Neuro Clinical skills

Question 1

What is the purpose of a subjective assessment

Answer 1

learn information about pt that can help you come up with treatments for the pt

learn about possible genetic conditions

diagnose

Question 2

What is the order of things you should ask in a subjective assessment

Answer 2

start with intro about urself

ask for pt demos (age name address gender pronouns)

ask for consent

presenting condition

history of presenting condition

drug/medication history

family history

social historyy

Question 3

what red flags should you look for during a subjective assessment?

Answer 3

MJthreads ca

myocardial infarction

jaundice

tuberculosis

hypertension

rheumatoid fever

epilepsy

asthma

diabetes

stroke

cancer

Question 4

What should you ask under history of present complaint

Answer 4

SOCRATEs - pain assess

Site

onset

character

radiation

associated symptoms

timing

exacerbating/relieving factors

severity

Question 5

What do you test for in motor assessment

Answer 5

active ROM, passive ROM, and resisted ROM

feel for muscle bulk and tone

test for reflexes (lower motor neuron lesions mean there would not be a reflex response)

Question 6

What are the characteristics of an upper motor neuron lesion

Answer 6

rigid paralysis
high tone
hyper reflexia
no atrophy of muscle

occur inside the brain or spinal cord

Question 7

What are the characteristics of a lower motor neuron lesion

Answer 7

low tone
hyporeflexia
flaccid paralysis
muscle atrophy

occur in peripheral motor nerves

Question 8

What do you do for a sensory LMN

Answer 8

tracts - light touch, pain, temp (dont have) , vibration, pressure on dermatomes

pressure, pain, temp - spinothalamic

light touch and vibration - dorsal column

joint position sense (is joint up or down) - spinocerebellar tract

proprioception movement sense - mirror movements with another limb with closed eyes - spinocerebellar tract

Question 9

What do you do for a sensory UMN

Answer 9

tracts - light touch , pain, temp (dont have) , vibration

joint position sense (is joint up or down)

proprioception movement sense - mirror movements with another limb with closed eyes

Localization test (touch one limb, make them touch the location with other limb)

posterior column

2 point discrimination test - have 2 points and see if pt can tell if its one or two points

Stereognosis - ability to identify object from feeling it - give pt something to hold, and then ask them to identify the shape with eyes closed

Graphesthesia - ability to recognize writing or shapes inscribed onto hand - eyes closed draw a number or letter in palm of hand

neglect - open hands infront of pt, and ask them to tell you which hand is opening, then have them close eyes and touch each hand and then both, and ask them to raise hand that is touched, can also do clock thing

Question 10

describe how you would position a pt for lying on affected side

Answer 10

1-2 pillows for head, affected shoulder with pillows,
unaffected leg flexed and pillows under with affected leg straight

Question 11

describe how you would set up a pt lying on unaffected side

Answer 11

1-2 pillows for head

affected shoulder forward with arm supported by pillow

affected leg straight back with pillows

unaffected leg flexedd

Question 12

how would you set up sitting in bed or lying on back

Answer 12

pillows supporting shoulders and head, with affected arm under pillow

same with sitting, but more pillows and pillows under both arms

Question 13

how would you set up sitting in chair

Answer 13

arms forward onto two pillows on table, feet flat on floor with knees above them, affected hand can go up on plinth with pillow under and towel to keep hand open

Question 14

How would you do neuro stretching

Answer 14

start at most proximal joint and work your way down

ex - arm would be shoulder flexion, extension, abduction, rotations, then into elbow extension/flexion, then soupination/pronation, then wrist flexion/extension, then thumb abduction, and splay fingers on towel

hip - anchor leg with stool and stretch into abduction, and also do hamsrting stretch my keeping knee flexed, going into hip flexion, and then straightening the leg

helps by increasing ROM and preventing contracture

Question 15

What is ataxia

Answer 15

impaired coordination

made up of :

dysmetria - cant control range of movement (under/overshoots)

dysynergia - errors in timing

Dysdiadochokinesia - inability to perform rapidly alternating movemtns

Question 16

What is cerebellar ataxia

Answer 16

impaired balancee

Question 17

how is cerebellar ataxia treated

Answer 17

balance exercises

standing with eyes closed

heel toe walking

reaching out while standing

catching/throwing on two legs

progression leads to single leg stands, single leg catching/throwing

Question 18

how is ataxia treated

Answer 18

dysynergia - reach cup by the time i count to 5, can be with upper or lower limb

dysdiadochokinesa - rapidly tap thighs and keep switching between pronated and soupinated

dysmetria - heel to shin, or finger to nose test, or stacking cups

Question 19

what are the functional movements?

Answer 19

sit to stand - head back, shoulders back, arms out, rock back n forth, ready steady stand while pushing off the chair

stacking cups

Question 20

what are strengthening exercises for those with ataxia

Answer 20

hypotonia - high energy, tactile stimulation, tapping and getting them riled up

no gravity, gravity, resistance

increases neural motor recruitment