Neuromuscular assessment Flashcards
History
- do you have unusually frequent or severe headaches?
- have you ever had a head injury?
- do you ever feel lightheaded or a swimming sensation, like feeling faint? Do you ever feel that you or the room is spinning?
- have you ever had a seizure?
- do you gave involuntary shaking, vibrating or trembling in the hands and face? Ask patient to stick their arms out straight
- do you have any weakness in or problem moving any body parts? do you have trouble with coordination and balance?
- Do you have any numbness or tingling sensation in any part of your body?
- Do you have any problem speaking or forming words or sentences? Do you have any problem swallowing?
- have you ever had a stroke, spinal cord injury, meningitis or suffered from alcoholism?
- are you exposed to any environmental exposures such as insecticides, lead or organic solvents? Do you take any medications or mood altering drugs?
- Any problem in your muscles with cramping or pain?
Inspect cranial nerves
III, IV, VI (PERRLA) - check the pupils for size, regularity, equality, and consensual light reactions and accommodations. Gauge the pupil size in milimetres. Test pupillary light reflex by bringing the light in from the side, you will notice constriction of both pupils. Ask patient to follow the pen light with their eyes without moving their head.
V - ask the patient to clench their jaw and palpate the temporal and masseter muscles, should feel equally strong on both sides. Try to separate the jaw by pushing down on the chin. Sensory function - ask patient to close their eyes and ask them to say now when you brush the cotton against their face
VII - noting mobility and facial symmetry ask patient to respond to your requests to smile, frown, close eyes tightly (against your attempt to open them), lift brows, show teeth, and puff cheeks and press on them to note where air escapes from.
IX and X- depress the tongue with a tongue blade, note pharyngeal movement when the patient says ahh or yawns, the uvula and the soft palate should rise in the midline.
XI - Assess the sternomastoid and trapezius muscles for equal size. Ask patient to rotate the head forcibly against resistance applied to the side of the chin
XII - Inspect the tongue, ask patient to stick out tongue and note no wasting or tremors. Ask patient to say light tight dynamite
