Neuro pt. 2 Flashcards
Motor System: if damage occurs ?
↓ or absent function distal to the injury
Motor System: if damage is above crossover in medulla, then problem is on ?
contralateral side
Motor System: if damage is below crossover in medulla, problem is on ?
ipsilateral side
Motor System: 3 kinds of pathways through anterior horn cells (cell bodies in spinal cord) ?
- Corticospinal (pyramidal) tract
- Basal ganglia system
- Cerebellar system
Corticospinal (Pyramidal) tract function ?
Voluntary movement
Delicate skilled movement ( fine motor skills)
Inhibits muscle tone (normal tension at rest)
residual tone
**keeps use from spasiscity or getting spastic **
Corticospinal (Pyramidal) tract damage results in ?
Weakness, paralysis, poor delicate movement
↑ muscle tone ( because it is not inhibited anymore) , ↑ DTR’s
only one that will result in paralysis
Basal Ganglia System function ?
Helps maintain muscle tone so we are not flaccid at rest
Gross movement
**this one increases it the other decreases it **
Basal Ganglia System damage results in ?
Changed muscle tone (increased)
Problems with posture, gait ( gross movements)
Bradykinesia - lowed movement
Involuntary movements
NO paralysis
Cerebellar System function ?
Coordinates motor activity
Maintains equilibrium
Maintains posture
Cerebellar System damage results in ?
Poor coordination
Problems with gait, equilibrium
↓ muscle tone
NO paralysis
Motor Exam Checklist focuses on ?
Involuntary movements
Posturing
Muscle tone, bulk, strength
Coordination
Of Arms, Legs, Trunk
Motor Exam ?
Inspect
Muscle tone
Muscle strength
ME: Inspect ?
Involuntary movements, abnormal positions
Muscle bulk – symmetry, atrophy
ME: Muscle strength ?
Bilaterally, with resistance
Grade it 0-5/5 b/l
Allow for age, sex, conditioning
**ROM to see if they are spastic
5/5 is NL
consider age **
Passive ROM Upper Extremity ?
Put limb through ROM
Grasp forearm and wiggle wrist
-Should be free but not floppy
Muscle Strength Terms: weakness ?
paresis
Ex: hemiparesis
Muscle Strength Terms: absence of strength ?
paralysis, plegia
Ex: quadriplegia, paraplegia
ME: upper extremities ?
Grip strength
Finger abduction
Opposition of thumb
Flex/extend elbow and wrist
ME: lower extremities ?
Flex/extend hip
Abduct/adduct hip
Flex/extend knee
Dorsiflex/plantar flex foot
**resist all of these movement to assess strength **
ME: trunk ?
Flex/extend, lateral bend spine
Thoracic expansion
Coordination requires what ?
Requires integration of all 4 areas working together:
4 ares of coordination ?
Motor system
for muscle strength
Cerebellar system
for rhythmic movement and steady posture
Vestibular system
for balance and coordination
Sensory system
for position sense - proprioception
**problems anywhere = problem with coordination **
Coordination: UE
Rapid alternating movements (for speed, dexterity)
-Pronation/supination of forearms
Fingers to thumb
Point to point testing
-Finger to nose – eyes open, then closed
Pronator drift
-Arms forward, palms up, eyes closed, push down
hand starts to fall away and pronate
Coordination: LE ?
Rapid alternating movements – tap foot
Point to point testing – heel down shin
Coordination: Trunk ?
Gait
Tandem walk (heel to toe)
Heel or toe walk, hop on 1 foot, knee bend
Rise from sitting/step onto a stool
Romberg – eyes open, then closed
Romberg ?
eyes open, then closed
- Feet together
- 20-30 seconds
- By a wall/bed
- Be ready to catch!
- maybe combine with pronator drift
Sensory System: sensory impulses ?
Are part of reflex activity
Give conscious sensation
Give position sense
Regulate autonomic function (BP, P, R)
Sensory System: Spinothalamic tract ?
pain (sharp vs. dull), temp, crude touch
- *Different types of sensations are conducted differently
- *
Sensory System: Posterior columns ?
proprioception (position sense), vibration, pressure, fine touch
- *Different types of sensations are conducted differently
- *
Sensory System: Sensory cortex ?
localization, discriminatory sense
Different types of sensations are conducted differently
depending on location of lesion you get different sxs.
Sensory Damage ?
Lesions at different points produce different types of sensory loss
Patterns help to identify location of lesions
Combine with motor findings
Dermatomes ?
Band of skin innervated by sensory root of a single spinal nerve
Overlapping occurs
Sensory Exam ?
Be efficient – unreliable once pt fatigues
Check areas with
Numbness/pain
Motor or reflex abnormalities
Trophic changes
May need to repeat later to confirm findings
**symmetrical dista weakness - DM , alcohol **
Sensory Exam consider ?
Central or peripheral lesion
Unilateral vs bilateral sensory loss
Dermatomal ( one band) vs. polyneuropathy vs. spinal cord
**DM - more bilateral , stroke - unilateral **
Correlate with motor and reflex activity ?
Sensory Exam
Analgesia ?
absence of pain sensation
Hypalgesia ?
↓ sensitivity to pain
Hyperalgesia ?
↑ sensitivity to pain
Anesthesia ?
absence of touch sensation
Hypesthesia ?
↓ sensitivity to touch
Hyperesthesia ?
↑ sensitivity to touch
Paresthesia ?
peculiar sensation w/o obv. stim
Dysesthesia ?
distorted sensation in response to stim
Sensory Exam facts and procedure ?
Tell patient what you are going to do
Eyes closed for exam!
Compare symmetrical areas
-Arms, legs, trunk
Compare proximal to distal areas
Vary the pace
Map out area of loss/change
- polyneuropathy
- or just single dermatome
- *this is sharp and this is dull and then have them close their eyes when you do it
- *
Sensory Exam facts and procedure ? cont…
Test for pain - “sharp or dull?”
Test for temperature
-Can omit if pain sensation normal
cause it is the same tract
Test for light touch – wisp of cotton
“Tell me when you feel a touch”
tell them what to say and when
Test for discriminative sensation
Sensory Exam facts and procedure ? cont… pt. 2 ?
Test for position sense (proprioception)
Grasp SIDES of toe, finger, etc.
“Up or down or middle?”
Test for vibration – start distally – DIP joint
“Tell me when it stops” – grasp TINES
**B 12 deficit, tertiary syyphillis etc etc **
Sensory Exam facts and procedure ? cont… pt. 3 ?
Discriminative sensations (evaluate sensory cortex) Need intact touch and position sense
Stereognosis –ID familiar object
Graphesthesia – number, letter recognition
Stereognosis ?
ID familiar object
Graphesthesia ?
number, letter recognition
Sensory Exam facts and procedure ? cont… pt. 4 ?
Discriminative sensations (cont’d)
Two point discrim (vs. 1) –opened paper clip
Point localization – where touched?
point to where i touched you dont let them explain the location cause it takes to long
Extinction – stimulate bilaterally
Feel both or only one?
Two point discrim (vs. 1) ?
opened paper clip
Point localization ?
where touched?
point to where i touched you dont let them explain the location cause it takes to long
**more sensitive on the finger tips than extremities like the thigh **
Extinction ?
stimulate bilaterally
Feel both or only one?
