Neural Integrity Tests

Question 1

How do you assess dermatomes?

Answer 1

• Gently stroke skin with tissue over the dermatomes
• Compare both sides (find % of sensation reduction or some degree of quantification)
• Document sensation changes

Question 2

What are you assessing for when looking at myotomes?

Answer 2

Assessing for weakness (not pain)

Question 3

What are the neural integrity tests?

Answer 3

• Dermatomes
• Myotomes
• Reflexes

Question 4

What are the Upper Motor Neurone Lesion Tests?

Answer 4

• Clonus
• Babinski

Question 5

How do you conduct a reflex assessment?

Answer 5

• Patient needs to be relaxed and comfortably supported
• A tendon reflex is elicited by briskly striking the tendon of a muscle which is on a slight stretch

Question 6

Which segments are you assessing when conducting a reflex assessment on the Quads tendon?

Answer 6

L3/4

Question 7

Which segments are you assessing when conducting a reflex assessment on the Achilles tendon?

Answer 7

L5/S1

Question 8

What does a brisk/hyperactive reflex indicate?

Answer 8

Upper motor neuron pathology

Question 9

What does a diminished/absent reflex indicate?

Answer 9

Lower motor neuron pathology

Question 10

What can be done to help elicit reflexes?

Answer 10

‘Reinforcement’ - tense muscles

Question 11

What are the contraindications to neurodynamic assessment?

Answer 11

• Malignancy
• Cauda equina / cord involvement
• Active inflammatory or infective disease
• Bone disease
• Joint instability, fracture or dislocation

Question 12

What are the precautions to neurodynamic assessment?

Answer 12

• Rheumatoid Arthritis
• Osteoporosis
• Spondylolisthesis
• Hypermobility
• Pregnancy
• Vascular disorders
• Previous malignant disease
• Recent trauma
• Psychological issues.

Question 13

How do you conduct a neurodynamic test?

Answer 13

• Test the pain free side first (baseline).
• Explain to patient what you’re looking for + when they should respond (“let me know as soon as you feel any pulling, stretching, tightness or pain”)
• Move slowly, adding components on one at a time
• Once the sensation is reported clarify what the patient can feel and where
• Remove a component at a joint away from the sensation to confirm neural
• Document range, response and final position

Question 14

What are the sensitising tests for a straight leg raise?

Answer 14

• Dorsiflexion
• Hip adduction
• Hip medial rotation
• Neck flexion