neurologic system assessment Flashcards
somatic nervous system
transfer impulses from CNS to skeletal muscles (voluntary)
autonomic nervous system
- relays impulses from CNS to involuntary organs, smooth muscles, cardiac muscles, glands (involuntary)
- SNS (stim by adrenaline)
- PNS (rest + relax)
peripheral nervous system
- sensory (afferent) messages to CNS from sensory receptors
- motor (efferent) messages from CNS out to muscles + glands
- autonomic messages that govern internal organs + blood vessels
aging adult: ____ w/ _____ of neuron structure in brain + spinal cord
- atrophy
- steady loss
age-related changes: ____ of nerve conduction ______ making rxn time ______
- velocity
- decreases
- slower
age-related changes: ____ delay at synapse results in _____ sensation of touch, pain, taste, smell
- increased
- diminished
age-related changes: motor system may show general _____ of movement, muscle strength, and agility _______
- slowing down
- decrease
age-related changes: progressive ______ in cerebral blood flow + oxygen consumption may cause _________.
- decrease
- dizziness + loss of balance
subjective data examples
- HA
- head injury
- dizziness/vertigo
- seizures
- tremors
- weakness
- incoordination
- numbness/tingling
- difficulty swallowing
- difficulty speaking
- pt-centered care
- env/job hazards
subjective data: HA.. ask about?
- onset, freq, severity
- location, quality description, associated factors
subjective data: head injury… ask about?
- event hist, type, description
- loss of consciousness + recall of event
subjective data: dizziness/vertigo… ask about?
- onset, duration, description, frequency
- associated w/ change in position
- vertigo characteristics: objective/subjective vertigo
subjective data: seizures… ask about?
- course + duration
- motor activity in body
- associated clin presentations
- postictal phase
- precipitating factors
- med therapy
- coping strategies
subjective data: tremors… ask about?
- onset, type, duration, freq
- precipitating + alleviating factors
subjective data: weakness… ask about?
- localized/generalized, distal/proximal
- impact on mobility or ADLs
subjective data: incoordination… ask about?
- probs w/ balance while standing/ambulating.
- lateral drifting, stumbling, falling
- legs giving way and/or clumsy movements
subjective data: numbness/tingling… ask about?
- onset, duration, location
- whether it occurs w/ activity
subjective data: difficulty swallowing… ask about?
- w/ solids/liquids
- drooling
subjective data: difficulty speaking… ask about?
- onset, pattern, duration
- forming words or saying what you want to say
subjective data: pt-centered care… ask about?
info regarding past pertinent med hist
subjective data: env/job hazards… ask about?
- exposure hist
- med hist: Rx + OTC
- alc hist
- substance abuse/drug hist
subjective data: dizziness… ask about?
- association w/ positional change/activity/medication
- impact on ADLs
- safety mods
subjective data: memory… ask about?
- decrease in mental fxn/confusion
- onset, duration, freq
subjective data: tremor… ask about?
- location
- precipitating + alleviating factors
- impact on ADLs
subjective data: sudden vision change… ask about?
- onset, duration, freq
- loss of consciousness/safety
- impact on ADLs
perform ____ neurologic exam on well persons w/ no significant findings from hist
screening
perform ____ neurologic exam on persons w/ neurologic concerns
complete
perform ______ exam on persons w/ demonstrated neurologic deficits who require periodic assessments
neurologic recheck
sequence for complete neurologic examination
- mental status
- cranial nerves
- motor system
- sensory system
- reflexes
objective data equipment
- penlight
- tongue blade
- cotton swab
- cotton ball
- tuning form: 128 or 256 Hz
- percussion hammer
ooo two titties and fat vagina glazed vaguely ah!
