intro to neuro assessment

Question 1

what’s the difference between UMN and LMN?

Answer 1

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

Question 2

what is an upper motor lesion?

Answer 2

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

Question 3

what is a lower motor lesion?

Answer 3

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

Question 4

what is ataxia?

Answer 4

ataxia describe poor muscle control that causes clumsy movements - due to damage of the cerebellum

Question 5

what are the important observations to note when doing assessment of neuro patient?

Answer 5

-location eg bedside, chair, monitiors etc?
-posture
-mobility
-alaterness, attention
-ability to follow command - eg 1 step, 2 step commands

Question 6

what is important to note about observing posture in neuro patients?

Answer 6

-what is the alignment of head trunk and limbs?
-symmetry between r & l?
-is there a contracture? (permanent tightening of muscle)
-spastic patterns?

Question 7

what are the 2 types of postures that high muscle tone can lead to?

Answer 7

-decorticate posture
-decerebrate posture

Question 8

what are other important observations to make in neuro assessment ?

Answer 8

-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?

Question 9

what is bradykinesia?

Answer 9

slowed movement - seen in parkinsons

Question 10

what are important things to look out for during movement assessment of neuro patients?

Answer 10

-ataxia - loss of co-ordination
-bradykinesia
-involuntary mvt eg tremor
-loss of range
-loss of voluntary movement

Question 11

what can be used to assess the patients power. strength?

Answer 11

Oxford scale

Question 12

what things may cause abnormal muscle power in neuro patients?

Answer 12

-muscle pathoogy
-NMJ defect
-UMNL
-anterior horn cell damage
-nerve root injury
-nerve plexus
-peripheral nerve lesion

Question 13

what are the assessment steps of muscle tone ?

Answer 13

1. observe appearance of limb
2. palpation of muscle - how does it react to stretch?
3. PROM - passive ROM of limb joints - proximal to distal direction for test

grading scale - ash worth or tardies scale

Question 14

what is the difference in positioning in decorticate vs decerebrate postures?

Answer 14

1. decorticate - hands and arms are posturing towards the spine - inward - protective response
2. decerebrate - hands are directed away from the body and spine - no attempt to guard the body at all

Question 15

which posture indicates more brain damage?

Answer 15

decerebrate

Question 16

what is a contracture?

Answer 16

shortening and hardening of muscles, tendons, or other tissue often leading to deformity and rigidity of joints caused by increased tone

Question 17

what are examples of common contractures in neurological patients?

Answer 17

-adducted shoulder w/ IR
-flexed elbow
-pronated forearm
-flexed wrist
-flexed fingers
-thumb in palm
-clenched fist

Question 18

what is spasticity?

Answer 18

stretch reflex disorder
-increase in muscle tone that becomes more apparent with more rapid stretching movement

Question 19

what is a clonus?

Answer 19

a muscular spasm - repeated muscular contraction

Question 20

what is an abnormal response to the babinski reflex?

Answer 20

-hallux (big toe) extends, toes spread, extensor plantar response - positive babinski sign
-indicates UMNL

Question 21

what are examples of things to test in the sensory system?

Answer 21

• 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)

Question 22

what does the DCML pathway convey?

Answer 22

-proprioception
-fine discriminative touch
-stereognosis
-vibration sense
-weight discrimination

Question 23

what do the anterolateral pathways convey?

Answer 23

-pain
-temperature
-crude touch
-pressure
-tickle
-itch

Question 24

how is joint position sense tested for upper limb?

Answer 24

–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

Question 25

define graphesthesia

Answer 25

ability to recognise writing on the skin purely by the sensation of touch

Question 26

define stereognosis / tactile gnosis

Answer 26

the ability to recognise symbols traced on skin

Question 27

how do you test upper limb co-ordination?

Answer 27

finger to nose test

-ask pt to touch their index finger to their nose, can change speed / position of target to further assess

Question 28

how do you test lower limb co-ordination?

Answer 28

-heel to shin test

-patient in supine - lift leg and place heel on knee and slide heel down along shin

Question 29

define dysdiadokokinesia

Answer 29

the inability to perform rapid alternating muscle movements
eg fast finger tapping, opening and closing of fists, foot tapping etc

Question 30

how do you test trunk co-ordination?

Answer 30

tandem walking

Question 31

what does TILE stand for? why is it important?

Answer 31

-task
-individual
-load ie patient
-environment

need to consider all of these for a safe transfer

Question 32

what are examples of functional mobility tasks to test>

Answer 32

-balance - sitting, standing, static, dynamic etc
-bed mobility - rolling, lying to sitting, STS
-transfers
-gait

Question 33

what are important things to note about observing functioning mobility in neuro pts?

Answer 33

-level of assistance?
-movement pattern?
-balance - their base of support? and stability?

Question 34

that is the Romberg test?

Answer 34

balance test

pt stands with feet together

eyes pen and eyes closed

Question 35

what does it mean if patient is unsteady with eyes closed Romberg?

Answer 35

sensory ataxia

Question 36

what does it mean if pt is unsteady w/ eyes open and closed with Romberg?

Answer 36

cerebellar ataxia

Question 37

what are good balance assessments / tests to do?

Answer 37

-Berg
-tinetti balance and gait
BESTest
-4 stage balance test
hiMAT - high level mobility and assessment tool

Question 38

what are examples of abnormal gait patterns?

Answer 38

hemiplegic gait (loss of canton & spasticity on muscles on 1 side of body)
-parkinsonian
-ataxic
-high stepping
-trenedelnburg
-foot drop

Question 39

what are additional assessments that are done for a neuro patient?

Answer 39

-communication and swallow (not physio specific)
-vision
-cranail nerve examination

Question 40

what is the Glasgow coma scale?

Answer 40

a scale to measure how conscious you are

Question 41

what is the abbreviated mental test score?

Answer 41

a 10 point assessment to rapidly assess elderly patients for the possibility of dementia