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NUR350 Final > Neurological assessment > Flashcards

Neurological assessment Flashcards

1
Q

Central nervous system (CNS)

A
  • Brain and spinal cord
  • Meninges; outer layer that covers the CNS to protect it
  • Cerebrospinal fluid; nourish the brain and a cushion
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2
Q

Peripheral nervous system (PNS)

A
  • Cranial nerves, spinal nerves and branches
  • Sensory (afferent) messages to CNS
  • Motor (efferent) messages from CNS
  • 12 cranial nerves
  • 31 spinal nerves and many branches
  • Some nerves can be both sensory and motor (mixed nerves)
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3
Q

Cerebral cortex

A

Outer layer in humans, tightly folded, divided into 2 hemispheres (right/left)

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4
Q

Basal ganglia

A

Deep within the cerebral hemispheres, associated with motor movements (autonomic and occur involuntarily)

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5
Q

Thalamus

A

Relay station, all sensory information from the periphery to the cerebral cortex

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6
Q

Hypothalamus

A

Vital section, controlling body temperature, coordination HR, BP, helps regulate sleep , actions happen in the background (not conscious)

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7
Q

Pituitary gland

A

Regulated by hypothalamus, master gland of the body, below the hypothalamus, released many hormones that direct different processes

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8
Q

Cerebellum

A

Back of brain, maintains equilibrium, coordination/smoothing out of more complex movements, role in maintaining muscle tone

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9
Q

Brain stem

A

Part of brain right before the spinal cord, many fibre tracts that send message to/from the brain, coordinated vital centre activity (HR, BP, respirations)

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10
Q

Spinal cord

A

Long structure that runs down column, continuous with brains stem, down until L1-L2, highway for motor/sensory messages, ascending/descending tract, nerve conduction

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11
Q

Frontal lobe

A
  • Personality
  • Behaviour
  • Emotion
  • Intellectual functions
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12
Q

Broca’s area

A
  • In frontal lobe
  • Motor speech
  • Expressive aphasia; if injured cannot say words
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13
Q

Temporal lobe

A
  • Hearing
  • Taste
  • Smell
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14
Q

Wernicke’s area

A
  • Temporal lobe
  • Speech comprehension
  • Receptive aphasia; if injuired cannot comprehend speech
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15
Q

Occipital lobe

A
  • Visual reception
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16
Q

Parietal lobe

A
  • Sensation
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17
Q

Precentral gyrus

A
  • Primary motor area

- Near frontal and parietal lobe meeting (central sulcus)

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18
Q

Sensory pathways

A
  • Up to brain
  • Detect things in peripheral and send it to the brain
  • Spinothalamic tract
  • Posterior (dorsal) column
  • Depends on type of message
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19
Q

Spinothalamic tract

A
  • Pain
  • Temperature
  • Light (crude) touch
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20
Q

Posterior (dorsal) column

A
  • Proprioception; where body parts are in relation to each other without visual aid
  • Vibration
  • Stereognosis; ability to identify familiar objects without visual aid
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21
Q

Motor pathways

A
  • Descending path from brain to periphery
  • Corticospinal (Pyramidal) tract
  • Extrapyramidal tract
  • Cerebellar system
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22
Q

Cortiospinal (Pyramidal) Tract

A
  • Skilled, purposeful voluntarily movements
  • Higher motor system
  • Fine muscles tone
  • i.e. playing the piano
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23
Q

Extrapyramidal tract

A
  • Muscle tone
  • Gross body movements
  • Older more primitive system
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24
Q

Cerebellar system

A
  • Coordinates movement
  • Maintains equilibrium
  • Posture
  • Unconscious level
  • Makes things smooth
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25
Q

Motor neurons

A

Upper motor neurons

  • Located in the CNS
  • Descending neurons
  • Influence LMN
  • i.e. stoke is a UMN disorder

Lower motor neurons

  • Located in PNS
  • Final pathway before innervating a muscle
  • i.e. spinal cord lesion is . LMN disorder
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26
Q

Cranial nerces

A
  • 12 Cranial Nerves
  • Exit the brain rather than the spinal cord
  • Mainly supply the head and neck (with a few exceptions)
  • Can be sensory nerves, motor nerves, or both
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27
Q

Spinal nerves

A
  • 31 pairs of spinal nerves
  • Named for region of spine with there exit
  • All mixed nerves – can sensory and motor impulses
28
Q

Dermatomes

A
  • Area on the skin that in innervated by one’s spinal nerve

- They overlap a little bit

29
Q

Reflex arc

A
  • PNS functioning

- Basic defence system of the body

30
Q

Autonomic nervous system

A

Sympathetic nervous system - fight or flight

Parasympathetic nervous system - rest and digest

31
Q

PNS afferent vs. efferent

A

Afferent

  • Sensory division
  • From sensory organs to brain

efferent

  • Motor divison
  • From brain to effectors
32
Q

Cranial nerves

A 
i - olfactory 
ii - optic 
iii - oculomotor
iv - trochlear
v - trigeminal
vi - abducens
vii - facial 
viii - acoustic 
ix - glossopharyngeal 
x - vagus 
xi - spinal accessory 
xii - hypoglossal
33
Q

