Neuro OE Flashcards
Overview
- (Cognition)
- Observation/Inspection
- Range of Motion
- Tone & Reflexes
- Strength
- Coordiation
- Sensation
- Functional mobility
Cognition
ONLY FOR Pt with:
* Dementia/Cognitive impairment
* In-Pt: Head trauma/difficulty following commands
- Oriented to time, place, person?
Observation/Inspection
Visually inspec the Pt’s entire body
- compare affected vs non-affected side–> look for asymmetries
Signs of the following
* Muscle wasting
* Pressure sore/wound
* Edema
* Involunatry movement (e.g. tremor, clonus, dyskinesia
* Limb posturing
* Deformity (e.g. shoulder subluxation, contractures)
* Neglect
Posture assessment
- Assess in sitting & standing (if able)
- Use a top-down approach to maintain consistency
- View multiple angle - side, front, back
Why is observation important?
This information will help me determine the baseline for the Pt. How much are they affected by the neurological?
This information can also be helpful as pre-post treatment outcome measure and can help guide my treatment plan
E.g. Post CVA: significant lim deformity due to severe tone vs normally posturing limb
PD: able to sit upright with good posutre vs unable to do so due to weakness & Tx kyphosis
Range of Motion
Start with a general screen of ROM in axial skeleton and limbs
- Start with AROM, if AROM is WNL and pain-free–>no futher ROM testing needed
- If painful/limited AROM–>proceed to PROM and assess end feel
–> if muscular resistance felt during PROM= procceed to tone assessment
–> if PROM is WNL & pain-free= AROM limted due to muscle weakness= proceed to focused strength assessment
If ROM deficits are noted, I will investigate specific ROM limitation using goniometry measurement
Why ROM testing is important?
It is important to understand the Pt’s limitation to movement. This will help me with my PT diagnosis & my Rx plan, especially when deciding which exercises are appropriate for my Pt.
In a neuro Ax, the most common cause of limited AROM is muscle weakness. This is typically due directly as a result of the neurological impairment (e.g. post stroke: unable to reach overhead, foot drop)
The most common causes of limited PROM are increased muscle tone and joint contractures. Resistance felt druing PROM is indicateive of increased muscle tone.
Gathering this information can help me determien my Pt’s movment potential
Tone & reflexes
Tone Assessment
* Grade tone with Modified Ashworth Scale
- Palpate the muscle
–>this provides me with information about the resting state of the muscle- Hypertonic–>taut & harder than normal
- Hypotonic–>flabby & softer
- PROM Ax
–>Note the ease of movement of the limb- Normal= easily moved and feels light
- Hypertonic= feels stiff and difficult to move
- Hypotonic= feels heavy & inactive
- Spasticity Ax
–>Passively move muscle at an increased speed (the speed that would occur if a limb fell with gravity)
Ensure the limb is supported and the Pt is comfortable
–>Note the following:- Any inc. resistance to passive motion when
speed is introduced - Any sudden catch of the muscle as it moves at a higher speed
- Any inc. resistance to passive motion when
Reflexes Testing
- Deep tendon reflexes (hypo: PNS vs hyper: CNS)
* Biceps brachii (C5-6)
* Brachioradialis (C6)
* Triceps (C7-8)
* Patella (L2-4)
* Achilles (S1-2)
- Long tract (CNS issue)
* Babinski, Clonus
Why tone and reflex testing is important?
Tone and reflexes are altered with neurological conditions and can vary based on the stages of recovery
E.g. acutely post TBI/CVA=hyporeflexia & hypotonia–>over time: hyperreflexia & spasticity
Tone assessments (including reflex testing) can provide insight into the degree of motor and functional impairment as a result of increased or decreased tone
Spasticity Ax: not performed on Pts with LMNL (e.g. GBS) or with PD as spasicity is not presented in these conditions
Strength testing
In the neurological population, strength is typically assessed using AROM & functional tasks. I am looking at the general strength of muscle groups through active movement.
E.g.1: Ask Pt to reach overhead to look at AROM & compensatory patterns indicate weakness
E.g.2: assessing a Pt’s ability to extend their knee in sitting/stand up–>assess strength of knee extensors
If muscle weakness is noted or suspected, graded strength testing can be performed using MMT
E.g. Trendelenbur sign was noted when Pt ambulating–>perform glute med./min. MMT
Why is strength testing important?
Weakness does not typically occur in isolation. Usually, there are multiple muscles affected
which is why gathering information about strength using functional movement is typically more informative than assessing and grading every muscle in isolation
Assessing overall strenth and its impact on function can help me determine my Pt’s baseline, their areas of struggle and a treatment plan that can increase strength through functional conditioning
MMT is not approlpriate if…
* Pt unable to assume the starting positing due to ROM limitaitons (contracture)
* Testing is impacted due to severe spasticity/tone
Coordination Testing
Dysdiodochokinesia
- UE: Rapid alternating supination & pronation of the forearm
- LE: Rapid alternating toe taps
Dysmetria testing
- UE: Finger to nose, Fingertip to thumb, opposition
- LE: heel slide on shin
Not appropriate for Pts with weakness–>impacts their ability to pefrom the desired movements
Why is the coordiantion test important?
Alternations in proprioception as well as conditions affecting parts of the CNS (cerebellum, basal ganglia), can result in coordiation deficits.
Assessing coordination can provide me with insight into my Pt’s functional challenges and impairments and
- help me formulate an appropriate treatment plan
- and/or incorporate effective activity modification strategies
E.g.1 PD: start with ambulation with 1 pole instead of 2 poles
E.g.2 Cerebellar stroke: difficulty walking due to coordination defectis and difficulty with foot placement–>seated foot-tapping strategies
Sensation testing
Including
* Light touch
* Temperature
* Sharp/dull
* 2-point discrimination
* Vibration
* Proprioception (joint position sense)
conduct these Ax on the limbs as those are related to function (dexterity/ fine motor use/ balance/ ambulation)
Why is sensation test important?
Sensation is frequently impaired in individuals with neurological conditions.
Understanding the type and extent of sensory impairments can provide you with insight into your patient’s condition
and a better understanding of why they may struggle with certain tasks
E.g. post-CVA has difficulty with fine motor control–>strength WNL but lost superficial sensation in hand–>the difficulty due to sensory impairment–>help me formulate an appropriate treatment plan
Functional Mobility
Make these tests meaningful to the patient
Refer to the SE/details regarding functional impairments within the case→state 3-4 formal outcome measure
Mobility (depend on Pt’s mobility & ability)
* Bed mobility (bridge, roll, supine to sit), transfers, sit to stand, ambulation (gait Ax), stairs, WC managment (independ vs dependent)
* Getting on and off the floor (determine if can get up off the floor after a fall)
* Upper limb function (if applicable)
–>Reach, grasp, pincer grip (e.g. hand hynamometer, box & block test)
–>Lift (e.g. lifting walker in/out of car)
–>Carry (e.g. walk and carry box with 1 or both hands)
Endurance (if applicable)
* 10-meter walk test
* 6-minute walk test
Balance
* Sitting & standing balance (if able)
Progression: vision–>BOS–>internal perturbations–>expected external perturbations–>unexpected external perturbations
* Berg balance scale (or parts of BBS e.g. SLS, tandem stance, standing eye closed)
* TUG
* Community balance & mobility scale (CB&M)
