Neuro Flashcards
Neurological Assessment (5)
- LOC
- CN Function
- Motor Function: muscle strength; cerebellar function; gait and balance
- Peripheral Nerves/ Sensation
- Reflexes (Babinski, DTRs)
Assessment LOC and mental Stat
alert
not alert
other
- Q4: person, place, time, situation
- Glasgow Coma Scale (GCS)
- ABCT: appearence, behavior, cognition, thought process
GCS
Glasgow Coma Scale
- eye opening
- verbal responce
- motor responce
This is a type of flexed posturing and can indicate damage to the cerebral hemispheres.
There will be adduction and flexion of the arms and the hands will be closed shut (flexed). The legs will be rotated internally and feet flexed.
Decorticate
This is a type of extended posturing and can indicate damage to the brain stem. Severe.
There will be adduction and extension of the arms and pronation of the hands and the fingers will be flexed along with extended legs and plantar flexion of the feet.
Decerebrate
Assessment of CN I - XII, and abnormal finding CN I- olfactory II- optic III- ocularmotor IV- Trochlear V- Trigeminal VI- Abducens VII- Facial VIII- Vestibulocochlear IX- Glossopharyngeal X- Vagus XI- Accessory XII- Hypoglossal
CN I- olfactory: Smell test. Abnormal- anosmia.
II- optic: Sullen eye chart, confrontation, ophthalmoscopic. Abnormal- visual field loss, papilledema.
III- ocularmotor, IV- Trochlear, VI- Abducens: EOMs, PERRLA. Abnormal- ptosis, nystagmus, strabismus, absence of PERRLA.
V- Trigeminal: muscles of mastication, light touch.
VII- Facial: facial symmetry, sweet/ salty taste.
VIII- Vestibulocochlear: whispered voice test.
IX- Glossopharyngeal: gag, sour/ bitter.
X- Vagus: gag “ahhhh”.
XI- Accessory: shoulder shrug, turn head against resistance.
XII- Hypoglossal: midline protrusion of tongue.
Examine Muscles (4)
- Size
- Strength
- Tone (assess via passive ROM)
- ROM
Muscle tone, 3 movements to note:
flaccidity
spasticity
rigidity
paresis
weakness, eg: 1/5 strength
Cerebellar Function Test (5)
- RAMs
- Finger-nose-finger
- Heel-to-shin
- Tandem walking
- Romberg
- RAMs
- Finger-nose-finger
- Heel-to-shin
- Tandem walking
- Romberg
RAMs: Rapid alternating movements (pronation/ supination on thighs; touching each finger to thumb)
- Finger-nose-finger: look for Dysmetira (tremmor or overshooting)
- Heel-to-shin: tests lower extremity coordination
- Tandem walking: Ataxia (uncoordinated unstready gait)
- Romberg: pt stands with feet together, ares at sides, eyes closed for 20 seconds
Assess Peripheral Sensation tests (5)
- sharp vs dull
- light touch
- vibration
- position (with pt eyes closed, move a finger or the big toe up or down and have the pt tell you which way it is moved)
- Monofilament Test: platar side of foot, test 7 sites at random, have pt tell you when they feel the filament (test for neropothy associated with DM)
Tactile Discrimination: Stereognosis Graphesthesia 2 point discrimination Point location
Abnormalities
Stereognosis: key in hand
Graphesthesia: number drawn on hand
2 point discrimination: 2-8mm on fingers
Point location: “put your finger where I touch you”
any abnormalities occur with parietal cortex lesions; or dermatome (spinal cord)
DTRs
where is each reflex, what movement is triggered
Deep Tendon Reflex Bicep: flexion Tricep- extension Brachioradialis: supination and flexion Quadriceps (patellar): extension Achelles: plantar flexion
DTRs
hyper/hyopflexion meaning
Clonus
Babinski
-Hyperflexion: LMN lesion
-Hypoflexion: UMN lesion
-Clonus: raipd rhythmic contractions of the same muscle (briskly dorsiflex the foot and hold; + = rapid tapping motion)
-Babinski: “J” drawn from heel across ball of foot. Toe curling= plantar reflex present, normal
Toe fanning= + Babinski, abnormal (unless <24 months old)
