Neurological Assessment Flashcards
Number of spinal nerves
8C, 12T, 5L, 5S, 1C
Function of the autonomous nervous system
Maintains involuntary functions of cardiac and smooth muscle of the viscera and glands
Function of the sympathetic nervous system
Produces body to action during periods of physiologic and psychologic stress
Function of the parasympathetic nervous system
Complements and counterbalances the SYN to conserve body resources and day-to-day functions
SCAT
Sport Concussion Assessment Tool, a way to measure concussions, often used as a baseline
Cranial nerves responsible for difficulty swallowing
9 (glossopharyngeal) and 10 (vagus)
Important cranial nerves in neurological assessment
2, 3, 7, 9, 10
Three indicators of the Glasgow Coma Scale
- Eye opening
- Verbal response
- Motor response
Range of the GCS
15 to 3
Oriented x 3
Patient knows their name, the time, and their location
GCS eye opening scores
4 - Spontaneously
3 - To speech
2 - To pain
1 - None
GCS best verbal response scores
5 - Oriented 4 - Confused 3 - Inappropriate 2 - Incomprehensible 1 - None
GCS best motor response scores
6 - Obeys commands 5 - Localizes 4 - Withdraws 3 - Flexion 2 - Extension 1 - None
Widening pulse pressure
Emergency situation; could indicate increasing ICP
Wernicke’s area
- Temporal lobe
- Language comprehension
Receptive aphasia
Issues with language comprehension. Speech and writing can be produced, but they do not understand what is being asked of them. They do not know there is a problem
Broca’s area
- Frontal lobe
- Speech production
Expressive aphasia
The ability to understand language, but the inability to produce speech
Central pressure points
Trapezius squeeze, supraorbital pressure
Decerebrate posture
- Damage to upper brain stem
- Arms adducted/extended, wrists pronated, fingers flexed, legs extended, feet plantarflexed
Decorticate posture
- Damage to corticospinal tract(s)
- Arms adducted/flexed, wrists/fingers flexed on chest, legs extended/internally rotated, feet plantarflexed
20/40 vision
Must stand at 20 feet to see what an individual with 20/20 vision can see at 40 feet.
PERRLA
Pupils equal, round, reactive to light, and accommodation.
How the oculomotor nerve is assessed
Pupillary response
Direct light reflex
Shine light in from temporal area 6 inches in front of the eye. Pupils should constrict briskly.
Consensual light reflex
Repeat above procedure on same eye but assess other eye for simultaneous constriction of pupil. Repeat light reflex assessments on other eye.
Accommodation
Ask client to focus on an object in the distance. Both pupils should dilate.
Pupillary response in an unconscious person
Should still be evident
Pupillary response in someone who cannot see out their eye
Should not be evident; without sensory input there will be no motor response
CN III lesion
Loss of consensual pupillary light reflex
CN II lesion
Loss of direct pupillary light reflex
Assessment of oculomotor, abducens, and trochlear nerves
Holding up a finger and having the patient follow the finger with their eyes without moving their head
Test for sensation in the facial nerve
Use the anterior 2/3 of the tongue
Test for motor function in the glossopharyngeal and vagus nerve
“Aah” uvula and palate rise, or test the gag reflex
Test for sensation in the glossopharyngeal and vagus nerve
Use the posterior 1/3 of the tongue
Spinal testing
Assesses movement and power of arms and legs and sensation on skin of arms and legs
Test for cerebellar function
Uses balance and proprioception, especially through gait
Tandem walking
Toe-to-heel walking where patients should not need to look at their feet or wobble significantly
Romberg’s test
Patients close their eyes and stand with their feet together. Wobbling may indicate cerebellar injury
Tests for coordination and skilled movements
Rapid alternating movements, finger-to-finger test, finger-to-nose test (proprioception), and heel-to-shin test
Decreased deep tendon reflexes
Indicate a peripheral problem
Exaggerated deep tendon reflexes
Indicate a central problem
Biceps reflex
- C5, C6
- Depress biceps brachii tendon
Brachioradialis reflex
- C5, C6, C7
- Strike brachioradialis tendon while arm is relaxed
Triceps reflex
- C6, C7, C8
- Tap triceps tendon with sharp end of hammer while forearm is hanging loose at right angle to arm
Patellar reflex
- L2, L3, L4
- Strike patellar tendon
Ankle jerk reflex
- S1 and S2
- Achilles tendon is tapped while the foot is dorsiflexed
Cremasteric reflex
Lightly stroke superior and medial part of the thigh.
Cremasteric reflex
Lightly stroke superior and medial part of the thigh
Babinski reflex
- L4 to S2
- Sole of foot is stimulated with blunt instrument
- CNS issues will fan toes in response unless they are under age of 2
Paralysis
Decreased or loss of motor nerve power due to problem with motor nerve or muscle fibres
Myoclonus
Rapid, sudden jerk at regular intervals (e.g. hiccups)
Tic
Involuntary, compulsive, repetitive twitching of a muscle group (e.g. wink, grimace, head movement, shoulder shrug)
Fasciculations
Rapid, continuous twitching of resting muscle that can be seen or palpated (fine or coarse)
Localization
Unable to follow commands but may move spontaneously or purposefully such as removing O2, IV lines, etc.
