Neurological Assessment Flashcards
Health History Points
- Headache
- Head Injury
- Dizziness or Vertigo
- Seizures
- Tremors
- Weakness
- Incoordination
- Numbness or Tingling
- Difficulty Swallowing
- Difficulty Speaking
- Significant Past History
Epilepsy
defined as 2+ seizures within a 24h period
Aura
a subjective sensation that precedes a seizure
→ auditory, visual or motor
Paresis
weakness of voluntary movements or impaired movement
Paralysis
loss of motor function as a result of a lesions in the neurological or muscular system, or loss of sensory innervation
Dysmetria
inability to control one’s ROM of their muscles
Paraesthesia
an abnormal sensation, such as burning or tingling
Dysphagia
difficulty swallowing
Dysarthria
difficulty forming words → can still understand words
Aphasia
difficulty with language compression or expression → can still form words (unrelated to conversation)
CN I
olfactory nerve → smell
- tested only when suspected/presence of head
trauma. changes in mental status, or
intracranial lesion
CN II
optic nerve → vision
- snellen eye chart
- confrontation test (peripheral vision)
CN III
oculomotor nerves → extraocular movement (EOM)
a. Eyelid opening
b. pupil constriction
c. lens shape
- 6 cardinal planes of vision
test CN III, IV, and VI together*
CN IV
trochlear nerve → EOM downwards and inward
test CN III, IV, and VI together*
CN V
trigeminal nerve → sensation
a. sensation of the face, scalp, cornea, mucous
membranes, mouth, and nose
b. blinking reflex →corneal reflex
c. muscles of mastication → palpate, feel for
bilateral strength
CN VI
abducens nerve → lateral eye movement
test CN III, IV, and VI together*
CN VII
facial nerve → facial movement, closing of eyes and mouth
a. taste (anterior 2/3 of tongue) → taste
b. saliva and tear production
c. speech
CN VIII
Auditory → hearing + equilibrium
- whispered voice test
- Romberg test
CN IX
Glossopharyngeal → production of speech and swallowing
- taste (posterior 1/3)
- gag and carotid reflex
test CN X and IX together* (observe uvula and soft palate elevation when saying “ahhh”)
CN X
Vagus nerve → talking and swallowing
- sensation from carotid body and sinus,
pharynx, and viscera
- carotid reflex - dec in HR and BP with bilateral
palpation of arteries
**test CN X and IX together ** (observe uvula and soft palate elevation when saying “ahhh”)
CN XI
spinal accessory nerve → movement in trapezius/ sternomastoid muscles
- test with should shrug against resistance
CN XII
Hypoglossal nerve → movement of the tongue
- tongue tone/ bulk
- tongue movement
- clear speech → “light, tight, dynamite”
Motor System (3)
- Muscles
- Cerebellar Function
- Coordination
Motor System: Muscles
- Inspection -
a. size - same bilaterally (<1cm difference)
b. no involuntary movements (if present, note
location, frequency, rate and amplitude) - Palpation - strength and tone (ROM tests with and without resistance)
a. strength - test power of homologous muscles
simultaneously
b. tone - normal degree of contraction in
voluntarily relaxed muscles (passive
resistance to mild stretch)
Motor System: Cerebellar Function (3 tests)
a. Gait - should be smooth, rhythmic, and
effortless
- tandem walk (heel-to-toe walk) normally
straight and balanced
b. Romberg Test
c. One-Leg Hop/ Shallow Knee Bend
Romberg test
ask the patient to stand with feet together and arms relaxed at their sides, close their eyes and stand for 20 seconds → some swaying is normal, but balance should be maintained
- A positive Romberg sign is loss of balance that
occurs when the eyes are closed → closed
eyes eliminate the advantage of orientation by
removing the compensatory response
One-Leg Hop/ Shallow Knee Bend
patient should perform a shallow knee bend or hop in place (depending on physical limitations/ capabilities) → Demonstrates normal position sense, muscle strength, and cerebellar function