- olfactory
- optic
- oculomotor
- trochlear
- trigeminal
- abducens
- facial
- vestibulocochlear (auditory/acoustic)
- glossopharyngeal
- vagus
- accessory
- hypoglossal
CN1
- olfactory
- smell
- sensory
CN2
- optic
- visual acuity
- sensory
CN3
- oculomotor
- opening of eyelids, eye movement (upward/medial, upward/lateral, medial, downward/lateral), pupil constriction, lens shape
- mixed
CN4
- trochlear
- eye movement (downward/medial)
- motor
CN5
- trigeminal
- facial and scalp sensation, chewing movements
- mixed
CN6
- abducens
- eye movement (lateral)
- motor
CN7
- facial
- motor: facial muscles, close eye, labial speech, close mouth
- sensory: taste sweet/salty/sour/bitter on anterior two thirds of tongue
- PNS: saliva + tear secretion
- mixed
CN8
- vestibulocochlear/auditory/acoustic
- hearing & balance
- sensory
CN9
- glossopharyngeal
- sensory: taste on the posterior third of tongue
motor: talking and swallowing - mixed
CN10
- vagus
- uvula (palate muscles) & swallowing
- mixed
CN11
- accessory
- shoulder shrug (movement of trapezius + sternomastoid muscles)
- motor
CN12
- hypoglossal
- tongue movement
- motor
CN1: olfactory nerve test
- sense of smell in ppl who report smell loss, head trauma, abnorm mental status
- presence of intracranial lesion suspected
CN2: optic nerve test
- visual acuity + visual fields by confrontation
- use ophthalmoscope to examine ocular fundus to determine color, size, shape of optic disc
CN 3/4/6: oculomotor, trochlear, abducens test
- check pupils for size, regularity, equality, direct/consensual light rxn, accommodation
- assess extraocular movements by cardinal positions of gaze
- assess nystagmus
CN III/IV/VI test for _______.
ocular rotations, conjugate movements, nystagmus
CN4/trochlear nerve specifically tests for ____, using _____.
- pupillary light reflex + ptosis
- direct + light consensual pupillary rxn to light
severe nystagmus in both eyes occurs w/?
dz of vestibular systems, cerebellum, or brainstem
CNV/trigeminal nerve assess motor fxn in what?
muscles of mastication by palpating temporal + masseter muscles as a person clenches their teeth
CNV/trigeminal nerve assess sensory fxn by?
w/ person’s eye closed, test light touch sensation by touching a cotton wisp to designated areas on a person’s face: forehead, cheeks, chin
assess WHAT associated w/ CNV/trigeminal nerve if person has abnormal facial sensations/abnormalities of facial movement?
corneal reflex
cotton wisp to the designated areas of the face test what divisions of CNV?
- ophthalmic
- maxillary
- mandibular
CNVII/facial nerve motor fxn
- note mobility + facial symmetry as a person responds to selected movements
- have person puff cheeks, then press puffed cheeks in to see that air escapes equally from both sides
CNVII/facial nerve sensory fxn test
- test only if suspect facial nerve injury
- test sense of taste by applying cotton applicator covered w/ solution of sugar, salt, lemon juice and ask person to identify taste
CNVIII/acoustic/vestibulocochlear test
- hearing acuity by ability to hear norm convos + by whispered voice test
- tuning fork tests
CN IX & X/glossopharyngeal + vagus nerves motor fxn test
- depress tongue w/ tongue blade + note pharyngeal movement as person says ahhh or yawns
- uvula + soft palate should rise in midline
- tonsillar pillars should move medially
- touch posterior pharyngeal wall w/ tongue blade, note gag reflex
- voice should sound smooth, not strained
CN IX & X/glossopharyngeal + vagus nerves sensory fxn test
CNIX does mediate test on posterior one thrid of tongue, but technically too difficult to test
CNXI/spinal accessory nerve examine?
- sternomastoid + trapezius muscles for equal size
- check equal strength by asking person to rotate head against resistance applied to side of chin
- ask person to shrug shoulders against resistance
CNXII/hypoglossal nerve inspects?
- tongue, no wasting or tremors should be present
- note forward thrust in midline as person protrudes tongue
- ask person to say “light, tight, dynamite” and note that lingual speech (sounds of letters l, t, d, n) is clear + distinct
motor system assess: inspect all muscle groups for?
size, note bilateral comparison
atrophy
- abnormally small muscle w/ wasted appearance
- occurs w/ disuse, injury, LMN dz like polio, diabetic neuropathy
hypertrophy
- increased size + strength
- occurs w/ isometric exercise
motor system assess: test what muscle grps for strength?
- extremities
- neck
- trunk
paresis
- weakness
- diminished strength
paralysis
- plegia
- absence of strength
tone
normal tension in relaxed muscles
how to test tone during motor system assessment
- persuade person to relax completely + move each extremity smoothly thru full ROM
- normally note mild, even resistance to movement
what to check for during tone motor system assessment
- limited ROM
- pain w/ motion
- flaccidity
- spasticity + rigidity
flaccidity
- decreased resistance
- hypotonia occur w/ peripheral weakness
spasticity + rigidity
types of increased resistance that occur w/ central weakness
involuntary movements
- norm none occur
- if present, note location, freq, rate, amp
- note movements can be controlled at will
tic
- involuntary, compulsive, repetitive twitching of muscle group
- EX: wink, grimace, head movement, shoulder shrug
- due to neruo cause, EX: tardive dyskinesia, Tourette syndrome, or psychogenic cause (habit tic)
fasciculation
- rapid, sudden jerk or short series of jerks at fairly reg intervals
hiccup
myoclonus of diaphragm
single myoclonic arm/leg jerk is _______ when person is falling asleep
normal
myoclonic jerks are severe w/?
