intro to neuro assessment Flashcards
what’s the difference between UMN and LMN?
UMN - larger & found in the cortex of the brain
LMN- small neurons that are found in the grey matter of the spinal cord or brainstem
what is an upper motor lesion?
a lesion that affects neurons in the cerebral cortex or their axons
- cause increase muscle tone, spasticity etc
- cause hyperreflexia
-some muscle atrophy seen
-fasculations generally absent
what is a lower motor lesion?
a lesion affecting the nerves in the spinal cord or brainstem that directly innervate muscles
- cause decreased muscle tone
- cause hyporeflexia - absent reflexes
-severe and rapid muscle atrophy
-fasiculations present due to nerve damage
what is ataxia?
ataxia describe poor muscle control that causes clumsy movements - due to damage of the cerebellum
what are the important observations to note when doing assessment of neuro patient?
-location eg bedside, chair, monitiors etc?
-posture
-mobility
-alaterness, attention
-ability to follow command - eg 1 step, 2 step commands
what is important to note about observing posture in neuro patients?
-what is the alignment of head trunk and limbs?
-symmetry between r & l?
-is there a contracture? (permanent tightening of muscle)
-spastic patterns?
what are the 2 types of postures that high muscle tone can lead to?
-decorticate posture
-decerebrate posture
what are other important observations to make in neuro assessment ?
-perception - ability to follow instructions
-facial palsy- weakness to one side of the face
-drooling
-presence of NG or PEG tube for feeding
-catheter?
-assistive devices - splints or use of mobility aid?
what is bradykinesia?
slowed movement - seen in parkinsons
what are important things to look out for during movement assessment of neuro patients?
-ataxia - loss of co-ordination
-bradykinesia
-involuntary mvt eg tremor
-loss of range
-loss of voluntary movement
what can be used to assess the patients power. strength?
Oxford scale
what things may cause abnormal muscle power in neuro patients?
-muscle pathoogy
-NMJ defect
-UMNL
-anterior horn cell damage
-nerve root injury
-nerve plexus
-peripheral nerve lesion
what are the assessment steps of muscle tone ?
- observe appearance of limb
- palpation of muscle - how does it react to stretch?
- PROM - passive ROM of limb joints - proximal to distal direction for test
grading scale - ash worth or tardies scale
what is the difference in positioning in decorticate vs decerebrate postures?
- decorticate - hands and arms are posturing towards the spine - inward - protective response
- decerebrate - hands are directed away from the body and spine - no attempt to guard the body at all
which posture indicates more brain damage?
decerebrate
what is a contracture?
shortening and hardening of muscles, tendons, or other tissue often leading to deformity and rigidity of joints caused by increased tone
what are examples of common contractures in neurological patients?
-adducted shoulder w/ IR
-flexed elbow
-pronated forearm
-flexed wrist
-flexed fingers
-thumb in palm
-clenched fist
what is spasticity?
stretch reflex disorder
-increase in muscle tone that becomes more apparent with more rapid stretching movement
what is a clonus?
a muscular spasm - repeated muscular contraction
what is an abnormal response to the babinski reflex?
-hallux (big toe) extends, toes spread, extensor plantar response - positive babinski sign
-indicates UMNL
what are examples of things to test in the sensory system?
- cutaneous sensations eg pain, temp, light touch, pressure, 2 point discrimination
-proprioceptive sensations eg vibration, joint position
-integrative sensations - eg stereognosis (understanding object by touch)
what does the DCML pathway convey?
-proprioception
-fine discriminative touch
-stereognosis
-vibration sense
-weight discrimination
what do the anterolateral pathways convey?
-pain
-temperature
-crude touch
-pressure
-tickle
-itch
how is joint position sense tested for upper limb?
–patients eyes open
-hold distal phalanx DIP joint index finger
-illustrate bent and straight
-patient closes eyes and is asked to report if joint is bent or straight
define graphesthesia
ability to recognise writing on the skin purely by the sensation of touch
define stereognosis / tactile gnosis
the ability to recognise symbols traced on skin
how do you test upper limb co-ordination?
finger to nose test
-ask pt to touch their index finger to their nose, can change speed / position of target to further assess
how do you test lower limb co-ordination?
-heel to shin test
-patient in supine - lift leg and place heel on knee and slide heel down along shin
define dysdiadokokinesia
the inability to perform rapid alternating muscle movements
eg fast finger tapping, opening and closing of fists, foot tapping etc
how do you test trunk co-ordination?
tandem walking
what does TILE stand for? why is it important?
-task
-individual
-load ie patient
-environment
need to consider all of these for a safe transfer
what are examples of functional mobility tasks to test>
-balance - sitting, standing, static, dynamic etc
-bed mobility - rolling, lying to sitting, STS
-transfers
-gait
what are important things to note about observing functioning mobility in neuro pts?
-level of assistance?
-movement pattern?
-balance - their base of support? and stability?
that is the Romberg test?
balance test
pt stands with feet together
eyes pen and eyes closed
what does it mean if patient is unsteady with eyes closed Romberg?
sensory ataxia
what does it mean if pt is unsteady w/ eyes open and closed with Romberg?
cerebellar ataxia
what are good balance assessments / tests to do?
-Berg
-tinetti balance and gait
BESTest
-4 stage balance test
hiMAT - high level mobility and assessment tool
what are examples of abnormal gait patterns?
hemiplegic gait (loss of canton & spasticity on muscles on 1 side of body)
-parkinsonian
-ataxic
-high stepping
-trenedelnburg
-foot drop
what are additional assessments that are done for a neuro patient?
-communication and swallow (not physio specific)
-vision
-cranail nerve examination
what is the Glasgow coma scale?
a scale to measure how conscious you are
what is the abbreviated mental test score?
a 10 point assessment to rapidly assess elderly patients for the possibility of dementia