Cranial nerve i

A
  • Olfactory
  • Type: sensory
  • Function: smell
34
Q

Cranial nerve ii

A
  • Optic
  • Type: sensory
  • Function: vision
35
Q

Cranial nerve iii

A
  • Oculomotor
  • Type: mixed
  • Function:
    motor; most EOM movement, opening of the eyelids
    parasympathetic; pupil constriction, lens shape
36
Q

Cranial nerve iv

A
  • Trochlear
  • Type: motor
  • Function: down and inward movement of the eye
37
Q

Cranial nerve v

A
  • Trigeminal
  • Type: mixed
  • Function:
    motor; muscles of mastication
    sensory; sensation of face and scalp, cornea, mucous membranes
38
Q

Cranial nerve vi

A
  • Abducens
  • Type: motor
  • Function: lateral movement of eye
39
Q

Cranial nerve vii

A
  • Facial
  • Type: mixed
  • Function:
    motor; facial muscles, close eye, labial speech, close moth
    sensory; taste (sweet, salty, sour, bitter) on anterior 2/3 of tongue
    parasympathetic; saliva and tear secretion
40
Q

Cranial nerve viii

A
  • Acoustic
  • Type: sensory
  • Function: hearing and equilibrium
41
Q

Cranial nerve ix

A
  • Glossopharyngeal
  • Type: mixed
  • Function:
    motor; pharynx (phonation and swallowing)
    sensory; taste on posterior 1/3 of tongue, pharynx (gag reflex)
    parasympathetic; parotid gland, carotid reflex
42
Q

Cranial nerve x

A
  • Vagus
  • Type: mixed
  • Function:
    motor; pharynx and larynx (talking and swallowing)
    sensory; general sensation from carotid body, carotid sinus, pharynx, viscera
    parasympathetic; carotid reflex
43
Q

Cranial nerve xi

A
  • Spinal accessory
  • Type: motor
  • Function: movement of trapezius and sternomastoid muscles
44
Q

Cranial nerve xii

A
  • Hypoglossal
  • Type: motor
  • Function: movement of the tongue
45
Q

Types of reflex arcs

A

1) Deep Tendon Reflexes (DTRs)
- i.e. hit tendon with a tool

2) Superficial Reflexes
- Exist within the skin

3) Visceral Reflexes
- Involuntary reflex that happen organically

4) Pathologic Reflexes
- Unexpected reflexive response

46
Q

Neurological developmental considerations: infants

A
  • Dramatic growth and development of neurological system during 1st year of life
  • Initially, movements directed primarily by primitive reflexes
  • Sensory and motor system develops during process of myelinization (helps transmit signals faster)
  • Cephalocaudal (head to toe) and proximal to distal order
47
Q

Neurological developmental considerations: older adults

A
  • General atrophy; impaired fine coordination and agility, correction, and balance.
  • Cranial/spinal nerves; velocity of nerve conduction decreases, slows reaction time in some individuals
  • Sensory changes
  • Motor system; slowing down of movement (motor system atrophy)
  • Progressive decrease in cerebral blood flow and oxygen consumption; may cause dizziness, loss of balance
  • Changes in intellectual functioning depend on the individual
48
Q

Subjective assessment of the neurological system

A
  • Headache
  • Head injury
  • Dizziness/vertigo/ syncope
  • Seizures
  • Tremors
  • Weakness
  • Coordination/balance
  • Numbness or tingling; Paraesthesia’s
  • Difficulty swallowing; dysphagia
  • Difficulty speaking; Dysarthria/dysphasia
  • Significant past history
  • Environmental and occupational hazards
  • Sleep, nutrition, medications, substance abuse can throw off findings; ensure accurate picture
49
Q

Sequence of complete neurological examination

A

1) Cranial nerves
2) Motor system
3) Sensory system
4) Reflexes

50
Q

Testing cranial nerve i

A

Assess patency and sense of smell

Patency
- Want both nostrils open; not blocked by secretion – occlude one nostril and sniff

Sense of smell

  • Use a familiar smell, i.e. mint, coffee, etc.
  • Have them let you know when they smell it with eyes closed
51
Q

Assessing cranial nerve ii

A

Assess visual acuity, visual fields, fundus

Visual acuity

  • Snellen chart – optimistrist, letters on the wall
  • Last line the patient can read with 2 or less errors
  • 20/20 in healthy visual acuity
  • Top number is distance standing from chart/bottom number is the number of letters the patient can read accurately

Visual field

  • Peripheral vision
  • Confrontation test
  • Testing assuming the examiner has healthy peripheral vision
  • Very gross assessment of peripheral vision
  • Cover same eye and work with finger to see
52
Q

Assessing cranial nerves iii, iv, and vi

A

Assess:
Palpebral fissures
- Symmetry, signs of infection, etc.
- Ptosis; drooping of one side of an eyelid, worried about nerve iii

