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Patient Evaluation > Neuro pt. 2 > Flashcards

Neuro pt. 2 Flashcards

1
Q

Motor System: if damage occurs ?

A

↓ or absent function distal to the injury

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2
Q

Motor System: if damage is above crossover in medulla, then problem is on ?

A

contralateral side

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3
Q

Motor System: if damage is below crossover in medulla, problem is on ?

A

ipsilateral side

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4
Q

Motor System: 3 kinds of pathways through anterior horn cells (cell bodies in spinal cord) ?

A
  1. Corticospinal (pyramidal) tract
  2. Basal ganglia system
  3. Cerebellar system
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5
Q

Corticospinal (Pyramidal) tract function ?

A

Voluntary movement

Delicate skilled movement ( fine motor skills)

Inhibits muscle tone (normal tension at rest)
residual tone

**keeps use from spasiscity or getting spastic **

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6
Q

Corticospinal (Pyramidal) tract damage results in ?

A

Weakness, paralysis, poor delicate movement

↑ muscle tone ( because it is not inhibited anymore) , ↑ DTR’s

only one that will result in paralysis

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7
Q

Basal Ganglia System function ?

A

Helps maintain muscle tone so we are not flaccid at rest

Gross movement

**this one increases it the other decreases it **

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8
Q

Basal Ganglia System damage results in ?

A

Changed muscle tone (increased)

Problems with posture, gait ( gross movements)

Bradykinesia - lowed movement

Involuntary movements

NO paralysis

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9
Q

Cerebellar System function ?

A

Coordinates motor activity

Maintains equilibrium

Maintains posture

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10
Q

Cerebellar System damage results in ?

A

Poor coordination

Problems with gait, equilibrium

↓ muscle tone

NO paralysis

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11
Q

Motor Exam Checklist focuses on ?

A

Involuntary movements

Posturing

Muscle tone, bulk, strength

Coordination

Of Arms, Legs, Trunk

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12
Q

Motor Exam ?

A

Inspect

Muscle tone

Muscle strength

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13
Q

ME: Inspect ?

A

Involuntary movements, abnormal positions

Muscle bulk – symmetry, atrophy

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14
Q

ME: Muscle strength ?

A

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 **

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15
Q

Passive ROM Upper Extremity ?

A

Put limb through ROM

Grasp forearm and wiggle wrist
-Should be free but not floppy

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16
Q

Muscle Strength Terms: weakness ?

A

paresis

Ex: hemiparesis

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17
Q

Muscle Strength Terms: absence of strength ?

A

paralysis, plegia

Ex: quadriplegia, paraplegia

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18
Q

ME: upper extremities ?

A

Grip strength

Finger abduction

Opposition of thumb

Flex/extend elbow and wrist

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19
Q

ME: lower extremities ?

A

Flex/extend hip

Abduct/adduct hip

Flex/extend knee

Dorsiflex/plantar flex foot

**resist all of these movement to assess strength **

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20
Q

ME: trunk ?

A

Flex/extend, lateral bend spine

Thoracic expansion

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21
Q

Coordination requires what ?

A

Requires integration of all 4 areas working together:

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22
Q

4 ares of coordination ?

A

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 **

23
Q

Coordination: UE

A

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

24
Q

Coordination: LE ?

A

Rapid alternating movements – tap foot

Point to point testing – heel down shin

25
Q

Coordination: Trunk ?

A

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

26
Q

Romberg ?

A

eyes open, then closed

  • Feet together
  • 20-30 seconds
  • By a wall/bed
  • Be ready to catch!
  • maybe combine with pronator drift
27
Q

Sensory System: sensory impulses ?

A

Are part of reflex activity

Give conscious sensation

Give position sense

Regulate autonomic function (BP, P, R)

28
Q

Sensory System: Spinothalamic tract ?

A

pain (sharp vs. dull), temp, crude touch

  • *Different types of sensations are conducted differently
  • *
29
Q

Sensory System: Posterior columns ?

A

proprioception (position sense), vibration, pressure, fine touch

  • *Different types of sensations are conducted differently
  • *
30
Q

Sensory System: Sensory cortex ?

A

localization, discriminatory sense

Different types of sensations are conducted differently

depending on location of lesion you get different sxs.

31
Q

Sensory Damage ?

A

Lesions at different points produce different types of sensory loss

Patterns help to identify location of lesions

Combine with motor findings

32
Q

Dermatomes ?

A

Band of skin innervated by sensory root of a single spinal nerve

Overlapping occurs

33
Q

Sensory Exam ?

A

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 **

34
Q

Sensory Exam consider ?

A

Central or peripheral lesion

Unilateral vs bilateral sensory loss

Dermatomal ( one band) vs. polyneuropathy vs. spinal cord

**DM - more bilateral , stroke - unilateral **

35
Q

Correlate with motor and reflex activity ?

A

Sensory Exam

36
Q

Analgesia ?

A

absence of pain sensation

37
Q

Hypalgesia ?

A

↓ sensitivity to pain

38
Q

Hyperalgesia ?

A

↑ sensitivity to pain

39
Q

Anesthesia ?

A

absence of touch sensation

40
Q

Hypesthesia ?

A

↓ sensitivity to touch

41
Q

Hyperesthesia ?

A

↑ sensitivity to touch

42
Q

Paresthesia ?

A

peculiar sensation w/o obv. stim

43
Q

Dysesthesia ?

A

distorted sensation in response to stim

44
Q

Sensory Exam facts and procedure ?

A

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
  • *
45
Q

Sensory Exam facts and procedure ? cont…

A

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

46
Q

Sensory Exam facts and procedure ? cont… pt. 2 ?

A

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 **

47
Q

Sensory Exam facts and procedure ? cont… pt. 3 ?

A 
Discriminative sensations (evaluate sensory cortex)
Need intact touch and position sense

Stereognosis –ID familiar object

Graphesthesia – number, letter recognition

48
Q

Stereognosis ?

A

ID familiar object

49
Q

Graphesthesia ?

A

number, letter recognition

50
Q

Sensory Exam facts and procedure ? cont… pt. 4 ?

A

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?

51
Q

Two point discrim (vs. 1) ?

A

opened paper clip

52
Q

Point localization ?

A

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 **

53
Q

Extinction ?

A

stimulate bilaterally

Feel both or only one?

Patient Evaluation (29 decks)

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