Module 3 pt.2 Flashcards
examine olfactory acuity non-noxious odors such as lemon oil, coffee, cloves, or peppermint
nerve olfactory 1
examine visual acuioty using a snellen chart, both central and peripheral vision is tested
cranial nerve II
determine equality and size of pupils; reaction to light, presence of strabismus (loss of ocular alignment); ability of eyes t ofollow a moving target without head movement; presence of ptosis on eyelid
cranial III, IV, VI
sensory tests of face (sharp/dull discrimination, light touch) open and close jaw against resisitance, jaw jerk reflex
cranial nerve V
examine any asymmetry of face at rest and during voluntary contraction
cranial nerve VII
test auditory using a vibrating tuning fork placed on vertex of skull or forehead, patient indicates on which side the tone is louder
cranial nerve VIII
examine taste on posterior one-third of tongue, examine gag reflex
cranial nerve IX
examine swallowing, observe ucula and soft palate for any asymmetry (tongue depressor)
cranial nerve X
examine strength of the sternocleidomastoid and trapezius muscles
cranial nerve XI
with tongue protruded examine ability to move tongue rapidly from side to side
cranial nerve XII
Olfactory Nerve test
test each nostril separately
have pt report if they can smell non-noxious odorants
olfactory treatment considerations
ties to memory, emotions, motivations
can affect tast and appetite
Optic Nerve
Visual Acuity - Snellen or Log MAR chart
Assess one eye at a time
Visual Fields - confrontation testing one eye at a time
asses each quadrant of visual field
pupillary light reflexes (sensory component)
if there is lesion to the sensory component: would not see a response in either eye
Oculomotor, Trochlear, Abducens
Congugate eye movements
- observe resting position
- H-test observe eyes movement when the patient is asked to follow a target
Convergence
- ask the patient to follow a target that is moved towards nose
Cranial Nerve III
Turns eye up, down, in
Ptosis of the eyelid
efferent limb of pupillary light reflex
Cranial nerve IV
turns the adducted eye down
Cranial nerve VI
turns eye out
the ability of the eyes to smoothly follow a moving object (slowly)
smooth pursuit
quick involuntary small movements of both eyes simultaneously occurs when the eyes fix on one point after another in the visual field
shoud move together
saccade
Trigeminal
Senosry portion - facial sensation, corneal reflex
trigeminal - motor portion
muscles of mastication ‘
Jaw jerk test
trigeminal - sensory portion
sesnory testing to face - bilateral, light touch/dull
open and close jaw
bite down
facial - motor portion
observe facial symmetry - show teeth, smile, eyes closed, etc
facial - sensory portion
taste - anterior 2/3 of the tongue
observation of gestures and facial movements
Treatment considerations: Bells Palsy
damage to peripheral nerve VII
Treamtment considerations: Facial weakness due to cortex lesion
lower face on contralateral side is affected
treatment considerations: facial weakness due to CN VII nucleus lesions
upper and lower ipsilateral side of face affected
Vestibulocochlear - cochlear portion
hearing loss
clinical examination
- snap, finger rub, whisper
- rinne test
- weber test
Vestibulocohlear treatment considerations
any suddent hearing loss should be reffered to a specialist
asymmetrical hearing loss of unknown cause should be assessed with audiogram
vestibulococohlear: vestibular portion
observe for nystagmus, head Impulse test, balance
Head Impulse Test (HIT)
the examiner quicly rotates the patient’s head from 10 degrees to one side back to midline while the patient focuses on a target
normal VOR response of HIT test
patient is able to fixate on central target
abnormal response HIT test
inability to maintain fixation during rotation of the head requiring a corrective saccade once head has stopped moving
Glossopharyngeal
sensory - taste to 1/3 tongue, pharynx and soft palate
motor - stylopharyngeus muscle
Look at swallowing, penlight “AHHH” observe soft palate symmertry, movement of uvula, gag reflex
vagus
motor - to pharynx, larynx, and soft palate and parasympathetic innervation
Lesion of Glossopharyngeal and Vagus could lead to
loss of taste, loss of gag reflex, dysphagia, vocal quality
treatment considerations to glossopharyngeal and vagus
swallowing issues should be evaluated by SLP
be aware of offering liquids to a patient with suspected swallowing issues
Spinal Accessory
Rotate head, Elevate scapula
Hypoglossal
eating, speech
appearance of the tongue - deviate to WEAKER side
the part of the exam that provides us with an awareness of the environment
essential part of the assessment
examination of conscious sensation
sensory exam
which two major sensory pathways that are examined
anterolateral system and dorsal column-medial lemniscus (DCML)
sensory deficit from a cerebral or brainstem lesion usually occur in a
unilateral distribution
a sensory deficit from a spinal cord injury usually occur in a
paraplegic or tetraplegic distribution
a sensory deficit from a spinal nerve lesion will be a
dermatome distribution
sensory deficit from a peripheral nerve lesion will be in the distribution of that
peripheral nerve
esnory deficit from a polyneuropathy will have a ____ distibution because the longest axons are the most effected
stocking and glove
Pain and Temperature
Anterolateral system
Joint position sense, pressure tocuh, vibration
DCML
light touch is represented in both the ___ and ___ system
ALS and DCML
Important part of patient preparation
patient should not be fatigued
occlude the patients vision during the testing
sequencing of the exam
- superficial, deep, combined cortical sensations
- compare bilaterally
