Neuro Assessment Flashcards
What is part of a neurological objective assessment?
- AROM
- Power/Strength
- Sensation
- PROM
- Tone
True/False
When assessing PROM you can also assess for tone at the same time?
True
What is used to assess upper limb co-ordination?
- Finger-Nose
- Dysadiadochokinesia (DDK) [hand flipping]
How is proprioception tested?
Using joint position sense
What is important to ask when exploring the history of present condition (HPC) in a neurological assessment?
- Nature of symptoms
- Duration of present symptoms
- Is there a pattern to the symptoms?
What are common signs and symptoms that neurological patients might present with that will guide a therapist towards a specific exercise plan?
- Changes in sensation
- Muscle weakness
- Spasticity
- Fatigue
- Changes in cognition
What are some important social history questions to ask in a neurological assessment?
- What hobbies or interests do they have?
- What accommodation do they live in?
- How does the patient manage with getting washed + dressed?
- Does someone help with their shopping?
- Are they working, on sick leave or unable to work?
What are some common difficulties when rolling a patient following a neurological event?
- Weakness
- Lack of initiation-processing delay
- Trunk restriction
- Weight-bearing asymmetry
- Asymmetrical lower limb placement
- Arm position (high/low tone, splints/casts)
- Pain
- Neglectful head orientation
What are some contextual factors that influence rolling + sitting-lying?
- Base of support (hospital bed, plinth, mat)
- Strength
- Vision & Hearing
- Drips/drains (reduced space)
- Tone
- Sensation
- Activity/task
- ROM
- Pain, anxiety, mood
- Age
- Body weight/nutritional
- Cognitive status (planning ability, problem solving, distraction)
What are some common difficulties with lying-sitting & sitting-lying?
- Weakness
- Lack of initiation (processing delay)
- Trunk restriction
- Weight-bearing asymmetry
- Asymmetrical foot placement
- Arm position (high/low tone, scapular stability)
- Pain
- Neglectful
What are the phases of a sit to stand?
Preparatory phase:
- Anticipatory isometric muscle contraction
- Horizontal and forward momentum is built
Flexion momentum:
- Trunk & pelvis rotate anteriorly
- Hips flex
Momentum transfer:
- Flexion is transferred to extension
- Displacement shifts from anterior to forwards + upwards
Extension:
- Body is brought into upright space
Stabilisation:
- Period from end of hip extension until all motion has stopped
What contextual factors influence sit to stand?
- Foot position
- Seat height
- Arm rests
- Age
- Strength
- Balance
- ROM
- Body weight
- Vision
- Sensation
- Pain
- Psychological status
What are some common difficulties with our patients and sit to stand?
- Instability
- Spasticity
- Muscle weakness
- Weight bearing asymmetry
- Visuo-spatial disorders
- Altered balance (consider anticipatory postural adjustments)
- Reduced sensory info (weighting, integration, etc.)
What are the components of reach to grasp?
Object location & Identification:
- Visual information to improve accuracy
Postural Control:
- APAs prior to movement and ongoing trunk stabilisation activity throughout the task
Transport:
- Hand shaping in preparation to hold object
- Acceleration and deceleration of the arm
Manipulation:
- Stabilisation and movement of an object
What contextual factors effect reach to grasp?
- Vision
- Size of object reached for
- Weight of object reached for
- Grip force
- Distance to be reached
What are some common difficulties with reach to grasp following a neurological event?
- Speed
- Accuracy
- Grading + timing of movement
- Weakness / Compensatory use of trunk
- Scapula stability
- Object location + identification
- Hand orientation + aperture formation
- Finger configuration
- Somatosensory disturbance
What are you observing during a neurological assessment?
- Position
- Posture
- Drips, drains, lines, monitoring
- Involuntary movement and/or tremor
- Environment (if in a person’s home)
What is tone (spasticity)?
The internal state of muscle-fibre tension within individual muscles and muscle groups.
- Normal resting state of the muscles
- Continuum from low (floppy or flaccid) to high (hypertonus or spasticity)
(Tone can increase over time and the patient presents with spasticity which can lead to pain, loss of function and contracture as well as interfering with return of active movement)
How can you assess sensation?
- Light touch
- Pressure
- Sharp-blunt
- Hot & cold
- 2-point discrimination
How can you assess proprioception?
- Mirroring
- Joint position sense
How can you assess co-ordination?
- Heel-Shin
- Finger-nose
- Disdiadochokinesia (DDK)
How can you assess power/strength?
- Testall four limbs for strength (be joint specific ifrequired)
- Check grip strength
- Use OxfordScale(ifappropriate)
What are anticipatory postural adjustments?
- Predictive control of balance
- Predictive contraction of muscles to resist whole body movement
What are postural adjustments?
- Ankle strategy
- Hip strategy
- Stepping mechanism
How can you assess balance?
- Berg
- Tinetti
- Activities-specificBalance Confidence Scale (ABC)
- Sitting or standing: Reaching, Small base of support, Eyes closed, Standing (tandem, one foot)
How do you assess upper limb dexterity & function?
- Doing up/ undoing buttons
- Writing
How do you assess gait?
- Walking aids
- Pattern
- Safety
- Assistance
- Speed + distance
- Stairs
What do you need to consider in your objective assessment?
- AROM
- PROM
- Sensation
- Power
- Tone
- Co-ordination
- Proprioception
- Functional ability
What is the best way to treat a neurological condition?
use repeated, intensive, task-specific & functional activities
Why do we splint?
- prevent contracture
- improve function
What equipment can be used to assist with postural management?
- Sleep systems
- Moulded wheelchairs
- Towels
- Pillows
What are the (2) main treatment strategies to prevent spasticity & manage soft tissue changes?
Stretching:
- Manual
- Splints
- Orthotics
Position & Postural Management:
- Chairs
- Beds
- 24hrs
Describe how to complete stretches to improve mobility.
- Isometric contraction of antagonistic muscle group (6s)
- Relaxation (2-3s)
- Passive stretching of antagonistic muscle group (15-18s)
- Isometric contraction of agonist muscle group (6s)
What are the aims of positioning?
- Encouragingcomfort andavoidance of pain
- Maintenance ofsoft tissue lengthand avoid contractures
- Promote hydration and nutrition
- Promote orientationfor the patient
- Avoidaspiration(aspiration pneumonia)
- Avoidsubluxationor pain ofthe UL (e.g. shoulder pain in stroke)
- Maintain appropriateskin integrity
What does therapeutic handling allow?
- Facilitated normal movement
- Provide de-weighting support
What are assessment tips to look for in terms of cranial nerves?
- Eye movement
- Pupil size
- Facial sensation
- Facial movements
- Tongue movements
- Listen to voice
- Check cough
What are the (4) stages of reach to grasp?
- Object location + identification
- Postural control
- Transport
- Manipulation
What contextual factors can influence reach to grasp ability?
- Weight of object reaching for
- Visual ability
- Sensation in their hand
True or False…
Lateral sitting balance is more dependent on trunk muscles than leg muscles
True
What is the average weight of the human head in kg?
5 kg
What is the approx. total % of whole body weight made up by the trunk?
55%
With neck flexion at 30 degrees, the translated weight of the head onto the trunk is how many pounds?
40
How many key spinal components make up the trunk support system?
4
When assessing PROM during a neuro assessment what are you also assessing for?
Tone
