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Clinical Assessment 1 > Neuromuscular System > Flashcards

Neuromuscular System Flashcards

1
Q

Somatosensory Function

A

Feel or sense things on or within the body.

Perception of light touch, temperature, pain, vibration, joint position, or discriminative sensation.

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2
Q

Examples of disease processes of the Somatosensory Function

A 
Diabetes Mellitus
Multiple Sclerosis
Guillain-Barre Syndrome
Hansen's disease
Lyme Disease
Alcoholic Neuropathy
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3
Q

Somatosensory Assessment Procedures and General Guidelines

A 
Explain the purpose
Demonstrate on an unaffected area
Don't test over clothing
Compare right to the left and distal to proximal area
Avoid areas of calloused skin
Vary your patterns and pace
If somatosensory loss is present, map distinct boundaries
Document findings
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4
Q

Sharp/Dull Test

A

Spinal tract: spinothalamic
Equipment: Safety pin, paper clip, or cotton-tipped stick
Perform a trial (sharp/dull)
Unilateral, then compare with similar area
Bilateral, test one limb then the other
Begin distally
Map the boundaries

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5
Q

Temperature Test

A 
Spinal tract: spinothalamic
Equipment: 2 test tubes (no more than 113 for the hot)
Perform a trial (hot/cold)
Unilateral, then compare with similar area
Bilateral, test one limb then the other
Begin Distally
Map the boundaries
Avoid repeated pattern
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6
Q

Light Touch Test

A 
Spinal tract: posterior columns (spinothalamic for crude touch)
Equipment: cotton, gauze, or none!
Perform a trial
Unilateral, then test at the same time
Bilateral, test one then the other
Begin distally
Map the boundaries
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7
Q

Vibration Test

A

Spinal tract: posterior columns
Equipment: 128 Hz Tuning fork
Perform a test (vibratory sense)
Begin distally, if normal stop!

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8
Q

Joint Position Test

A 
Spinal tract: posterior columns
Equipment: none
Perform a trial (up/down)
Hold the sides of a distal segment
Don't touch adjacent digits
Begin distally. If normal, stop!
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9
Q

Discriminative Sensation Tests

A

Spinal tract: posterior columns (cerebral cortex)
Requires Integration, analysis, interpretation of touch and position sense in sensory cortex
Demonstrate first! Start with unaffected

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10
Q

Stereognosis

A

Ability to sense and identify objects in hand

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11
Q

Astereognosis

A

Inability to identify object in hand

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12
Q

Graphesthesia

A

Ability to sense and identify numbers or letters drawn in hand

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13
Q

Agraphesthesia

A

Inability to sense and identify numbers or letters drawn in hand

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14
Q

How to perform the Two-Point Discrimination Test

A 
Patient to close eyes
Touch finger pad w/ 2 points
Patient indicates 1 or 2
Alternate between 1 and 2 points
5 mm distance normally felt 2 points
Normal distance varies by area.
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15
Q

How to perform Point Localization Test

A

Patient to close eyes
Touch an area of pt’s skin
Patient to open eyes and point to the place
Several trials to different areas

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16
Q

Protective Sensation

A

Spinal tract: Spinothalamic and posterior columns
Equipment: 5.07 (10 gm) monofilament)
Minimum force you can take before you feel the light touch
Assess all 9 areas

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17
Q

What are dermatomes and how do you test them?

A

Assesses sensory component of a nerve root

Area of skin supplied by a single nerve

Light finger touch

Limit testing to region of least overlap

Test levels above, at and below level of suspected damage

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18
Q

What are myotomes and how do you test them?

A

Assesses motor component of a nerve root

Group of muscles supplied by a single nerve root.

Muscles may be supplied by multiple nerve roots

Tested using isometric break test

Test levels above, at and below

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19
Q

What are deep tendon reflexes and how/why do you test them?

A

Assesses integrity of nerve pathway in the peripheral and central nervous system.

