Neuro Flashcards
What are some general questions you might want to ask your pt as part of the neuro exam?
- Have you ever had a sz, stroke, or paralysis?
- have you ever been diagnosed as having a tremor or parkinsons dx?
- have you ever had numbness, tingling, or “pins-and-needles” in your arm or leg that has lasted more than 2 hours?
- Have you ever had nerve injury, MS, or any other nervous system disease?
- Have you had migraine HAs?
- Have you been working at your usual jobs or activities?
- there are more…..also ask more clarifying questions if they answer yes
What is your goal for the pre-op neuromuscular assessment?
Why is this importnat?
- Goal to determine range of motion, any abnormalities or joint problems
- This is important b/c we will take away the normal protective pain reflexes with anesthesia
- dont want to injur them further
How do you assess the temporomandibular joint?
- Place tips of index finger just in front of the tragus of ear, ask pt to open mouth
- fingertips should drop into joint spaces as mouth opens
- check for smooth range of motion, swelling/tenderness
- snapping and clicking is normal
- ask pt to open and close mouth, protrude and retract jaw and side to side
How do you assess the cervical spine?
- Flexion- chin to chest
- extension- look up
- rotation
- lateral bending
How do you assess the shoulder girdle?
- abduct the arms to shoulder level
- raise arms vertical position above head, palms facing each other
- place both hands behind the neck with elbows out to side
- place both hands behind the small of back
What is thoracic outlet syndrome?
why do we care about this?
- compression of brachial plexus and subclavian vessels near the first rib
- be certain pt can work or sleep with arms elevated over their head before putting arms beside head
- we care because arms are better above head for prone positioning
How do you assess the pts elbow?
- ask pt to bend and straighten elbow
- with arms at sides and elbows flexed instruct pt to turn palms up (supination) and down (pronation)
How do you assess the hip?
- focus on ROM that will affect positioning
- Flexion: supine pt bends each knee to chest/abdomen
- abduction: supine pt, stabilize anterior superior iliac spine and abduct the extended leg until the iliac spine moves, this is their limit!

How can you assess the nervous system?
- mental status
- speech
- cranial nerves
- gait
- motor function
- sensory function
How do you assess cranial nerves
I
II
III
- CN I: (olfactory) have them smell something; vanilla or mint
- CN II: (optic)
- sight confrontation test- stand in front of pt, both covering mirrored eye, bring finger in from the periphery, both should see it at same time
- pupillary reaction to light
- CN III: (oculomotor) pupillary reaction to light, look for extraoccular movements
How do you assess cranial nerves
IV
V
VI
- CN IV: (trochlear) look for extraoccular movements
- CN V: (trigeminal)
- ask pt to clench teeth as you paplate temporal muscles
- check sensation (see pic)
- corneal reflex with cotton ball
- CN VI: (abducens) look for extraoccular movements

How do you assess Cranial nerve VII?
- CN VII- Facial
- have pt raise both eyebrows
- frown
- close eyes tightly so you cant open them
- show teeth
- smile
- puff out cheeks

How do you assess cranial nerves
VIII
IX & X
- CN VIII ( acoustic)- this is done by audiology
- CN IX & X ( glossopharyngeal and vagus)
- listen for voice hoarseness
- gag reflex
- say AHHH, palate should rise symmetrically
How do you assess Cranial nerve
XI
XII
- CN XI: (spinal accessory)
- have pt turn their head side to side against your hand
- ask pt to shrug both shoulders up against your hand
- CN XII: (hypoglossal)- ask them to stick out tongue

How is the assessment of muscle strength graded?
- test flexion and extension and compare symmetry
- Grade 0-5 scale
- 0- no muscle contraction detected
- 1- barely detectable
- 2- active movement with gravity eliminated
- 3- active movement against gravity
- 4- active movement against gravity with some resistance
- 5- active movement against gravity with full resistance
Weakness or change in elbow flexion would indicate an injury at ___, ___
elbow extension ___, ____, ____
flexion: C5, C6
extension: C6, C7, C8
A changed or weaked grip strength would indicate injury at ____, ____, _____
- C7, C8, T1
A change or weakness in finger abduction would indicate an injury where?
C8, T1, ulnar nerve
A weakness or change in ability to oppose the thumb would indicate an injury where?
C8, T1, median nerve
A change in strength or inability to flex or adduct the hip would indicate an injury where?
L2, L3, L4
A change in strength or inability to abduct hip would indicate an injurey where?
L4, L5, S1
A change in strenght or inability to extend hip would indicate an injury where?
S1
Problems extending knee,
injury where?
L2, L3, L4
problems flexing knee,
injury where?
L4, L5, S1, S2