Neuromuscular: Examination: History, Systems Review Flashcards
Orientation
- Person
- Place
- Time
Consciousness
- Screen for patients level of conscious arousal which can range from alert to coma.
Memory
- Examine for different types of recall
- Immediate (Brief i.e. 5 minutes)
- Recent (short term recall of recent events, can be same day event)
- Remote (Long term recall, typically past events)
Attention
- Length of attention span
- Sustained attention=ability to attend to a task without redirection.
- Divided Attention=ability to shift attention between tasks
- Focused attention=ability to stay on task in presence of distractors
- Ability to follow commands, single or multiple step
Emotional Response
- Examine for behavior of patient
Higher Level Cognitive Reasoning
- Judgement
- Problem solving
- General Knowledge
- Calculation
- Sequencing
Expressive Function
- Examine for fluency of speech, speech production
- Typically associated with damage to Broca’s area
- NEED TO KNOW DYSARTHRIAS
- NEED TO KNOW NEUROMUSCULAR FOUNDATIONAL DEFINITIONS FOR SPEECH DISORDERS
Receptive Function
- Examine comprehension
- Typically associated with damage to Wernicke’s area
- NEED TO KNOW DYSARTHRIAS
- NEED TO KNOW NEUROMUSCULAR FOUNDATIONAL DEFINITIONS FOR SPEECH DISORDERS
Non-verbal Communication
- Examine ability to read, and write
- Use of gestures, symbols, pictographs
Vital Signs
- Irregularities in pulse
- Increase or decrease in BP
- Changes in response to activity
- O2 SAT SHOULD BE GREATER THAN 94 FOR PATIENTS WITH CENTRAL NERVOUS SYSTEM DAMAGE AND IDEALLY BETWEEN 97-100% AS PER THE AMERICAN HEART AND STROKE ASSOCIATIONS
Examine Respiration
- Examine RR
- Cheyne-Stokes: Period of apnea lasting 10-60 second accompanied by gradually increasing depth and frequency of respiration.
- Hyperventilation: Increased rate and depth of respiration.
- Apneustic Breathing: Prolonged inspiration
Meningeal Irritation/Brain Infection
- IMPAIRMENT TO NECK MOBILITY WITH STIFFNESS AND PAIN WITH LIMITATION AND GUARDING TO NECK FLEXION.
- KERNIG’S SIGN
- BRUDZINSKI’S SIGN
- IRRITABILITY AND DISCOMFORT WITH BRIGHT LIGHT
- Altered consciousness
Intracranial Pressure/Cerebral Edema/Brain Herniation
- Progressively decreasing levels of consciousness.
- Altered vital signs especially to BP and respiration.
- Headache
- Vomiting
- PUPILLARY CHANGES: IPSILATERAL DILATION, SLOWED REACTION TO LIGHT, PROGRESSION TO FIXED DILATED PUPILS (A poor prognostic sign).
- Progressive impairment to motor function.
- Seizure
Spatial Relations: Figure Ground Discrimination
- Pick one item out from an array of items.
Spatial Relations: Form Constancy
- Have patient pick out an item from an array of similarly shaped items but different sized sized objects.
Spatial Relations: Spatial Relations
- Patient duplicates a pattern of two or three blocks.
Spatial Relations: Position in space
- Have patient demonstrate different limb positions
Spatial Relations: Topographical Disorientation
- Determine if the patient can navigate a familiar route on his or her own.
Spatial Relations: Depth and Distance Imperceptions
- Determine if patient can judge depth and distance (i.e navigate stairs and sit down in chair)
Spatial Relations: Vertical Disorientation
- Determine if patient can accurately identify when something is upright.
Muscle Tone
- PROM to assess muscle stretch reflexes and responsiveness to passive elongation.
- Limited resistance=Low tone/Flaccid
- Excessive resistance=High tone/Spastic
Muscle Tone: Flaccidity
- Absent tone
- Hypotonia: Decreased tone
Muscle Tone: Flaccidity: LMN
- Low tone seen in segmental/LMN lesions to:
- Nerve roots and peripheral injury.
Muscle Tone: Flaccidity: UMN
- Low tone seen in UMN lesion (spinal shock in SCI or cerebral shock in CVA).
- Characterized by decreased or or no resistance to PROM.
Muscle Tone: Spasticity
- Seen in UMN lesions.
- Check for varying resistance to PROM with varying speed (i.e velocity dependent tone)
- Spasticity is distinguished from Rigidly via velocity dependent testing. If PROM resistance is velocity dependent it is classified as spastic, if not it is rigid.
Muscle Tone: Rigidity
- Increased resistance to PROM that is independent of the velocity of movement.
- Leadpipe=Uniform rigidity throughout the range of motion.
- Cogwheel=Interrupted by a series of jerks.
Muscle Tone: Opisthotonos
- Prolonged severe spasms causing head, neck, and heel to arch backwards.
- Associated with meningitis, tetanus, epilepsy, and strychnine positioning.
Muscle Testing: Myopathies and Neuropathies
- Myopathies=Typically proximal weakness
- Neuropathies=Typically see distal weakness of extremities
Balance Testing: Sitting
- Maintaining a vertical posture with and without arm support.
Balance Testing: Standing
- Feet apart, eyes open
- Feet apart eyes closed
- Feet together eyes open
- Feet together eyes closed
Balance Testing: Standing/Semi-Tandem
- Eyes open
- Eyes closed
Balance Testing: Tandem Stance
- Eyes open
- Progress to eyes closed
Single Leg Support
- Eyes open
- Eyes closed
Balance Strategies: Ankle Strategy
- Ankle muscles and leg/foot proprioception used to maintain balance.
Balance Strategies: Hip Strategy
- Hip and lower trunk muscles maintain balance by shifting center of mass/using hip motions.
Balance Strategies: Stepping Strategy
- Rapid steps used to realign COM with BOS.
Gait: Ataxia: Polyneuropathy
- Ataxic gait typically improved by looking down
Gait: Ataxia: Cerebellar Disorder
- Ataxic gait associated with postural and limb intention tremor
- NOT typically improved by looking down
Gait: Ataxia: Cervical Myelopathy
- Ataxic gait if dorsal columns involved
- Patients may also demonstrate spasticity related deformities if corticospinal tracts are compressed.
Gait: Hemiplegic
- Slow and asymmetrical
- Decreased stance time
- Decreased push off
- Stroke affected UE and LE move as a unit instead of as a dissociated arm and leg swing
Gait: Festinating/Parkinsonian
- Characterized by freezing with initiation/termination and short rapid steps once gait starts.
Gait: Myopathic Gait
- Pelvic girdle and proximal muscle weakness results in hyper lordosis and compensated Trendelenberg on weight bearing limb.
https://www.google.com/url?sa=i&url=https%3A%2F%2Fpubs.rsna.org%2Fdoi%2Ffull%2F10.1148%2Frg.286085502&psig=AOvVaw1WTOLPmWiSElIGcLtm1X08&ust=1614645541125000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCJDC453uje8CFQAAAAAdAAAAABAL
Hemorrhagic Stroke
