Medical Neurological Assessment Flashcards
Pain complaint
Location Quality Severity Duration Precipitating factors Associated symptoms Exasperation/diminished pain Onset
Use pain rating scales
Headaches
Multiple causes, not good indicator of neuro trouble
Vertigo
Sensation of moving around in space or objects moving around them.
Assessing Cerebral Function
Mental status Intellectual function Thought content Emotional status Perception Motor ability Language ability
Mental Status- Alert
Open eyes spontaneously, Responds appropriately, briskly, and is oriented
Lethargic
Opens eyes to verbal stimuli, Slow to respond but appropriate, Short attention span, Obtunded (sleepy)
Stupor
Responds to stimuli (usually physical) with moans and groans, Never fully awake, Confused, Conversation unclear.
Semi-Comatose
Responds to painful stimuli, Conversation=none, Protective reflexes are present.
Comatose
Unresponsive except to severe pain, protective reflexes absent, pupils fixes, no voluntary movement.
Unconscious
Non-medical word, ranges from stupor to coma
Persistent Vegetative state
No cognitive brain function, Wake sleep cycles, Very poor prognosis (3-6 months)
Brain Dead
No brain function, Only reflexive movements
Types of stimuli -> Response
Voice Touch Shaking Voice + shaking Noxious/painful stimuli (sternal rub)
Nature of response
Eye opens,
Remove stimuli,
Abnormal posturing,
No response
Glasgow Coma Scale- Eye opening
Spontaneous- 4
To speech- 3
To pain- 2
Nil- 1
Glasgow Coma Scale- Best motor response
Obeys-6 Localizes- 5 Withdraws- 4 Abnormal flexion- 3 Extension response- 2 Nil- 1
Glasgow Coma Scale- Verbal response
Oriented-5 Confused conversation- 4 Inappropriate words- 3 Incomprehensible sounds- 2 Nil- 1
Glasgow Coma Scale scoring
13= mild brain injury 9-12= Moderate brain injury <8= Severe brain injury (coma)
General appearance
How do they look?
Grooming, dress, aids, eye deviation, skin
Visual assessment
Signs of trauma, wounds, scrapes, ecchymosis, etc.
Bruising over the mastoid
Suggests skull fractures
Periorbital edema and bruising (raccoon’s eyes)
Suggests frontal-basal fracture
Rhinorrhea
Drainage of CSF from the nose: suggests fracture of the cribiform with torn meninges
Otorrhea
Drainage of CSF from the ear: suggests fracture of the temporal bone with torn meninges.
Decorticate posturing
Flexed posturing= Flexed arm/elbow, Flexed wrists/fingers, adducted arms, legs with internal rotation, plantar flexed foot.
Suggests damage to the cortico-spinal tract (more favorable than decerebrate posture)
Decerebrate Posturing
Extension posturing= extended arm/elbow, flexed wrists/fingers, adducted arm, pronation of arm, foot is plantar flexed.
Suggests severe injury to the brain at the level of the brainstem.
Opisthotonos
Severe muscle spasm of the neck and back.
Orientation
X4= Person Place Time Situation
Bottom up
Measure component skills
Top down
Performance in task
Evaluation
Gathering data from: medical record/chart review Observation of client including with family, staff, other clients, Interviews with client and family, Quantitative assessment.
OT Assessments
Sensation,
ROM/MMT (deformity control)- head and neck
-UE
-Head and UW motor control
Wrist and hand function
Trunk control
ADLs
Vision/visual perception
Cognition (thinking, memory, personality)
Apraxia/Perception
Endurance- assess ability to tolerate activity (bed, sitting EOB, Chair, standing) *not the type of activity, Resistance, and time tolerated.
Psychosocial
Client's understanding of the situation Coping skills available Problem solving skills Ability to direct others Family involvement Discharge plans/options Motivation/Participation in goal setting
Problem list
Identify strengths and deficit areas from evaluation
Re-evaluate as patient improves,
Apparent problems are combination of cognitive, sensory-perceptual, sensorimotor, and behavior deficits.
-identify each deficit
-Determine severity of deficit in relation to others.
