P4 - Advanced Neuro Assessment Flashcards
What should be noted about a patient’s position during general observation?
Observe the patient’s position, for example, whether they are in bed, sitting out, leaning to one side, or pushing themselves up.
What should be observed regarding a patient’s appearance?
Pay attention to signs of discomfort or pain in the patient’s appearance.
Why is it important to observe a patient’s general position during assessment?
The patient’s position can provide clues about their comfort, physical limitations, or distress.
What might a patient leaning to one side indicate during general observation?
Leaning to one side could indicate discomfort, weakness, or pain in a specific area of the body.
What is the first step in assessing a patient’s muscle activity?
Facilitate the limb to counteract gravity and check for signs of activity, such as flicker at fingers or toes.
What should you do if a patient shows no signs of muscle activity?
What should you do if a patient shows no signs of muscle activity?
What is the next step if the patient can demonstrate AROM?
Provide resistance throughout the range of motion (ROM) and check if the patient can move against you.
What does Grade 0 indicate in muscle strength grading?
Grade 0 indicates no muscle contraction.
What does Grade 1 indicate in muscle strength grading?
Grade 1 indicates visible or palpable muscle contraction but no movement.
What does Grade 2 indicate in muscle strength grading?
Grade 2 indicates movement with gravity eliminated.
What does Grade 3 indicate in muscle strength grading?
Grade 3 indicates movement against gravity only.
What does Grade 4 indicate in muscle strength grading?
Grade 4 indicates movement against gravity with some resistance.
What does Grade 5 indicate in muscle strength grading?
Grade 5 indicates movement against gravity with full resistance.
What are the key components to assess during “Lying to Sitting” transition?
Ability to process the task
Ability to perform the task (e.g., level of independence)
Movement analysis
What aspects of balance are evaluated in “Sitting Balance”?
Static balance
Posture/alignment
Dynamic balance
Movement outside base of support (BoS)
Consideration of seating
What are the key considerations for assessing “Sit to Stand”?
Ability to process the task
Ability to perform the task (e.g., level of independence)
Movement analysis
Consideration of equipment
What are the components of “Standing Balance” assessment?
Static balance
Posture/alignment
Dynamic balance
Movement outside BoS
Consideration of equipment
What are the key points to assess in “Gait”?
Ability to process the task
Ability to perform the task (e.g., level of independence)
Movement analysis
Consideration of equipment
What are the elements of “Dynamic Balance” assessment?
Combination of movements
Higher-level functional activities (e.g., stairs)
What types of touch are evaluated in a sensation assessment?
The ability to detect light or crude touch, and sharp or blunt sensations.
What does pressure sensation assessment evaluate?
The ability to detect and respond to pressure applied to the skin.
How is temperature sensation assessed?
By determining the patient’s ability to differentiate between hot and cold stimuli.
What is “one and two-point discrimination”?
It is the ability to distinguish between one point and two points of touch on the skin.
What does proprioception assess in a sensation evaluation?
Proprioception assesses the awareness of body positioning, either of the whole limb or specific joints.
How do we assess coordination formally or informally?
Coordination can be assessed using tasks that evaluate control of upper and lower limb movements through specific tests and observations.
What is the “Finger-Nose” test used for in coordination assessment?
The Finger-Nose test evaluates upper limb coordination by having the patient touch their nose and then extend their finger to touch the examiner’s finger.
What is the “Finger Chase” test used for?
The Finger Chase test assesses upper limb coordination by requiring the patient to follow and touch the examiner’s moving finger.
What does the “Pronation/Supination” (DDK) test evaluate?
It assesses rapid alternating movements (dysdiadochokinesia or DDK) by having the patient repeatedly alternate between palm-up (supination) and palm-down (pronation) positions.
How are reach, grasp, and ADLs used in upper limb coordination assessment?
Reach, grasp, and activities of daily living (ADLs) tests evaluate the patient’s ability to control and coordinate movements for functional tasks like picking up objects or performing self-care activities.
What is the “Heel-Shin” test used for in lower limb coordination assessment?
The Heel-Shin test assesses lower limb coordination by asking the patient to slide the heel of one foot down the shin of the opposite leg.