- organization based on patient presentation/diagnosis
Light Touch
cottob ball, tissue
demonstrate to patiet
close eyes
ask to response every time they feel the sensation
provide variability by asking the patient when no sensation is being applied
Pain perception - superficial exam
share and dull
paperchip or reflex hammer
demonstrate procedure, defining sharp and dull
ask pt to close eyes
hold in place several seconds
temperature awareness - superficial exam
metal handle of reflex hammer, hot/cold water
demonstrate procedure of defining cold
ask pt to close eyes
vibration Perception - deep
vibration perception
examines ability to perveive a vibratory stimulus
tuning fork, eyes closed, ask the pt if they feel any vibration
pressure touch - deep
not usually assessed formally in PT examination
deep vs light pressure
semmes-weinstein monofilament testing
lateral corticospinal tract - direct connections
signals travel from the motor cortex to the alpha motor neurons of the spinal cord
lateral corticospinal tract - indirect connections
bidirectional connections with extrapyramidal motor system (basal ganglia, cerebellum, brainstem)
Ventromedial Pathways
controlled by brainstem
innervate axial and antigravity muscles and help keep head positioned during dynamic activities
motor neurons that are in the medial part of the ventral horn
tectospinal tract
vestibulospinal tract
reticulospinal tract
generally performed prioer to transferring the patient, abnormal findings are identified and lead to a more detailed ROM and strength
motor exam: screen
things you can observe/inspect for motor skills
posture.positioning, movement, muscle mass (bulk, contour, symmetry, look for atrophy or hypertrophy)
Present when muscles are resting, may go away or become less noticeable with activity of the muscles that are involved, “pill-rolling” temor
resting tremor
oscillations that are exaggerated at the end of the voluntary movement, will often disappear while the affected body part is at rest, seen with cerebrallar pathologies
action/intention tremor
resistance of muscle to passive stretch when the patient attempts to maintain muscle relaxation
muscle tone
flaccidity
a type of paralysis in which a muscle becomes osft and yields to passive stretching
hypotonia
reased muscle tone
spastic hypertonia
a motor disorder characterized by a velovity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks
rigid hypertonia
stiffness separate from the degree of movement
dystonia
unintended muscle contractions that cause slow repetitive movements or abdnormal postures that can sometimes be painful
Muscle Tone Assessment
can be difficult in proximal muscles, issues with inter-ratr reliability, noticed signs of abnormal tone on observation
decorticate rigidity
occurs from disruption of influence from the cerebral cortex, spasticity of the flexor muscles of the upper extremity, extensors of the lower extremity
decerebrate rigidity
occurs from disruption of excitatory input to brainstemp nuclei, spasticity of the antigravity (extensors) muscles of the entire body
Spasticity
Manifestation of UMN lesion (damage to corticospinal pathways)
“catch” or a very stiff limb that cannot be moved passively
tone state is velovity dependent
MAS
Ridigidy/Rigid Hypertonia
“lead pipe or cogwheel” resistance to passive movement
seen in Parkinson’s Disease
Flaccidity and Hypotonia
often seen with LMM lesions and damage to the cerebellum
less resistance than expected to passive elongation of the muscle
may see temporary flaccidity (days-weeks) after a CVA or SCI due to cerebral or spinal shock
motor control of movement
smoothness, initiation, cessation, fractionation, vary velocities
ability to execute smooth, accurate, controlled movement
coordination
primary motor cortex, supplementary motor area, premotor area
motor cortex
internal representation of the environment to provide input that guides motor responses
somatosenosry cortex
initiation and regulation of intentional movement; planning and execution of complex motor task, ability to accomplish automatic movements and postural adjustments
basal ganglia
regularion of movement, muscle tone, postural control
provides signals for error correction
cerebellum
coordination impairments
Ataxia
- dysdiadochokinesia
- dysmetria
- intention tremor
-Synergistic action of mucles
-safety, risk factors for falls
-level of skill, efficiency of movement
-initiation, control, termination of movement
-contributing underlying pathology
-timing, sequencing accuracy of movement
-effect of therapy or medication on motor function
purposes of coordination examination determine. . .
the ability to reverse movement between opposing muscle groups
reciprocal motion
movement control achieved by synergist muscle groups acting together
movment composition/synergy
the ability to gauge or judge distance and speed of voluntary movement
movement accuracy
the ability to hold the position of an individual limb or limb segment
fixation/limb holding
Finger to nose
Pt is asked to alternately touch his/her nose and tip of examiner’s finger
observe
- reciprocal mvoment
-movement composition
-time to perform designated amount and number of errors
Heel to Shin
heel is placed on opposite shin and run up to the knee and back down to the ankle
observe
-performed quickly and without interruption or side to side wavering
-unsteady movement and unable to maintain contact batween the heel and tibia crest
-time to perform designated amount
Rapid Alternating Movements
Rapidly supinate/pronate the forearm
observe
-if performed rapidly and rhythmically
inability to perform rapidly altnerating movements or simple motor tasks involving the rapid contraction and relaxation of the agonist/antagonist muscles
Dysdiadochokinesia