- grand mal seizures
- rapid, continuous twitching of resting muscle or part of muscle w/o movement of limb
fine fasciculation
- occurs w/ LMN dz
- associated w/ atrophy + weakness
coarse fasciculation
- occurs w/ cold exposure
- not significant
athetosis
- sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
- occurs at irregular intervals
- not rhythmic or repetitive
- more convulsive than a tic
sudden/jerky/rapid athetosis: some are _______, some are _______, all are accentuated by _______.
- spontaneous
- initiated
- voluntary acts
athetosis disappears with?
sleep
sudden/jerky/rapid athetosis is common with?
- Sydenham chorea
- Huntington dz
athetosis can also look like?
- slow, twisting, writhing, continuous movement, resembling a snake or worm
- involves distal more than proximal part of limb
slow/twist/writhing athetosis occurs w/?
cerebral palsy
athetoid hand
some fingers flexed, some extended
tremor
- involuntary contraction of opposing muscle grps
- results in rhythmic, back-and-forth movement of one or more joints
tremors may occur ____ or with _____.
- at rest
- voluntary movement
all tremors disappear while?
sleeping
tremors may be slow (____ per sec) or rapid (______ per sec)
- 3 to 6
- 10 to 20
how to test rapid alternating movements (RAM) with hands and knees
- ask person to pat knees w/ both hands, lift up, turn hands over, and pat knees w/ backs of hands
- ask person to do this faster
- norm done w/ equal turning + quick rhythmic pace
what to check for when testing RAM
- lack of coordination
- slow, clumsy, sloppy response = dysdiadochokinesia; occurs w/ cerebellar dz
alternative test to RAM
- ask person to touch thumb to each finer on same hand, starting w/ index finger, then reverse direction (finger-to-finger test)
- finger-to-nose and heel-to-shin
balance test: gait
observe as person walks 10-20 ft, turns, and returns to starting point
normal gait during balance tests
- person moves w/ sense of freedom
- smooth, rhythmic, effortless
- opposing arm swing coordinated
- person turns smooth
- step length is about 15 inches from heel to heel
balance tests: tandem walking
- ask person to walk straight line in heel-to-toe fashion
- check ataxia (uncoordinated/unsteady gait)
tandem walking checks for?
- upper motor neuron lesion
- multiple sclerosis
- acute cerebellar dysfxn
- alc intoxication
how to test for Romberg sign
- ask person to stand up w/ feet together + arms at sides
- when in stable position, ask person to close eyes + to hold position about 20 secs
norm finding during test for Romberg sign
person can maintain posture + balance even w/ visual orienting info blocked
positive Romberg sign means?
loss of balance that occurs when closing the eyes
a (+) Romberg sign occurs w/?
- cerebellar ataxia (multiple sclerosis, alc intox)
- loss of proprioception
- loss of vestibular fxn
cerebellar fxn: asking a person to perform shallow knee bend or hop in place (first on one leg, then other)
- demos normal position sense, muscle strength, cerebellar fxn
- some individuals cannot hop bc aging/obesity
- unable to perform knee bend bc weakness in quadriceps muscle or hip extensors
ask the person to identify various sensory stimuli in order to test?
intactness of peripheral nerve fibers, sensory tracts, higher cortical discrimination
when testing the sensory system, the person’s eyes should be?
closed
sensory tests order
- light touch: cotton ball
- superficial pain: pinprick (split tongue blade w/ pointy end or dull end)
- touch person’s body in random, unpredictable order
- vibration w/ tuning fork in few distal locations
complete testing of sensory system warranted in who?
- those w/ neurologic symptoms, EX: localized pain, numbness, tingling
- discover abnormalities
compare sensations on?
symmetric parts of body
what to do when you find definite decrease in sensation?
map it by systematic testing in that area
proceed from point of decreased sensation toward ___. ask the person to tell you _________. you can map ______.
