Neurological Assessment

Question 1

How does the nervous system develop as an infant?

Answer 1

Myelination of nerves to and from the brain is complete at 2 years old

Myelination and growth of connective muscle tissue is developed until adolescence.

Question 2

What are some planned assessment for neurological systems?

Answer 2

1. MSK and Neuro assessed by health visitor at developmental ASQ (structural approach)
2. Developmental milestones checked for delays
3. Presence of primitive reflexes

Question 3

What are some red flags that can be picked up in planned developmental assessments?

Answer 3

1. Slow, stagnant and regression
2. Delay motor skills (hypotonia or cerebral palsy)
3. Language (babbling by 12 months, single words by 16 months, two word sentence 24 months or loss of language)
4. Vision - fix gaze 6-8 weeks - track at 3 months - track and reach for at 3-6 months
5. Behaviour - social behaviour impacting functioning

Question 4

Define - congenital malformations

Answer 4

Disruption to central nervous development eg. Hydrocephalus

Question 5

Define - Non-progressive brain damage

Answer 5

Persistent disorder due to early developmental brain damage, impacts subsequent development

Question 6

Define - vascular disorders

Answer 6

Structural abnormalities eg. Arteriovenous malformation (blood vessels complex web that can burst easily), Cerebral bleeds and strokes

Question 7

Define - Seizure disorders

Answer 7

Affect motor, sensory and cognitive function

Question 8

State the different types of neurological abnormalities

Answer 8

Congential malformation
Non-progressive brain damage
Vascular damage
Seizure disorders
Neoplastic disorders
Neuromuscular disorders
Learning disabilities
CNS infections like meningitis

Question 9

What is a type of neuro plastic disorder?

Answer 9

Brain tumour

Question 10

What is cushing triad?

Answer 10

Increased BP, decreased heart rate and decreased respirations.
- Sign that there is increased intracranial pressure

Question 11

State the different subsections of the neurological assessment

Answer 11

• Vital signs
• GCS
• Pupillary responses
• Limb movement/power

Question 12

Explain GCS scale

Answer 12

• Glasgow coma scale
• Best motor response (adapted for spontaneous movement in infants who can obey commands or consciously move)
• Eye opening - size, responsiveness (age dependant)
• Verbal response - (development of language and child fear to consider like babbling counts)

Question 13

In what situations would you require a neurological assessment?

Answer 13

• Teenager with DKA
• Child pre-op
• Child post-op
• Child in outpatients for routine appointment
• Infant presenting unwell
• Child required CPR
• Child asleep at night on the ward
• Child that has received medication for seizures

Question 14

What is the range of motor responses for children?

Answer 14

1. No motor response
2. Abnormal extension to pain
3. Abnormal flexion to pain
4. Withdrawal from pain
5. Localises to pain stimuli or withdraws to touch
6. Obey commands or performs normal spontaneous movements

Question 15

What is the range of verbal response for children?

Answer 15

1. no vocal response
2. incomprehensible sounds
3. inappropriate words
4. confused
5. orientated