Neurological Assessment

Question 1

Give some signs and symptoms of a neurological injury/disease

Answer 1

Weakness
Loss of sensation
Loss of proprioception
Loss of co-ordination
Changes in tone
Behaviour changes
Altered cognition and thinking skills
Incontinence
Loss of balance
Loss of functional activities

Question 2

What is involved in a neurological subjective assessment?

Answer 2

1. Presenting condition and HPC
   - Symptoms and their duration (sudden v slow onset)
   - Progression of disease
   - Aggravating and easing factors
   - Pain
   - Fatigue
   - Tone/spasms
   - Falls
   - Mobility – indoor, outdoor, aids, steps and stairs
2. PMH
   - Previous surgery
   - Previous therapy
3. SH
   - Accommodation
   - Carers/ family support – personal care, shopping, cooking, cleaning, ADLS
   - Employment and leisure
4. DH
   - Drugs for pain relief and tone

Question 3

What might influence the objective assessment of a patient with a neurological disease or injury?

Answer 3

Inpatient v outpatient
Fatigue
Pain
Level of consciousness

Question 4

What is involved in a neurological objective assessment?

20 steps

Answer 4

1. Check the obs chart
2. Check thewider environment
3. Do a respiratory assessment if indicated
4. Vision
5. Hearing
   - Do they usually wear hearing aids?
6. Speech and swallow
7. Mood/Behaviour
8. Cognition
   - Orientation – person, place, time and situation
   - Ability to follow commands (stick out tongue, touch nose and nod head)
9. Observe
   - Posture
   - Drips, drains, lines, monitoring
10. AROM
11. PROM
12. Tone
13. Sensation (compare on both sides)
    - Light touch
    - Sharp blunt
    - 2-point discrimination
    - Hot and cold
14. Proprioception
    - Mirroring
    - Joint position sense
15. Co-ordination
    - Heel Shin
    - Finger nose
16. Power
    - Testall four limbs for strength –be joint specific
    - Check grip strength
    - Use OxfordScaleifappropriate
17. Bed mobility
    - Rolling
    - Lie to sit and sit to lie
    - Transfers
18. Balance
    - Sitting balance
    - Standing balance
19. Gait
    - Walking aids
    - Pattern
    - Stairs
20. Upper limb dexterity and function
    - Buttons
    - Writing

Question 5

What is tone?

Answer 5

Tone is the resistance of muscles to passive stretch.
It is the amount of tension a muscle has at rest
Tone is the internal state of muscle-fibre tension within individual muscles and muscle groups
It is a continuum from low (floppy or flaccid) to high (hypertonus or spasticity)

Question 6

What 3 strategies are there to maintain balance?

Answer 6

Postural Adjustments

1. Ankle strategy
2. Hip strategy
3. Stepping mechanism