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
