Neurological Exam Flashcards
Assessing tone
Tone is graded 0-4
No response
Hypotonia
Normal response
Mild
Moderate hypertonia
Wrist-> flexion/ extension
Elbow-> flexion/ extension
Shoulder-> abduction/ adduction
Hips-> roll
Knee-> flexion
Clonus= take pressure off gastroc and Dorsi flex- present then foot spasm
Myotomes
Corticospinal tract
=nerve that supplies area of muscle to do a movement
0-5
0=no visible contraction
5= normal power
C1/2- flex/ ext
C3- sidebend
C4- shoulder elevation
C5- shoulder abduction and adduction
C6- elbow flexion, wrist extension
C7- elbow extension, wrist flexion
C8- finger abduction, addiction
T1- thumb extension
L2/3- hip flexion (psoas)
L4/5- hip extension (hams)
L5/S1- heel to bum (knee flexion) (glute max)
L3/4- kick door (knee extension) (quads)
L4/5- Dorsiflexion (tib ant)
S1/2- plantarflexion
L4- inversion
L5/S1- eversion
Deep tendon reflexes
0-4. Norm= 2
0- absent
4- brisk/ clonus
C5- biceps (fingers on tendon and tap finger. Biceps curl)
C6- brachioradialis (hammer curl and tap muscle)
C7- triceps (hang arm up and tap)
L4- patella (seated/ laying down. Tap patella tendon)
S1- Achilles (Dorsi flex foot and lay down with knee pointed out)
Superficial reflexes
Umbilical (t8-12)- draw x around umbilical. Absent with corticospinal tract lesion
Babinskis (L5-s1)- side of foot and run up foot to medial toes. Normal= toes curl. Usually accompanied with hyperreflexia, clonus and increased tone
Dermatomes
Spinothalmic
Soft and sharp around
C4-5= shoulder
C5-6= forearm
T1= medial arm (inside)
C6= thumb
C7= middle finger
C8= pinky
C5/T1= dorsal hand
L1-S2= down leg diagonally
S1= penis
Vibration
Dorsal column (medial Lemniscus)
Place tuning fork (128hz) over bony prominsences. Work distally to proximal. Patient says when can’t feel buzzing anymore
Lower limb= tip of big toe, interphalangeal joint, medial malleolus, tibial tuberosity, ASIS
Upper limb= distal interphalangeal of forefinger, radial styloid, olecranon, acromion
Joint position sense (proprioception)
Dorsal column
Demonstrate procedure to pt can see
Ask pt to say up or down when flex ext big toe. From side
Pt closes eyes perform random movements up or down
