Neuromuscular Assessment 2 LAB

Question 1

Beginning Procedure

Answer 1

1. Identify patient
2. Explain procedure
   2a. Are you comfortable? Do you know what day it is? Why are you here? Where are you?
3. Hand hygiene
4. Neurological history? Stroke? seizures? TBI?
5. Musculoskeletal history? Osteoporosis? Arthritis?

Question 2

How to assess smell? Nerve?

Answer 2

Close eyes, wave scented pad under nose “Let me know what you smell, if you smell anything.”
Tests Cranial Nerve 1: Olfactory (S)

Question 3

How to assess visual acuity? Nerve?

Answer 3

Snellen’s Chart.
Ask Pt to read line on chart.
Tests CN 2: Optic (S)

Question 4

How to assess pupil reaction to light & accommodation?

What’s the P word?

What’s the nerve?

Answer 4

Pen light, checking both pupils constrict no matter which eye.

Tests CN III: Oculomotor (M)

Question 5

How to assess eye movement? Nerves?

Answer 5

“Track the pen light w/o moving your head.” 6 cardinal positions of gaze.

Tests CN III - Oculomotor (M), IV-Trochlear (M), and V (M)I-Abducens

Question 6

How to assess facial movement/sensation? Nerves?

Answer 6

Ask patient: smile, frown, poof cheeks, shrug your eyebrows up.
Touch areas on Pt Face w/pt eye closed to verify sensation.

Tests CN V-Trigeminal and VII-Facial.

Question 7

How to assess hearing? Nerves?

Answer 7

Close eyes. Which side can you hear?

Tests Acoustic/Vestibulocochlear nerve(IIX).

Question 8

Assessing 9&10? Name?

Answer 8

Stick out mouth, ahh. (Watching for uvula to rise)
Feel trachea during dry swallow

Glossopharyngeal-(IX), Vagus-X

Question 9

Assessing CN11? Name?

Answer 9

Shrug shoulders against resistance, turn head against resistance.

Question 10

Assessing CN12? Name?

Answer 10

Stick out tongue side to side

Hypoglossal (XII)

Question 11

How to examine all major muscle groups of body

Answer 11

Assess for any wasted or highly developed muscles

Question 12

How to assess UE?

Answer 12

a. Feel the tone of the muscle
b. Test for strength and resistance bilaterally
c. Palplate bones, muscles and joints during ROM
d. Assess for Pronator drift (arms out, palms up)
e. Assess hand grip strength billaterlly

Question 13

How to assess LE?

Answer 13

a. Feel the tone of the muscle (flaccid, clonic, normal)
b. Test for strength and resistance bilaterally
c. Palpate bones, muscles, and joints during ROM

Question 14

How to assess sensory superficial sensation and touch?

Answer 14

Ask patient to close their eyes. Lightly touch them and ask where they feel the sensation.

Question 15

How to assess coordination?

Answer 15

a. supination and pronation with hands (patty cake)
b. rapid movement of fingers to thumb
c. finger to nose to finger.

Question 16

How to assess balance?

Answer 16

ROMBERG Test

Stand up with feet together and close eyes.

Question 17

How to assess gait?

Answer 17

heel-toe walking away, then have pt walk back with normal gait.

Question 18

How to close the assessment?

Answer 18

a. Assist pt back to comfortable pos
b. Perform hand hygiene
c. Document assessment findings.

Question 19

CN I Abnormal findings

Answer 19

Loss of smell may be caused by an olfactory tract lesion

Nasal allergies can impair ability to smell.

Question 20

CN II Abnormal findings

Answer 20

Lesions in the CNS (tumors) may cause peripheral visual defects. Refer to ophthalmologist for further evaluation of vision and eye function when abnormalities are suspected.

Question 21

CN III, CN IV, and CN VI abnormal findings

Answer 21

Eye movements that are not parallel indicate oxtraocular muscle weakness or dysfunction.

Report nystagmus other than that noted as normal.

Report ptosis (eyelid droop) that may occur with ocular myasthenia gravis.

Question 22

CN V or CN VII Abnormal findings

Answer 22

Inequality in muscle contractions, pain, twitching or asymmetry is abnormal

Disorers of the pons may cause altered functino of these.

Tic/mimic spasm is involuntary movement of small muscles.

Question 23

CN IIX Abnormal findings

Answer 23

Weber’s Test (lateralization of sound to unaffected ear

Rinne test

Question 24

CN XI Abnormal findings

Answer 24

weakness or pain when pushing your hand or asymmetry

Unilaterail or bilateral muscle weakness or any pain/discomfort is abnormal.

Question 25

Olfactory I

Answer 25

Sensory: smell reception and interpretation

Question 26

Optic (II)

Answer 26

Sensory: Visual acuity and visual fields

Question 27

Occulomotor (III)

Answer 27

Motor: Raise eyelids, most extraocular movements
Parasympathetic: Pupilllary constriction, change lens shape

Question 28

Trochlear (IV)

Answer 28

Motor: Downward, inward eye movement

Question 29

Trigeminal (V)

Answer 29

Motor: Jaw opening and clenching, chewing and mastication
Sensory: Sensation to cornea, iris, lacrimal glands, conjunctiva, eyelids, forehead, nose, nasal and mouth mucosa, teeth, tongue, ear, facial skin

Question 30

Abducens (VI)

Answer 30

Motor: Lateral eye movement

Question 31

Facial (VII)

Answer 31

Motor: Movement of facial expression muscles except jaw, close eyes, labial speech sounds (b, m, w, and rounded vowels)

Sensory: Taste - anterior 2/3 of tongue, sensation to pharynx

Parasympathetic: Secretion of saliva and tears

Question 32

Vestibulocochlear=ACoustic (VIII)

Answer 32

Sensory: Hearing and equilibrium

Question 33

Glossopharyngeal (IX)

Answer 33

Motor: Voluntary muscles for swallowing and phonation

Sensory: Sensation of nasopharynx, gag reflex, taste - posterior 1/3 of tongue

Parasympathetic: secretion of salivary glands, carotid reflex

Question 34

Vagus (X)

Answer 34

Motor: Voluntary muscles of phonation (guttural speech sounds0 and swallowing)

Sensory: Sensation behind ear and part of eternal ear canal

Parasympathetic: Secretion of digestive enzymes; peristalsis; carotid reflex; involuntary action of heart, lungs, and digestive tract

Question 35

Accessory, SPinal, XI

Answer 35

Motor: Turn head, shrug shoulders, some actions for phonation

Question 36

Hypoglossal XII

Answer 36

Motor: Tongue movements for speech sound articulation (l, t, n) and swallowing