Neurological Examination Flashcards
1
Q
Red flags associated with neurological problems (immediate medical assistance required)
A
- loss of consciousness or difficult arouse
- extreme confusion not consistent with premorbid status
- uncontrolled seizure activity
- acute infection with other associated neurologic signs
- rapid onset of focal neurologic deficits
- evidence of spinal column instability
- non responsive autonomic dysreflexia
2
Q
Yellow flags associated with neurological problems (outside referral required)
A
- acute onset of neurologic signs such as incontinence, saddle paresthesia, abnormal reflexes
- progressive neurologic signs in a known neurologic diagnosis that is not degenerative
- evidence of motor neuron disease
- new onset of involuntary movements or tremor
- change in autonomic status
- bulbar & other cranial nerve signs or symptoms
- constant headache that worsens over time
- neurologic signs inconsistent with medical diagnosis
- signs or symptoms of systemic illness
- significant changes in personality or cognitive status
3
Q
Signs with rapid onset suggesting a stroke in progress
A
- weakness, numbness, or tingling of face, arm, or leg especially of one side of body
- blurred or decreased vision in one or both eyes or double vision
- loss of speech or trouble understanding speech
- headache that is sudden, severe, and unusual
- dizziness, loss of balance, or loss of coordination with any of the other signs
4
Q
Indications for a neurological exam
A
- referral
- result from a neurological screening during ROS (review of systems)
5
Q
Examples of clinical indications for neurological exam
A
- Body structure/functions/impairments: numb feet, muscle weakness, abnormal posture, balance problems
- Functions/activity limitations: difficulty with functional mobility or ADLs
- Participation restrictions: difficulty with home management, work, job, play
6
Q
Components of a comprehensive neurological exam
A
- Mental status
- Sensation
- Motor function
- Balance/coordination
- Functional skills
7
Q
Why do we test mental status
A
- tested 1st
- accuracy of data from sensory & motor exam depends on the ability to understand & communicate effectively
- tested to determine pt’s ability to participate in POC, give consent, follow directions, communication needs understand precautions
- Cognitive domains assessed: arousal, attention, orientation, cognition (IQ), memory, communication, calculation, logic/abstraction
8
Q
What cognitive domains are assessed to determine mental status
A
- Arousal
- Attention
- Orientation
- Cognition (IQ)
- Memory
- Communication
- Calculation
- Logic/abstraction
9
Q
Define arousal/consciousness
A
- physiological status of being aware with ability to understand/respond to stimuli: readiness for activity
- brainstem and other brain areas control arousal, sleep-wake cycles
10
Q
What are the 5 levels of consciousness
A
- Alert: fully awake, interactions with PT are appropriate
- Lethargic: drowsy, may fall asleep, difficulty maintaining focus, interactions with PT may get diverted
- Obtunded: sleepy state, difficult to keep awake, confused when awake, interactions with PT are mostly unproductive
- Stupor: responds only to strong noxious stimuli like flexion of great toe, sharp pinch, rubbing knuckles on sternum, & then returns back unconscious state
- Coma: cannot be aroused
11
Q
What are the 3 components of the Glasgow Coma Scale (Gold Standard)
A
- Eye opening (4 = spontaneous opening of eyes, 3 = opening in response to speech, 2 = eye opening to pain, 1 = no eye opening response)
- Best verbal response (5 = verbal response demonstrate personal orientation to location, 4 = confused conversation is the best verbal response, 3 = inappropriate words in response to question, 2 = incomprehensible sounds, 1 = no verbal response)
- Best motor response (6 = follows motor commands, 5 = localizes a painful stimulus, 4 = withdraws specifically from pain, 3 = abnormal flexion response to pain “decorticate posturing”, 2 = abnormal extensor response to pain “decerebrate posturing”, 1 = no motor response)
12
Q
Standardized tests for assessing level of consciousness (LOC)
A
- Rancho Los Amigos Levels of Cognitive Function (LOCF): widely used in brain injury, tracks cognitive & behavioral responses of pt, level I = no response to level X = purposeful/appropriate response
- Coma Recovery Scale (CRS-R): better sensitivity. for lower levels - comas <-> veg state <-> minimal conscious state
13
Q
Define orientation
A
- awareness of person, place, time, & situation
- oriented X1/2/3/4 (example: A&Ox2 = person/place)
14
Q
Define attention
A
- awareness towards a stimuli in the environment
- Selective attention: awareness towards a stimuli in the environment w/o being distracted by the other stimuli, towards an object, task, or thought
- Sustained attention: time on particular task, repeat letters, words or digits forward or backward, digit span test, test of vigilance
- Alternating/switching attention: attention flexibility, back and forth between 2 tasks
- Divided attention: 2 tasks simultaneously, walkie talkie test (walk 20ft & return saying the alphabet), c-TUG
15
Q
Define memory
A
- registration, retention, & recall of past experiences & knowledge
- immediate memory (seconds) vs STM (day to day events) vs LTM (remote memory, years)
- explicit/declarative memory vs implicit/procedural/motor memory
- drugs can improve memory (cholinergic agents) or degrade memory (benzodiazepines, anticholinergics)
16
Q
Memory deficits
A
- injury to medial temporal lobe (limbic lobe/hippocampus) may show deficits in explicit memory, while retaining implicit memory (distributed broadly in CNS motor areas)
- amnesia: anterograde (inability to learn new material after injury) vs retrograde (inability to remember things prior to brain injury) “tip of the tongue phenomenon”
- PTA (post traumatic amnesia): lost of memory of event surrounding brain injury & inability to process info after brain injury
17
Q
Define perception
A
- integration of sensory info into meaningful info for making decisions & movement
- test after checking that peripheral sensory pathways are WNL: visual, auditory, somatosensory, etc.
18
Q
Perceptual disorders associated with neurologic conditions
A
- Body image/scheme disorders: unilateral spatial neglect, extinction, R/L discrimination
- Visuo-spatial disorders: depth perception, spatial relationship, figure-ground
- Apraxia: ideomotor, ideation, construction, dressing
- Agnosia: inability to recognize familiar objects, persons, sounds, shapes, or smells, visual, tactile, auditory
19
Q
Tests to assess unilateral spatial neglect
A
- Clock/house drawing test
- Albert’s cancellation test
- Comb & razor test: scoring using percent bias formula = L-R/total+ambiguous strokes, scoring varies b/w -1 to +1, close to -1 = L USN and close to +1 = R USN