- sensitive area
- where sensation changes
- exact borders of deficient area
upper extremities dermatomes
- shoulder: C4
- lateral inner bicep: C5
- thumb: C6
- middle finger: C7
- pinky/5th finger: C8
lower extremities dermatomes
- groin: L1
- anterior thigh: L2
- above knee: L3
- medial area at knee level: L4
- on top of foot: L5
- lateral side of foot: S1
anterolateral (spinothalamic) tract
sensory tract that carries pain, temp, crude touch, and pressure from our skin to the somatosensory area of the thalamus
pain is tested by?
person’s ability to perceive pinprick
temperature is tested?
- only when pain sensation is abnorm
- can omit bc fiber tracts are pretty much the same
light touch is tested by?
- applying wisp of cotton to skin in random order of sites + at irregular intervals
- include arms, forearms, hands, chest, thighs, legs
- ask person to say now or yes when touch is felt
- compare symmetric points
dorsal column-medial lemniscus pathway (DCML) or posterior column-medial lemniscus pathway (PCML)
sensory pathway of the CNS that conveys sensations of fine touch, vibration, 2-point discrimination, proprioception (body position) from skin + joints
test vibration by?
test person’s ability to feel vibrations of tuning fork over bony prominences
position (kinesthesia) tests?
person’s ability to perceive passive movements of extremities
loss of vibration sense occurs w/______. often, this is the ____ sensation lost.
- peripheral neuropathy (ex: diabetes + alcoholism)
- first
peripheral neuropathy (a complication of severe, uncontrolled _____) is worse at the _____. it gradually improves as you move ______, as opposed to a specific nerve lesion, which as a _________.
- diabetes
- feet
- up the leg
- clear zone of deficit for its dermatome
how to test position (kinesthesia)
- move finger or big toe up/down + ask person to tell you which way it is moved
- test done w/ eyes closed
- loss of position sense occurs w/ peripheral neuropathy (DM), multiple sclerosis, spinal cord lesions
tactile discrimination (fine touch) tests also?
measure discrimination ability of sensory cortex/stroke
stereognosis
test the person’s ability to recognize objects such as coins/keys by feeling their forms, sizes, weights
astereognosis
- inability to identify object correctly
- occurs in sensory cortex lesions
graphesthesia
- ability to read a number by having it traced on skin
- use blunt instrument to trace single digit number or letter on palm
two-point discrimination
test ability to distinguish separation of two simultaneous pin points on skin
extinction
- simultaneously touch both sides of body at same point
- norm both sensations felt
point location
touch skin + w/draw stimulus promptly; ask person to put finger where you touched
measurement of the ____ or _____ reveals an involuntary muscle contraction. it reveals _____ of reflex arc at specific _____ and normal override on reflex of ______.
- stretch reflexed (DTRs: deep tendon reflexes)
- myotatic reflex
- intactness
- spinal levels
- higher cortical levels
for an adequate response for DTRs:
- limb should be relaxed + muscle partially stretched
- stim reflex by directing short, snappy blow of reflex hammer onto muscle’s insertion tendon
- bilateral comparison: responses should be equal
use of reflex hammer for DTRS
- action takes place at wrist
- strike brief, well-aimed blow + bounce up promptly; do not let hammer rest on tendon
it is the ___ of the hammer, not the _____ of the strike that get the best results
- swing
- strength
use the pointed end of the reflex hammer when aiming at a _____ such as _____ use the flat end when the target is ____ or to ____ the impact and prevent ____.
- smaller target
- thumb on the tendon site
- wider
- diffuse
- pain
4-point scale of reflex response
- no response
- diminished, low norm, or occurs w/ reinforcement
- avg, norm
- brisker than avg, may indicate dz
- very brisk, hyperactive w/ clonus, indicative of dz
subjective scale of DTRs require?
- clinical practice
- scale not completely reliable
- wide range of norm exists in reflex responses
reinforcement
- sometimes reflex response fails to appear
- try further encouragement of relaxation, varying positions, or increasing strength of blow
alternate techniques when doing DTRs testing to help?
