Neuro Assessment Day 2 Flashcards
what is spasticity?
rate dependent rigidity
moving the limb faster causes it
what would spasticity indicate?
Upper motor neuron lesion
CP, stroke
what is rigidity?
non-rate dependent rigidity
lead pipe rigidity
what would rigidity indicate?
parkinsonism
what would flaccid muscles indicate?
lower motor neuron lesion
what is the thenar eminence?
pad of hand at the thumb
what would cause atrophy of the thenar eminence?
carpal tunnel syndrome
what is important to consider when evaluating muscle strength?
- what would be “normal” for that person
2. symmetry
what the scale for evaluating muscle strenght?
0-no movement 1-flicker of muscle 2-moves but not against gravity 3-moves against gravity but not against resistnace 4-moves against some resistance 5-normal
what nerves does the grip test evaluate?
C7, C8, T1
what nerves does intrinsic hand muscle evaluate?
C8, T1, ulnar
what nerves does wrist flexion evaluate?
C7, C8, T1
what nerves does wrist extension evaluate?
C6, C7, C8
what does C6 innervate?
thumb and forefinger
what does elbow extension evaluate?
C7, C8
what does elbow flexion evaluate
C5, C6
what does shoulder adduction evaluate?
C5 through T1
what does shoulder abduction evaluate?
C5, C6
what does hip flexion evaluate (bringing the leg forward)?
L2, L3, L4
what does hip extension evaluate (bringing the leg backward)?
L5, S1
what does hip abduction evaluate?
L4, 5, S1
what does hip adduction evaluate?
L2, 3, 4
what does ankle dorsiflexion evaluate?
L4,5
what does ankle plantar flexion evaluate?
S1, 2
what is the usual progression of sensory deficits?
start distal and move proximal
what will help to evaluate where the nerve pathology is located?
combining muscle and sensory findings
what are possible causes of sensory neuropathy?
- peripheral afferent nerve fibers (DM)
- spinothalamic tract (crosses at the level of the spine) pain, temperature, crude touch
- dorsal column (crosses at the level of the brain stem)-discriminate touch, vibration, pressure
- cortex
what is stereognosis?
being able to identify an object with eyes closed
when testing sharp/dull which side is used as a control?
cotton side of the wooden cotton stick so that patients don’t say sharp, sharp, sharp
when would you use temperature test?
if pain stimulus was abnormal
where do you test proprioception first?
toes and fingers and only if that is not in-tact would you go more proximal
what is graphesthesia?
ability to identify a number by feel alone when traced in the pt’s hand
what is 2 point discrimination?
ability to identify 2 simultaneous stimuli
what is extinction?
you are touching both arms, but they only feel that you are touching one
what is a positive Romberg test?
pt can’t stand still with eyes closed
-may indicate dorsal column problem
how would a cerebellar issue manifest itself?
can’t stand without wobbling
what are the specific cerebellar tests?
finger to nose (point to point)
rapid alternating movements
gait
what is dysmetria
missing the mark
what is dysdiadokinesia?
inability to perform movements with speed and accuracy
absent reflexes would indicate
peripheral neural damage
normal reflexes with other problems could indicate
spinal cord damage
hyperreflexes would indicate
central neural damage
how would a normal reflex evaluation be documented?
2+
what is clonus?
reflex turns into muscle contraction and is documented as a 4+
what does patellar reflex test?
L2, 3, 4
what does achilles reflex test?
S1, 2
what does biceps reflex test?
C 5, 6
what does triceps reflex test?
C7, C8
what does brachioradialis relfex test?
C5, C6
what is asterixis?
sudden, brief, non-rythmic flexion of hands and fingers when holding out arms with wrists extend
-liver flap (metabolic encephalopathy)
what is winging of scapula?
scapula protrudes out
-may be seen in nerve injury or muscular dystrophy
what are meningeal signs?
- nuchal rigidity
- kernig’s sign
- brudzinskis sign
stroke is defined as…
death of brain tissue due to lack of oxygen
what is a thrombotic stroke?
blocks blood flow to the brain at a local area that creates a clot
what is an embolic stroke?
blocks blood flow to the brain that comes from a distant area
- common cause is plaque from the carotid artery
- afib
what are common causes of hemorrhagic stroke?
aneurysm (outpouching of a blood vessel)
what would decerebrate position indicate?
brain stem lesions
what would decorticate position indicate?
stroke
what would a positive pronator drift test indicate?
contralateral lesion in the corticospinal tract
what is the first sensation to be lost in PPN?
vibration