What do “Toe Taps” evaluate in lower limb coordination?
Toe Taps assess the ability to perform rapid, repetitive movements with the feet, indicating lower limb coordination.
How are step and gait used to assess lower limb coordination?
Step and gait observation evaluates the coordination of the lower limbs during walking or stepping tasks, if appropriate for the patient.
What is muscle tone?
Muscle tone is the degree of contraction of a muscle and the proportion of motor units that are active at any one time.
How is muscle tone assessed through palpation?
Muscle tone is evaluated by the compliance of a muscle on palpation and its resistance to passive stretch or movement.
What are the two main types of factors that influence muscle tone?
Muscle tone can be influenced by neural or non-neural (biomechanical) factors.
How is muscle tone assessed during passive movement?
Muscle tone is assessed by applying variable speed to the passive range of motion and observing the muscle’s resistance.
What is the purpose of the Modified Ashworth Scale?
The Modified Ashworth Scale is used to grade muscle spasticity.
What does a score of 0 on the Modified Ashworth Scale indicate?
A score of 0 indicates no increase in muscle tone.
What does a score of 1 on the Modified Ashworth Scale indicate?
A score of 1 indicates a slight increase in muscle tone, with a catch and release or minimal resistance at the end of the range of motion.
What does a score of 1+ on the Modified Ashworth Scale indicate?
A score of 1+ indicates a slight increase in muscle tone, with a catch followed by minimal resistance through less than half of the range of motion.
What does a score of 2 on the Modified Ashworth Scale indicate?
A score of 2 indicates a marked increase in muscle tone throughout most of the range of motion, but the affected part is still easily moved.
What does a score of 3 on the Modified Ashworth Scale indicate?
A score of 3 indicates a considerable increase in muscle tone, making passive movement difficult.
What does a score of 4 on the Modified Ashworth Scale indicate?
A score of 4 indicates that the affected part is rigid in flexion or extension.
What causes spasticity?
Spasticity results from neuroplasticity and neuronal reorganization.
What is the role of the α motor neurone in spasticity?
Loss of inhibition and hyperexcitability of the α motor neurone contribute to spasticity due to impaired supraspinal control.
What is axonal sprouting and how does it relate to spasticity?
Axonal sprouting is the growth of new nerve fibers which can increase the excitability of motor pathways, contributing to spasticity.
What reflex is involved in spasticity?
Spasticity involves excitation of the cutaneous stretch reflex.
How does rigidity differ from spasticity?
Rigidity does not depend on the velocity of movement, unlike spasticity.
In which neurological condition is rigidity a cardinal sign?
Rigidity is a cardinal sign in Parkinson’s disease.
What is the “lead pipe” phenomenon in rigidity?
The lead pipe phenomenon refers to uniform resistance to passive stretching in all directions, affecting both flexors and extensors.
What is the “cogwheel” phenomenon?
The cogwheel phenomenon is an intermittent increase in tone during passive movement, with a ratchet-like release due to a combination of lead pipe rigidity and tremor.
What aspects of vision are typically assessed?
Visual fields, acuity, tracking (smooth pursuit, saccades), nystagmus, and neglect/inattention.
What is smooth pursuit in vision assessment?
Smooth pursuit refers to the ability to follow a moving object smoothly with the eyes.
What are saccades in vision assessment?
Saccades are rapid eye movements between two points of focus.
What is nystagmus?
Nystagmus is an involuntary, rhythmic eye movement that can affect balance and vision.
What does neglect or inattention refer to in vision assessment?
It refers to the inability to attend to or recognize one side of the visual field, often seen in stroke patients.
What are the two main stages of the gait cycle?
The two main stages of the gait cycle are the Stance Phase (60%) and the Swing Phase (40%).
What are the sub-stages of the Stance Phase in the gait cycle?
The sub-stages of the Stance Phase are:
Initial Contact (Heel Strike)
Load Response (Foot Flat)
Mid-Stance (Single Leg)
Terminal Stance (Heel Off)
Pre-Swing (Toe-Off)
What are the sub-stages of the Swing Phase in the gait cycle?
The sub-stages of the Swing Phase are:
Initial Swing
Mid-Swing
Terminal Swing