elicit reflexes by performing an isometric exercise in a diff muscle grp
EX of isometric exercise in diff muscle grp when performing DTRs
- person lock fingers together + pull as hard as they can, and then strike tendon in knee
- person clench teeth or grasp thigh when doing biceps
biceps reflex
- C5-C6
- support person’s forearm on yours, place thumb on biceps tendon, strike blow on thumb
- norm response: contract of biceps muscle + flexion of forearm
triceps reflex
- C7-C8
- tell person to let arm go dead as you strike triceps tendon directly just above elbow
- norm response: extension of forearm
brachioradialis reflex
- C5-C6
- hold person’s thumb to suspend forearms in relaxation + strike forearm directly, about 2-3 cm above radial styloid process
- norm response: flexion + supination of forearm
quadriceps reflex
- L2-L4
- patellar/knee reflex
- let lower legs dangle freely to flex knee + stretch tendons, strike tendon directly just below patella
- norm response: extension of lower leg
Achilles reflex
- L5-S2
- ankle jerk
- position person w/ knee flexed, hold foot in dorsiflexion + strike Achilles tendon directly
- norm response: foot plantar flexes against examiner’s hand
clonus
- set of rapid, rhythmic contractions of same muscle
- very sudden, jerky movements mainly in hands + arms
- may not present during sleep
hyperreflexia
- exaggerated reflex
- occurs w/ upper motor neuron (UMN) lesions (ex: stroke)
hyporeflexia
- absence of reflex
- lower motor neuron prob
- occurs w/ interruption of sensory afferents or destruction of motor efferents + anterior horn cells (ex: spinal cord injury)
plantar reflex
- L4-S2
- Babinski’s reflex
- apply pressure to outer/lateral bottom of for moving toward + across base of toes
norm response to plantar reflex test
- toes move downward
- plantar flexion of toes + inversion & flexion of forefoot
abnormal response of plantar reflex
- toes fan outward + move toward ceiling
- dorsiflexion of big toe + fanning of all toes
- (+) Babinski’s sign (normal for infants)
- upper motor neuron dz (EX: stoke, CNS dz like meningitis)
neuro exam for head trauma/increase ICP or neuro deficit caused by systemic dz
- change in LOC: perform relative assessments
- motor fxn: check voluntary movement of each extremity by giving specific commands
- pupillary response: check PERLA, note size in mm
- VS: measure + motor, Glasgow + diabetic neuropathy screening
Glasgow coma scale
- eye-opening, motor, verbal response
- quantitative measurement tool to assess LOC/measure decreases in consciousness
- 15: best response
- 8 or less: comatose client
- 3: totally unresponsive
Diabetic neuropathy screening
- monofilament test
- standardized measurement tool to detect peripheral neuropathy
motor fxn check - pronator drift
- ask person to extend both arms forward/halfway up, palms up, eyes closed, and hold for 10-20 secs
- pronator drift: downward unilateral drift + turning in of forearm that occurs w/ mild hemiparesis or stroke
Glasgow eye response
- how awake + alert you are
- 4: spontaneously
- 3: to speech
- 2: to pain
- 1: no response
Glasgow motor response
- how well brain can control muscle movement
- show if there are any issues w/ connections btw brain + rest of body
- 6: obeys commands
- 5: moves to localized pain
- 4: flexion w/drawl from pain
- 3: abnorm flexion (decorticate)
- 2: abnorm extension (decerebrate)
- 1: no response
Glasgow verbal response
- how well certain brain abilities work (thinking, memory, attention span, awareness of surroundings)
- 5: oriented to time, place, person
- 4: confused
- 3: inappropriate words
- 2: inappropriate sounds
- 1: no response
GCS ranges for head injuries
- 13-15: mild TBI/concussion
- 9-12: moderate TBI
- 3-8: severe TBI
pupillary response in a brain injured person:
sudden unilateral dilated + nonreactive pupil is ominous
cranial nerve ___ runs parallel to the brainstem. when increasing _____ pushes the brainstem down (_______), it puts pressure on CN ____, causing _______.
- III
- ICP
- herniation
- III
- pupil dilation
aging adult: CN mediating ____ and ____ not usually tested, may show some ___ in fxn
- taste
- smell
- decline
aging adult: _____ in muscle bulk apparent in ___. ____ muscles often look wasted, even w/ no apparent ____. grip strength is relatively ____.
- decrease
- hand
- dorsal hand
- arthropathy
- good
aging adult: _______ occasionally occurs.
- senile tremors
- benign tremors: intention tremor of hands, head nodding, tongue protrusion
aging adult: dyskinesias
- repeated stereotyped movement in jaw, lips, or tongue may accompany senile tremors
- no associated rigidity present
aging adult: gait
- may be slower + more deliberate than in younger person
- may deviate from midline path
aging adult: RAMs
rapid alternating movements may be difficult to perform
aging adult: ____ of sensation and ____ stimulus needed to elicit a response.