Monosynaptic reflex: afferent sensory to efferent motor

Quick stretch activates muscle spindles

Injury along any part of the pathway can lead to an abnormal muscular response to the stretch stimulus.

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20
Q

How many pairs of spinal nerves exit the spinal cord at each vertebral level?

A

31 pairs

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21
Q

Dorsal roots contain what kind of fibers?

A

Afferent sensory fibers

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22
Q

Ventral roots contain what kind of fibers?

A

Efferent motor fibers

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23
Q

C3 Myotome

A

Cervical Lateral Flexion

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24
Q

C4 Myotome

A

Shoulder Elevation (Shrug)

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25
Q

C5 Myotome

A

Shoulder Abduction

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26
Q

C6 Myotome

A

Elbow Flexion (wrist extension)

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27
Q

C7 Myotome

A

Elbow Extension (wrist flexion)

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28
Q

C8 Myotome

A

Thumb Extension (finger flexion)

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29
Q

T1 Myotome

A

Finger Abduction and Adduction

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30
Q

L2 Myotome

A

Hip Flexion

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31
Q

L3 Myotome

A

Knee Extension

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32
Q

L4 Myotome

A

Ankle Dorsiflexion (Ankle Inversion)

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33
Q

L5 Myotome

A

Great Toe Extension

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34
Q

S1 Myotome

A

Hip Extension (Ankle Plantar Flexion & Ankle Eversion)

35
Q

S2 Myotome

A

Knee Flexion, ankle plantar flexion

36
Q

Hypotonic Deep Tendon Reflex

A

Injury or compression along the nerve pathway, including nerve root

Normal Transfer of the reflex message prohibited

Contraction less than expected

37
Q

Hypertonic Deep Tendon Reflex

A

Central Nervous System Dysfunction

Modulated influence prohibited

Exaggerated reflex response

38
Q

0 on the Deep Tendon Reflex

A

No reflex

39
Q

1+ on the Deep Tendon Reflex

A

Minimal or depressed response

40
Q

2+ on the Deep Tendon Reflex

A

Normal Response

41
Q

3+ on the Deep Tendon Reflex

A

Overly Brisk Response

42
Q

4+ on the Deep Tendon Reflex

A

Extremely brisk response with clonus

43
Q

Primary Nerve Root of Biceps Brachii

A

C5 (C6)

44
Q

Primary Nerve Root of Brachioradialis

A

C6 (C5)

45
Q

Primary Nerve Root of Triceps

A

C7 (C6)

46
Q

Primary Nerve Root of Patellar Tendon (Quadriceps)

A

L4 (L2, L3)

47
Q

Primary Nerve Root of Achilles Tendon (Gastroc/Soleus Complex)

A

S1 (S2)

48
Q

What are the main functions of the cerebellum?

A 
Coordination
Movement Synergies
Maintenance of upright posture
Maintenance of muscle tone
Receives sensory input from spinal cord and brain
49
Q

What is ataxia?

A

Without coordination, lack smooth trajectory and fine motor control

50
Q

What is tremor?

A

Shaking that begins and increases as the limb reaches a target during a volitional movement (intention tremor)

51
Q

What is hypotonia?

A

An overall decrease in normal resting muscle tone in the region of the body that corresponds to the lesion or dysfunction

52
Q

What is dysarthria?

A

Poor control of word formation due to the inability to coordinate the muscles and structures of speech.

53
Q

Describe deviations in eye control.

A

Nystagmus, lack of smooth pursuit, saccades, or delayed initiation of eye movements

54
Q

Rapid Alternating Movements Test

A

Ask the patient to increase the speed of alternating movements (i.e. move both arms repetitively from a fully pronated to a fully supinated position).

55
Q

What is dysdiadochokinesia?

A

Individuals who have significant difficulty producing rapid alternating movements (slow, irregular, clumsy)

56
Q

Finger Opposition Test

A

Ask the patient to touch the tip of the thumb to the tip of each ipsilateral finger in sequence.

