Neurological Disorders

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What sensory receptor in the spinal cord monitors internal organs?

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Interoceptors

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What sensory receptor in the spinal cord monitors body position/change

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Proprioceptors

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What sensory receptor in the spinal cord monitors external environ, perceive pain, tactile stimulation

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Exteroreceptors

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Damage depends on nature, length of time and intensity
Neuropraxia: temporary
Axonotmesis: prolonged pressure nerve grows 1mm per day
Neurotmesis: axon and sheath are damaged

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Peripheral nerve lesions

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what are these classifications of?

• Neuropraxia
• Axonotmesis
• Neurotmesis

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3 classifications of injuries

Nerve injuries

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classification of an injury: temporary, no structural change

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Neuropraxia

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classification of an injury: prolonged pressure with atrophy of mm, degeneration of neuronal axon

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Axonotmesis

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classification of an injury: no path to follow to grow back

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Neurotmesis

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Inflammation, tumor, space occupying lesion

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Compression

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Compression where nerve root exits

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Radiculopathy

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What types of injuries are these?

• Compression
• Radiculopathy
• **may affect blood vessels

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Nerve injuries

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What nerve is being injured below?

• Repetitive stress
• Pregnancy
• Narrowing of carpel tunnel

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Median nerve; injuries

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What is happening when there is weakness, atrophy of intrinsic muscle of thenar eminence of hand?

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Narrowing of carpel tunnel

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What nerve is being injured below?

• Damaged by pressure leaning against wall or hard object
• **Aka Saturday night palsy
• Crutch palsy”WB through palsy
• Fractured humerus

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Radial nerve: injuries

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Brachial plexus compression, subclavian blood vessels compressed
Pressure between clavicle and first rib
Cervical rib
Pallor of skin of upper extremity
Reduced temp
Weak/absent pulse
Weakness
Pain

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Thoracic Outlet Syndrome

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• Compressed at head of fibula

- casts

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Common Peroneal nerve

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Tests for neurological system

• Bleeding, damage, change in brain tissue
• Determine location of damage
• Tumors
• CVA

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CT

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Tests for neurological system Looks at integrity of nerve roots

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Deep tendon reflex

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Tests for neurological system

• Rate of transmission along nerve
• Slow= damaged
• Helps determine site of damage

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Electrodiagnostics/Nerve conduction

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Tests for neurological system
-Measure level of consciousness, assess progress
-Eye opening, verbal response, motor response
Pg 293

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Glasgow Coma Scale

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Tests for neurological system

• Usually better image than CT
• Cannot use with metal or pacemakers

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MRI

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Tests for neurological system

• Manual or dynamometer
• Grip strength with dynamometer
• Isokinetic testing (cybex, biodex)

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Muscle testing

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Tests for neurological system

-Evaluate level of nerve damage pg 296

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Myotomes

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Tests for neurological system

• Mobility of nervous system
• Place nervous system on a stretch
• Look for tethering, damage or inflammation

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Neural tension testing

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Tests for neurological system

-Abnormal tightness or density, temperature, joint effusion

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Palpation

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Tests for neurological system

-Help determine severity

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Posttraumatic amnesia scales

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Tests for neurological system

-Level of consciousness and ability to problem solve, concentrate, behave appropriately

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Rancho Los Amigos Levels of Cognitive Function

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Tests for neurological system

• Used to measure joint motion
• Measure progress
• May use goniometer, tape measure

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Range of Motion

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• Phalen’s wrist flex test

- Reverse Phalen’s

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Specific testing

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Hands in pray test

• Median nerve injury
• Tingling along median nerve distribution

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Phalen’s wrist flex test

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backs of hands together in reverse prayer-

• Creates pressure over carpel tunnel
• Parasthesia in median nerve distribution

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Reverse Phalen’s

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Can use over any nerve
Irritation of nerve (compression or injury)
Tap over nerve
Pins and needles distal

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Tinel sign

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pt sitting: shoulder abd to 90, horizontally extend and lat rotate arm with elbow flexed. Positive if radial pulse disappears when rotate head opp side

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Allen test: Thoracic Outlet Test

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Pt rotates head to side to be tested. Extend, lat rotate shoulder, arm in full ext. Positive test if radial pulse disappears when take a deep breath

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Adsons maneuver: Thoracic Outlet Test

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Thoracic Outlet Test
-Pt elevates arms over head, make fist and open x 15 times. Positive test: cramping, fatigue, tingling in forearms and arms

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Provocative elevation test

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Thoracic Outlet Test:

Skin sensation

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2 Pt discrimination

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Thoracic Outlet Test:
Passive neck extension with rotation: compress vertebral arteries, positive if dizzy, lightheaded, change in vision, speech, swallowing problems

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Vertebral Artery test