neuro- DTRs

Question 1

what do we want to note when examining DTRs?

Answer 1

Note speed, force, and amplitude to grade reflex (0-4+)

Compare side to side (should be symmetric!)

Question 2

what is the DTR grading scale?

Answer 2

0:no response
1 +: somewhat diminished, low normal
2+: average/normal
3+:brisker than average; maybe indicative of disease
4+: very brisk, hyperactive , w/ clonus (rhythmic oscillations between flexion and extension)

Question 3

what is reinforcement for DTRs ?

Answer 3

what to do with Symmetrically diminished or absent reflexes
–>Isometric contraction of other muscles for up to 10 seconds that may increase reflex activity
Arms – Clench teeth or squeeze thigh with opposite hand
Legs – Lock fingers and pull one hand against the other just before striking tendon

Question 4

what is clonus?

Answer 4

Clonus – test for when reflexes appear hyperactive
Support partially flexed knee
Passively plantar flex then dorsiflex foot several times while encouraging patient to relax
Sharply dorsiflex foot and maintain position
Observe/feel for rhythmic oscillations between dorsiflexion and plantar flexion – usually no reaction

Question 5

where do you strike for brachioradialis reflex?

Answer 5

1-2 inches above wrist - look for flexion and supination of forearm

Question 6

abdominal cutaneous reflex? what if they are obese?

Answer 6

Observe for contraction of abd muscles and deviation of umbilicus toward stimulus
Obesity – retract pt’s umbilicus away from stimulated side and feel for muscular retraction during stimulus

Question 7

what to do if you suspect meningeal inflammation?

Answer 7

check for Neck mobility…Ensure no cervical injury
Passively flex neck forward until chin touches chest
normal = supple

Question 8

what are two types of meningeal signs?

Answer 8

Brudzinski’s Sign: Flex neck, Observe hips and knees in reaction. Should remain relaxed/motionless
Kernig’s Sign: Flex leg at both hip and knee and then straighten knee. Should not produce pain
Bilateral? Meningeal irritation

Question 9

how do you test lumbosacral radinopathy? what would indicate you to test this?

Answer 9

Straight leg raise:
Low Back Pain with Radiation of Nerve Pain Down Leg (Sciatica in S1 distribution)
Raise relaxed straight leg then dorsiflex foot
At what elevation does pain occur, quality, distribution
What is the effect of dorsiflexion?

Question 10

what would a positive be for lumbosacral radinopathy test?

Answer 10

Pain into ipsillateral leg is positive for lumbosacral radiculopathy

Question 11

what it asterixis?

Answer 11

Metabolic encephalopathy?
Extend both arms and with palms facing outward and fingers spread as if to say “stop”
Observe 1-2 minutes for any sudden, brief, nonrhythmic flexion of hands/fingers

Question 12

what is winged scapula?

Answer 12

Shoulder muscles weak? Atrophic?
Patient extends both arms and pushes against your hand or wall
Observe scapula for winging of the scapula
Medial border juts back
Weak serratus anterior (Muscular dystrophy or injured long thoracic nerve)