Pupils

  • PERRLA; Pupils Equal Round, Reactive to Light, and Accommodate
  • Use pen light from side and then in front, pupil will constrict in response to light
  • Inspect for roundness
  • Accommodation means change in pupil size as someone changes from focusing on something close to something far away

Eye movements (EOM)

  • Extra ocular movements
  • Both eyes move together in a coordinated, smooth fashion
  • Nystagmus – vibration of the eyes
  • Test using a 6-points star
  • Look straight ahead, with just eyes follow your finger movement
53
Q

Assessing cranial nerve v

A

Sensory Function
- Assess light touch; use a wisp of cotton or gauze
3 spots on the face; chin, cheek, and forehead

Corneal reflex – touching the cotton towards the eye, expect the eyes to blink

  • Assess corneal reflex only if necessary

Motor Function
- Assess temporal and masseter muscles, lower jaw movement

54
Q

Assessing cranial nerve vii

A

Motor Function

  • Assess mobility & symmetry with facial expressions
  • Have them make faces, blow up cheeks and push air looking for symmetry

Sensory Function

  • Assess sense of taste
  • Not routinely tested (only when suspect injury)

Parasympathetic Functions

  • Saliva and tear production
  • Ask if mouth is dry and if they are producing tears or not
55
Q

Assessing cranial nerve viii

A
  • Assess hearing acuity; ability to hear
  • Hear regular conversation; just while talking
  • Whispered voice test; stand 2ft behind client, assess one ear at a time
  • Occlude the tragus (one at a time)
  • Whisper something abscure, then test the other side
56
Q

Assessing cranial nerves ix and x

A

Motor Function

  • Assess movement of pharynx
  • Assess for gag reflex
  • Only if observed no movement of the pharynx

Sensory Function
- Difficult to assess posterior
one third of tongue for taste

57
Q

Assessing cranial nerve xi

A
  • Trapeus and sternomastoid muscles
  • Assess against resistance of examinor
  • Equal resistance on both side
58
Q

Assessing cranial nerce xii

A
  • Assess movement of the tongue
  • Assess movement of the tongue and person’s ability to articulate “light, tight, dynamite”
  • Assessing strength of voice, enunciation
59
Q

Motor system assessment: muscles

A
  • Gross screening
  • GO head to toe
  • Size; equal on both sides
  • Strength; equal on both sides
  • Symmetry
  • Tone; engage the client in passive ROM
  • Involuntary movements; tremors, twitches, etc.
60
Q

Motor system assessment: cerebellar function

A

Balance test
- Gait; smooth, steady, coordinated walking
- Ataxia; uncoordinated, unsteady gait
- Tandem walking; walking on line, heal to toe – any issue of coordination is increased when we decrease base of support
- Romberg test; feet together, arms at side, ask them to close their eyes (20 secs, positive test is if they completely lose balance
Coordination and skilled movements
- Rapid alternating movements; take finger and touch it to thumb, perform smoothly; OR hand son thighs alternate back and forth smoothly
- Finger to finger test; able to mostly do it; your finger, touch their nose then touch tour finger while you move your finger around
- Finger to nose test; eyes close, touching their nose with alternating finger
- Heel to shin test; lying or sitting on bed, have opposite heel touching shin, and slide down; should do smoothly on both sides

61
Q

Sensory system assessment: spinothalamic tract

A
  • Pain; break tongue blade and have them assess with eyes closed to feel sharp or dull sensation on skin
  • Temperature; done if abnormal pain sensation test
  • Light touch; points on periphery with light touch to assess
62
Q

Sensory system assessment: posterior column tract

A
  • Vibration; tuning fork
  • Position; close eyes and move limbs in different positions
  • Fine touch;
  • Stereognosis – eyes closed put something familiar in hand, should be able to detect what it is
  • Graphesthesia; use finger to write in hand letter or number
  • 2 point discrimination; take paper clip and unfold it (2 pointy ends) and can alter the distance; fingertips can detect that it’s two distinct pints but not in gross areas such as back
63
Q

Deep tendon reflex testing

A
  • Test the reflex arc at a specific spinal level
  • Biceps, Triceps, Brachioradialis, Quadriceps (patellar, knee jerk), Achilles
  • Grade the response on a 4 point scale
  • To elicit a good response; limb needs to be slightly bent, patient completely relaxed, if they know you will strike them they may tense (good to distract them)
  • Examinor needs to be relaxed holding the hammer, relaxed wrist, strike in a quick gentle way
64
Q

Grading a deep tendon reflex

A 
\+4 - Very brisk, hyperactive with clonus (rhythmic jerking of muscles after reflex is elicited)
\+3 - Brisker than average
\+2 - Average, normal
\+1 - Diminished, low normal
0 - No response
65
Q

Superficial reflex testing

A
  • Sensory receptors in the skin rather than muscles
  • Plantar reflex; bottom of foot with back of hammer, draw and upside down ‘J’
  • Expect tickle and toes turn over
  • Unexpected finding is a full Babskini fan out of toes (only seen in infants)

NUR350 Final (17 decks)

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