Neurological Assessment Flashcards
Central Nervous System includes
Brain
Spinal Cord
- Meninges (dura, arachnoid and pia mater) layers of membrane that protect CNS
- Cerebrospinal fluid
Peripheral Nervous System includes
cranial nerves (12 pairs) spinal nerves (31 pairs) and their branches
sensory (afferent) messages to CNS
motor (efferent) messages from CNS
Cerebral cortex
cerebrum’s outer folded layer of nerve cell bodies
- lacks myelin
- “grey matter”
Basal Ganglia
bands of grey matter buried deep within the two cerebral hemispheres
- subcortical associated motor system
- controls automatic movements (i.e. arm swing when walking)
Thalamus
Main relay system for the nervous system
- sensory pathways of the spinal cord and brain stem form synapses on the way to cerebral cortex
Hypothalamus
Control centre for vitals
- temperature
- heart rate
- blood pressure
- regular sleep, anterior and posterior pituitary glad
- emotional status
Cerebellum
Coiled structure under occipital lobe
- Motor coordination of voluntary movements
- Equilibrium (balance)
- Muscle tone
- smooths movement
Brain Stem
Mostly nerve fibres, connects to spinal cord
- Midbrain
- Pons
- Medulla
Spinal Cord
Long cylindrical structure of nervous tissue down to L1/L2, main pathway for ascending and descending fibre tracts
Frontal Lobe
- personality
- behaviour
- emotion
- intellectual functions
Broca’s area: mediated motor speech
injury can cause expressive aphasia - can understand language but cannot talk
Temporal Lobe
- hearing
- taste
- smell
Wernicke’s area: language comprehension
injury can cause receptive aphasia - hears words but cannot comprehend
Parietal Lobe
- sensation
Occipital Lobe
- visual receptor
Sensory Pathways
a. Spinothalamic tract
- pain
- temperature
- light touch
b. Posterior (dorsal) column
- proprioception (body position in relation to surrounding)
- vibration
- stereognosis (identify an object without visual input)
Crossed Representation
Right cerebral cortex controls left side of the body
Left cerebral cortex controls right side of the body
Motor Pathways
a. Corticospinal (pyramidal) tract
- skilled, purposeful voluntary movement
- higher order motor skills (writing, playing piano)
b. Extrapyramidal tract (primitive system)
- muscle tone
- gross body movements (walking)
c. Cerebellar system (on a subconscious level)
- coordinates movement (making them smoother)
- maintains equilibrium
- posture
Motor Neurons
Upper Motor Neurons
- located in CNS, influence lower motor neurons
- corticospinal or extrapyramidal tract
i. e. of upper motor neuron disease: cerebral palsy
Lower Motor Neurons
- located in PNS, final pathway
- cranial and spinal nerves
i. e. of lower motor neuron disease: spinal cord lesions
Cranial Nerves
Exit from the brain
Mainly supply head and neck
Spinal Nerves
Named by the region of the spine they exit
- all mixed nerves: both sensory and motor
Dermatome
circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve
Reflex Arc
Defence system of the PNS
- quick, involuntary and below level of conscious control
Automatic Nervous System
A division of PNS
a. Sympathetic Nervous System
- fight or flight
b. Parasympathetic Nervous System
- rest or digest
4 Types of Reflexes
- Deep Tendon Reflexes
- knee jerk - Superficial Reflexes
- corneal reflex, abdominal reflex - Visceral Reflexes
- pupillary response - Pathologic Reflexes
- Babinski, pathologic because it should not be seen in adults
Dev Considerations - Infants
- dramatic growth and development of neurological system during 1st year of life
- movement directed by primitive reflex
- sensory and motor systems develop from myelinization (from proximal to distal)
Dev Considerations - Older Adults
General atrophy
- impaired coordination and agility
Cranial/spinal nerves
- conduction reduces, slowed reaction
Motor system
- slowed movement, loss of balance
*Intellectual functioning change is person-dependent!
Subjective Assessment of Neuro
- Headache
- Head injury
- Dizziness or vertigo
- Seizures
- Termors
- Weakness
- Incoordination
- Numbness or tingling
- Difficulty swallowing (dysphagia)
- Difficulty speaking
- Significant past history
- Environmental and occupational hazards
Complete Neurological Exam
- Cranial Nerves
- Motor System
- Sensory System
- Reflexes
Cranial Nerve I
Olfactory
sense of smell (smell test)
Cranial Nerve II
Optic
visual acuity (snellen/jaegar) visual fields (confrontation)
Cranial Nerves III, IV, VI
Oculomotor
Trochlear
Abducens
movement (palpebral fissure, PERRLA, EOM)
Cranial Nerve V
Trigeminal
sensory (light touch test)
motor (temporal, masseter and jaw)
Cranial Nerve VII
Facial
motor (symmetry of expressions)
sensory
parasympathetic
Cranial Nerve VIII
Acoustic (Vestibulocochlear)
hearing acuity (whispered voice test)
Cranial Nerves IX and X
Glossopharyngeal
Vagus
motor (movement of pharynx - uvula, soft palate, tonsillar pillars)
sensory, taste
Cranial Nerve XI
Spinal Accessory
motor (neck - head rotation and shrug)
Cranial Nerve XII
Hypoglossal
motor (tongue and articulation)
“light, tight, dynamite”
Motor System Assessment
a. Muscles
- size, tone, strength, involuntary movement
b. Balance Tests
- gait
- tandem walking (heel-to-toe)
- Romberg Test (stand with eyes closed)
c. Coordination & Skilled Movements
- rapid alternating movement
- finger to finger test
- finger to nose test
- heel to shin test
Sensory System Assessment
a. Spinotholamic Tract
- pain
- temperature
- light touch
b. Posterior Column Tract
- vibration (tuning fork)
- position (passive movement)
- fine touch (tactile discrimination)
stereognosis - recognize object with eyes closed
graphesthesia - draw letter on hand
two-point discrimination
Deep Tendon Reflex Testing
a. Biceps
b. Triceps
c. Brachioradialis (forearm)
d. Quadriceps (patellar)
e. Achilles (heel)
*grade on 4-point scale
Superficial Reflex Testing
Plantar Reflex
