Nervous System Flashcards
Screening of Cortical Function
Frontal
Parietal
Temporal
Occipital
Frontal lobe Screening
State months backward, alertness, orientation (name, place, time), follows 1
Parietal lobe Screening
Pin prick testing, light touch , position sense (proprioception), perceptual sense, impaired reading writing (L)
Temporal lobe Screening
Hearing screening (finger rub), ability to follow verbal cues/commands, memory tests.
Occipital lobe Screening
Homonymous hemianopsia
Homonymous Hemianopsia
Damage to the left side of the brain/ occipital. Would cause inability to see on the right
Neurologic Examination
Patient history
Observation
Mental status examination
Vital sign measurement
Cranial nerve examination
Motor function
Sensation
Coordination
Diagnostic testing
Neurologic Examination (Pt Hx)
A detailed history, initially taken by the physician (true neurologic event or another process?).
Is typically presented by the pt or a family member
Pt History (Suggested Framework)
- What is the pt feeling
- When did the problem initially occur , and has it progressed
- What relieves or exacerbates the problem?
- What are the onset , frequency , and duration of S&S
Pt History (related questions)
- Does the problem involve loss of consciousness
- Did a fall precede or follow the problem?
- Is there headache, dizziness , or visual disturbance?
- What are the functional deficits associated w/ the problem?
- Is there an alteration of speech ?
- Does the pt demonstrate memory loss or altered cognition
- Does the pt have an altered sleep pattern?
Neurological Examination (Observation)
- Alertness, arousal
- head, trunk, extremity posture
- Active movement
- ease or difficulty w/ ADLs
- presence of involuntary movements
- muscle atrophy
- RR & patter
Mental Status Examination (LOC)
- Alert
- Lethargic
- Obtunded
Mental Status Examination (LOC)
Alert
- Completely awake
- Attentive to normal levels of stimulation
- Able to interact meaningfully with clinicians
Mental Status Examination (LOC)
Lethargic
- Arousal w/ stimuli
- Falls asleep when not stimulated
- Decreased awareness
- Loss of train of thought
Mental Status Examination (LOC)
Obtunded
- Difficult to arouse
- Constant stimulation to maintain consciousness
- Confused when awake
- Unproductive interactions
Mental Status Examination (LOC)
Stupor (semicoma)
- Arousal only with strong stimuli , returns to unconscious, when stimulation is stopped
- Patient is unable to interact w/ clinician
Mental Status Examination (LOC)
Coma
- Unarousable to any type of stimulus
- Reflex motor responses may or may not be seen
Mental Status Examination (LOC)
Delirium
- State of disorientation marked by irritability or agitation , paranoia , and hallucinations
- Pt demonstrates offensive, loud, and talkative behaviors
Glascow Coma Scale
- Measures the level of consciousness
- ≤8 signifies coma
Mental Status Examination (Cognition)
Attention: have them repeat a sequence of numbers or words back to you
Orientation
Memory
Calculation
Abstraction: metaphor
Judgement:
Mental Status Examination (Cognition)
Clinical Tip
Mental Status Examination (Speech and language)
- SLP is often consulted to perform a more in depth examination of cognition , speech , and swallow .
- PT should be aware of appropriate types of commands , activity modification, and positioning as related to risk of aspiration according to the SLP’s suggestions.
Homeostatic center of the body
The brain (BP, HR, RR, temp control)
Cranial Nerve Examination
- PERRLA
- If vision or pupil size /shape changes during PT session, discontinue –> notify the nurse/physician immediately.
- Nystagmus during the visual exam should also be noted.
Cranial Nerve Examination
Clinical Tip
- Diplopia: double vision or seeing double
- Eye patch can be worn temporarly improve PT participation
Dtermining Motor Function
- Strength testing
- Muscle tone
- DTR
Modified Ashworth Scale