57
Q

Finger to Nose Test

A

Ask the patient to be seated with arms abducted to 90 degrees. With eyes open, the patient brings the tip of the index finger to the tip of his or her nose.

58
Q

Finger to Clinician Finger Test

A

Ask the patient to first touch his or her nose with the tip of one finger, then touch the tip of your finger. Continue this back and forth motion from the patient’s nose to your finger as you move your finger to different target areas.

59
Q

What sign of cerebellar dysfunction can you find with Finger to Nose or the Finger to Clinician Finger tests?

A

Overshooting the target also known as dysmetria. Intention tremor can also be presented.

60
Q

Heel to Shin Test

A

From supine, ask the patient to place the heel of one foot onto the opposite knee and then run the heel down the shin to the ankle and back up to the knee.

61
Q

Toe to Clinician Finger Test

A

From seated position, ask the patient to touch his or her great toe to your finger and then return the foot to the table. Alter your finger in space after each trial.

62
Q

Toe Tapping Test

A

From seated position, ask the patient to repetitively tap the ball of one foot on the floor without raising the leg or lifting the heel from the floor.

63
Q

Romberg or Tandem Romberg Test

A

Assesses balance

Ask the patient to stand unsupported with feet together or in tandem (heel to toe) for up to 30 seconds. If patient is unable to maintain stance in the original Romberg position, it is highly unlikely that he or she will be able to stand in tandem.

64
Q

How many pairs of cranial nerves are there?

A

12

65
Q

What are the common causes of cranial nerve dysfunction?

A

Trauma, tumor, ischemic/vascular lesions, diseases that affect peripheral nerves

66
Q

Cranial Nerve I (Name and Function)

A

Olfactory, Identify Odor

67
Q

Cranial Nerve II (Name and Function)

A

Optic, Contralateral pupil constriction in light, Vision

68
Q

Cranial Nerve III (Name and Function)

A

Oculomotor, Elevate eyelids, Ipsilateral pupil constriction in light, Most extraocular movements (follow a moving target)

69
Q

Cranial Nerve IV (Name and Function)

A

Trochlear, Convergence (Diagonal downward-medial movement of the eye)

70
Q

Cranial Nerve V (Name and Function)

A

Trigeminal, Sensation to the face, Masseter and temporalis muscles, closing and lateral motion of the mandible

71
Q

Cranial Nerve VI (Name and Function)

A

Abducens, Lateral Deviation of the Eye

72
Q

Cranial Nerve VII (Name and Function)

A

Facial, Taste from Anterior 2/3 of tongue, facial movements for facial expressions, closing eyelids, closing mouth

73
Q

Cranial Nerve VIII (Name and Function)

A

Vestibulocochlear, Hearing and Balance

74
Q

Cranial Nerve IX (Name and Function)

A

Glossopharyngeal, Taste for the Posterior 2/3rds of tongue, posterior portions ear drum and ear canal, control of pharynx, saliva production

75
Q

Cranial Nerve X (Name and Function)

A

Vagus, pharyx and larynx sensation and motor control, control of many thoracic and abdominal viscera

76
Q

Cranial Nerve XI (Name and Function)

A

Accessory, Sternocleidomastoid and Trapezius

77
Q

Cranial Nerve XII (Name and Function)

A

Hypoglossal, Tongue

78
Q

Upper Motor Neurons are located:

A

Within the brain and spinal cord

79
Q

Lower Motor Neurons are located:

A

Within the spinal nerve roots

80
Q

Hypotonia is affected by:

A

Peripheral nervous system diseases

81
Q

Hypertonia & Spasticity are affected by

A

Chronic central nervous system conditions

82
Q

A positive Babinski test sign and indication:

A

Splaying (extension of the toes)

Indicates that there is a dysfunction in the corticospinal tract (CNS)

83
Q

A positive Hoffman’s test sign and indication:

A

Patient’s thumb flexes and adducts and the other fingers flex
Indicates that there is a CNS problem

Clinical Assessment 1 (13 decks)

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