Lecture 2: BSF Exam- Cognition, ACOM, Sensation Flashcards
What are important questions to ask during subjective history?
prior level of function, living environment, work?, resources available, current limitations, client goals
What are main components of neuro systems review?
gross movement, motor function
What are areas of gross movement?
balance, transfer, gait/ wc mobility
What are areas of motor function?
motor control/ muscle tone
What are two different approaches that can be taken for a neuro exam?
- impairment or body structure based/ function oriented
2. activity oriented
What factors influence what method you choose?
setting, pt status, level of expertise
What are components of BSF oriented exam?
ROM, MMT, muscle tone, consciousness, sensation, cognition, motor control/ACOM, reflexes, cranial nerve integrity
What do you do during an activity based exam?
examine and analyze activities then formulate list of hypothesized contributing factors (HCF)
then perform tests specific to HCF to refute or confirm
What are components of activity based exam?
balance, trunk control, reaching, bed mobility, transfers, ambulation, stairs, sit to stand
What is consciousness and level of arousal?
determines level of readiness for activity
What is alert?
awake, attentive, interactive
What is lethargic?
drowsy, brief response to stimuli, poor attention
What is obtunded?
difficult to arouse, confused when alert
What is stupor/ semicoma?
not self alerting, responds to vigorous or noxious stimuli
What is a coma?
can’t be aroused, unconscious, no sleep wake cycle
What is a vegetative state?
irregular sleep wake cycle, can be aroused but no awareness of environment
What is persistent vegetative state?
remain in vegetative state for greater than 3 months(anoxia) or 1 year (TBI)
What is locked in syndrome?
alert and unable to respond to environment, no speech or active movements
What are two standardized tests for consciousness?
glasgow come scale
rancho los amigos scale
What are different areas of cognition?
orientation - AO x 3
attention, memory, executive functions
What are components of attention?
ability to screen and process sensory info
ability to concentrate and dual task
document: speed of response, duration
What are components of memory?
register, retain and recall
short vs long term, ability to follow multi step commands
What is retrograde amnesia?
can’t recall past info
What is anterograde amnesia?
can’t learn new info
What are executive functions?
awareness, reasoning, planning, judgement, intuition, decision making
What are two standardized test and measures for cognition and what scores are needed to “pass”?
mini mental state exam- 24/30
Montreal cognitive assessment 26/30
What is Wernicke’s aphasia?
receptive or unable to understand language
What is Broca’s aphasia?
expressive, trouble with speaking
What is dysarthria?
poor articulation
Why is somatosensation so important?
critical to motor learning and motor performance, guides selection of movement pattern required in a given sensory environment, used by CNS to modify or adapt ongoing movements
What is so important about sensory integration?
vital to planning and allowing interaction with environment
people can have intact somatosensation but impaired integration
What does light touch, pain and temperature assess?
anterolateral column in spinal cord, fibers slow and small
What does vibration, two point discrimination and proprioception test?
dorsal column of spinal cord
large and fast fibers
What will be affected in nerve root lesion?
dermatomal distribution or abnormal sensation
What will be affected in peripheral nerve involvement?
distribution of that specific nerve
What is will neuropathy affect?
stocking glove distribution
What do you test for superficial sensation?
pain- sharp/dull
temp- hot/ cold
light touch- cotton balls/ swab, monofilaments
pressure- finger tip
start distal to proximal and usually done first
How to test deep sensation?
kinesthesia- movement sense
proprioception- joint position
vibration perception
What are combined cortical sensations?
cortical sensory areas that involve both superficial and deep sensation
What is agnosia?
not knowing
What is neglect?
lack of awareness or attention
What is stereognosis?
object recognition
What is 2 point discrimination?
distinguish between one or two stimuli
What is double simultaneous stimulation?
apply stimuli to one or both sides or the same body location simultaneously, identify between one or two stimuli
What is graphesthesia?
identify figures drawn on skin
What is barognosis?
identify which object is heavier or lighter
What is active control of movement?
ACOM, assessment of motor control
ability to execute a motor plan and isolate muscle of muscle groups
What are two different types of movement seen in neuro patients?
- selective or isolated
2. abnormal synergistic patterns, occurs with attempt to actively move limb
What are you looking for during ACOM?
is motion absent? initiated?
complete range of motion? AG or GM?
isolated?
abnormal patterns?
When do you use MMT for neuro pts?
if movement is isolated even just a little
What is a classic UE flexion synergy pattern?
scap retraction and elevation shoulder ABD and ER Elbow flexion forearm supination wrist finger flexion
What is classic LE flexion synergy pattern?
Hip flex. ABD, ER
knee flexion
ankle DF, inversion
What is classic UE extension pattern?
scap protraction shoulder ADD/IR elbow extension forearm pronation wrist finger flexion
What is classic LE extension pattern?
hip ext, ADD, IR
knee extension
ankle PF/ INV