- loss
- increased
after 65 years of age, loss of sensation of ______ at ______ common; loss of ______; tactile sensation may be ______; may need ____ stimuli for light touch; and especially for _____
- vibration
- ankle malleolus
- ankle jerk
- impaired
- stronger
- pain
aging adult: plantar reflex
- may be absent/difficult to interpret
- often not see definite norm flexor response
- still should consider definite extensor response abnorm
aging adult: superficial abdominal reflexes
- may be absent
- prob bc stretching of musculature thru pregnancy or obesity
aging adult: DTRs _____; those in upper extremities usually _____, but ankle jerk commonly _____; knee jerks may be ____; bc aging ppl find it difficult to relax limbs, always use _____ when eliciting DTRs.
- less brisk
- present
- lost
- lost
- reinforcement
health promo: FAST plan
- by american heart association-stroke
- F: face drooping
- A: arm weakness
- S: speech difficulty
- T: time to call 911
health promo: review risk factors
- HTN
- cigarette smoking
- heart dz
health promo: vaccination to reduce risk for?
herpes zoster (shingles) in older adult
warning signs of Alzheimer’s
- memory loss
- losing track
- forgetting words
- getting lost
- poor judgment
- abstract failing
- losing things
- mood swings
- personality change
- growing passive
abnormalities in CN I, olfactory nerve
anosmia
abnormalities in CN II, optic nerve
- defect or abstract central vision
- defect in peripheral vision, hemianopsia
- absent light reflex
- papilledema
- optic atrophy
- retinal lesions
abnormalities in CN III, oculomotor nerve
- dilated pupil, ptosis, eye turns out + slightly down
- failure to move eye up, in, down
- absent light reflex
abnormalities in CN IV, trochlear nerve
failure to turn eye down or out
abnormalities in CN V, trigeminal nerve
- absent touch + pain, paresthesias
- no blink
-weakness of masseter or temporalis muscles
abnormalities in CN VI, abducens nerve
failure to move laterally, diplopia on lateral gaze
abnormalities in CN VII, facial nerve
- absent or asymmetric facial movement
- loss of taste
abnormalities in CN VIII, acoustic nerve
decrease or loss of hearing
abnormalities in CN IX, glossopharyngeal nerve
no gag reflex
abnormalities in CN X, vagus nerve
- uvula deviates to side
- no gag reflex
- voice quality: hoarse/brassy, nasal twang/husky
- dysphagia, fluids regurgitate thru nose
abnormalities in CN XI, spinal accessory nerve
absent movement of sternomastoid or trapezius muscles
abnormalities in CN XII, hypoglossal nerve
- tongue deviates to side
- slowed rate of tongue movement
abnormalities in muscle tone
- flaccidity
- spasticity
- rigidity
- cogwheel rigidity
cogwheel rigidity
- ratchet-like movement
- common sign of Parkinson’s dz
- moving limb feels similar to bending a lead pipe
Parkinson’s dz
- stooped posture
- shuffling walk w/ short steps
- flat facial expression
- pill-rolling finger movements
diabetes pts: test?
- skin sensation on soles of feet
- hold filament by paper handle + touch filament to skin at each site (10 total) for only 1-2 secs
- push filament to make it bend and ask person to say now/yes at each site
decorticate rigidity upper extremities
- flexion of arm, wrist, fingers
- adduction of arm, tight around thorax
decorticate rigidity lower extremities
- extended + rigid legs
- internal rotation
- plantar flexion
- indicated hemispheric lesion of cerebral cortex
decerebrate rigidity upper extremities
- stiffly extended
- abducted
- internal rotation
- palms pronated
decerebrate rigidity lower extremities
- stiffly extended
- plantar flexion
- teeth clenched
- hyperextended back
- more ominous than decorticate rigidity
- indicates lesion in brainstem at midbrain or upper pons
flaccid quadriplegia
- complete loss of muscle tone + paralysis of all 4 extremities
- indicate nonfxnal brainstem
opisthotonos
- prolonged arching of back, w/ head + heels bent backward
- indicates meningeal irritation
Kernig’s sign
- person ly on back w/ hips + knees flexed & bent at 90-degrees, extend + straighten one knee at a time
- (+) Kernig’s sign: resistance, pain (lower back) or inability to extend knee
- (+) sign raise sus for meningitis
Brudzinski’s sign
- forced flexion of neck elicits reflex flexion of hips
- severe neck stiffness cause pt’s hips + knees to flex when neck is flex
- indicates meningitis, subarachnoid hemorrhage, possible encephalitis
