next to general proprioceptive tracts
UMN - knuckling or scuffing seen?
Varies - but can be
UMN paresis;
What is the gait like?
Long-strided gait with a delay in the swing phase and stiffness.
LMN gait
short-strided gait with inability to support weight in many cases,
Which nerves are commonly affected with LMN paresis causing inability to support weight?
Radial and femoral
The LNMs that innervate the muscles of the limbs are located in the spinal intumescences;
Where for FL?
C6-T2
The LNMs that innervate the muscles of the limbs are located in the spinal intumescences;
Where for HL?
L4-S1
The cell bodies of the lower motor neurons lie within the ? of the spinal intumescences,
ventral horn
Cell bodies of LMN connect what?
Effect organ (muscle with limbs) to SC
What muscle atrophy do LMN cause?
Neurogenic