- Inability to perform knee bend because of
weakness in quadriceps muscle or hip
extensors is abnormal
Motor Function Coordination Tests
a. Rapid Alternating Movements
b. Ringer-to-Finger Tests
c. Fingers-to-Nose Test
d. Heel-to Shin Test
Sensory System (2)
- Spinothalamic Tract
- Posterior Column Tract
Sensory System: Spinothalamic Tract
a. Pain
b. Temperature
c. Touch
Sensory System: Posterior Column Tract
a. Vibration
b. Position (kinasthesia)
c. Tactile Discrimination
Hypoalgesia
decreased pain sensation
Analgesia
absence of pain sensation
Hyperalgesia
increased pain sensation
Hypoaesthesia
decreased touch sensation
Anaesthesia
absent touch sensation
Hyperasthesia
increased touch sensation
Stereognosis
patient’s ability to recognize objects by feeling their forms, sizes, and weights, with the eyes closed
Astereognosis
inability to identify objects correctly, occurs with sensory cortex lesions
Graphesthesia
the patient’s ability to read a number traced on skin
Two-point discrimination (test)
test the patient’s ability to distinguish the separation of two simultaneous pinpoints on the skin, noting the distance at which the point becomes one
Extinction (test)
simultaneously touch both sides of the body at the same point, asking the patient to identify how many sensations they felt and where
point location (test)
touch the skin and withdraw the stimulus promptly, ask the patient to identify where the sensation was
Reflexes (2)
- Deep Tendon Reflexes
- Superficial (cutaneous) Reflexes
Deep Tendon Reflexes
involuntary muscle contractions in response to an external stimulus (reflex hammer)
Grading Deep Tendon Reflexes
4+ = very brisk, hyperactive with clonus
(abnormal, muscles are contracting without
coordination),
indicative of disease
3+ = brisker than average, may indicate disease
2+ - average, normal
1+ = diminished, low normal
0 = no response → patient might need to be
repositioned or distracted to elicit reflex
response (have patient perform isometric
muscle contraction at a muscle group distal to
the location being examined)
Biceps Reflex
- contraction of biceps
- flexion of the forearm
Triceps Reflex
- extension of forearm
Brachioradialis Reflex
- flexion and supination of forearm
Achilles Reflex
- plantar flexion of the foot
Colonus
Tested for when reflexes examined are hyperactive
- If colonus is present, rapid, rhythmic
contractions of the muscle and movement of
the foot is visible and palpable
Superficial Reflexes
sensory receptors are located in the skin rather than the muscles
Abdominal Reflexes
- ipsilateral contraction of the abdominal muscle
with an observed deviation of the umbilicus
towards the stroke
Plantar Reflex
- plantar flexion of the toes
- inversion and flexion of the forefoot
Flaccidity
Decreased muscle tone (hypotonia), muscle feels limp, soft, and flappy, muscle is weak and fatigued
Spasticity
Increased tone (hypertonia), increased resistance to passive lengthening and then suddenly giving way
Rigidity
Constant state of resistance, resistance to passive movement in any direction, dystonia (constant state of involuntary muscle contraction)
Cogwheel Rigidity
Type of rigidity in which the increased tone lessens by degrees during passive ROM so that it feels like small, regular jerks
Multiple Sclerosis
Chronic, progressive, immune-mediated disease
- Axons become inflamed, demyelinated,
degenerated, and undergo sclerosis
- results in uncoordinated muscle movement, muscle spasms, loss of coordination and balance
Paraplegia
Lower motor neuron damage caused by spinal cord injury
- Initially produces “spinal shock” (no movement
or reflexes below lesion) → gradual return of
deep tendon reflexes (flexor spasms of legs
into extensor spasms of leg
- Spasms lead to extensor tone (knees don’t
bend easily, limited ROM)
