Practical Final Exam Flashcards
Deep Tendon Reflex steps
tendon should be in a slight stretch, pt should be relaxed
assess bilaterally
can use jendrassik maneuver if no reflex
Jendrassik maneuver
link fingers as shaking your own hands, pull apart
cross legs and squeeze them together
Neuroanatomy being testing w/deep tendon reflex
UMN: hyperreflexia
LMN: hyporeflexia
Documentation of Deep tendon reflexes
note reflex being tested
describe with grading system
Biceps
C5, C6
Brachioradialis
C6
Triceps
C7
Patellar
L4
Achilles tendon
S1
Grading scale for deep tendon reflexes
0: absent
1: trace
2: normal
3: brisk
4: nonsustained clonus
5: sustained clonus
Hearing screen test
pt should have closed eyes
pt should verbalize when they hear you
rub fingers together near ear. vary side, speed, rhythm
document as intact, impaired, absent
Neuroanatomy of hearing screen
CN VIII, special somatic sensory
Rinne Test
using tuning fork, tell pt that youre going to be placing it next to their ear
strike tines against hand
place tuning fork on mastoid process, ask pt if they can hear it. Ask when they cannot hear it anymore
move the fork to the front of the ear, see if they can hear it and for how long
repeat with other ear
document: intact or impaired
Neuroanatomy of Rinne test
CN VIII, cochlear
Mastoid: cochlear, inner ear
Outer ear: tympanic membrane, ossicles
Visual Fields test
pt looking at the tip of your nose
they cover one eye with thier hand
test each 4 quadrants, start FAR away
pt responds when they see your finger wiggle
document which eye and visual field/quadrant showed impairment
Neuroanatomy of visual fields
CN II
LGN
Optic radiations
Visual cortex
Pupillary light reflex
Both eyes open, dimly lit room
pt focuses on target in distance
shield contralateral eye from light
check ipsilateral eye and then view contralateral eye
document: normal/impaired/absent for ipsilateral and contralateral respones
Neuroanatomy of pupillary light reflex
CN 2: visual pathways
CN 3: motor pathways, brainstem nuclei, parasympathetic pathway
Eye movements/Ocular ROM
Ask if the pt has difficult with eye movement or gaze, blurry vision, double vision
notice any asymmetry at rest
pt follows pen with eyes, movement is in a H pattern
document asymmetry in rest and in movement, with which direction
Neuroanatomy of eye movements
CN 3, 4, 6
Smooth pursuit test
Assessing coordination of eye movements
PT holds target with point perpendicular to pt’s eyes
pt maintains focus on target as head stays still
should be about 20 in from pt face
move pen in + pattern. Eyes should move without any sudden starts, skips, stops
document: normal or saccadic, direction of saccadic intrusions
Neuroanatomy of Smooth Pursuit
Cerebellum–Flocculonodular lobe, vermis
Saccades Test
pt should have intact oculomotor innervation
pen adjacent to your ear, should be same height as nose
ask pt to shift gaze from nose to your pen
vary the timing of cues
ear to top of head
opposite ear, below chin
normal should be 1-2 saccades
documentation: normal, hypermetric, hypometric & direction
Neuroanatomy for saccades
cerebral cortex (frontal eye fields)
basal ganglia (impaired initiation/suppression)
cerebellar vermis (dysmetria)
Gaze holding nystagmus
Target is 20” from face
move target in + sign
maintain gaze for 10 s on each target
don’t move them into end range
gaze holding = intact or impaired
direction of impaired, which eye, symptoms
Neuroanatomy for gaze holding nystagmus
vestibular
cerebellum
Facial sensation
ask if pt has noticed numbness or tingling
ask pt to close eyes, and tell you when they feel cotton ball
touch forehead, cheekbone, lower jaw
document: diminished/absent, note location and side
Neuroanatomy of facial sensation
CN V
opthalmic, maxillary, mandibular
Muscles of mastication
ask if there are difficulty w/chewing or eating
palpate muscles of mastication in rest
view muscle without resistance
provide resistance to jaw
ask pt to bite down, so you can palpate
document: asymmetries, weakness, atrophy
Neuroanatomy of mastication
CN V
branchia motor, special visceral efferent
Facial expression
Ask pt for difficulties
observe resting positions
raise eyebrows (frontalis)
close eyes tightly (orbicularis oculi)
smile widely (zygomaticus)
purse lips (orbicularis oris
draw corners of mouth down (platysma
document asymmetries or weakness
Neuroanatomy of facial expression
CN VII
branchial motor, special visceral efferent
Pharynx/Palate Testing
ask if there is any problems swallowing
ask pt to do “ahhh”
observe soft palate for symmetrical movement, uvula should be midline (deviates to non-affected side)
document: intact or impaired
Neuroanatomy for pharynx/palate
CN IX motor to pharynx
CN X motor to muscles of soft palate
Tongue movement test
testing strength of the muscles of their tongue
ask the pt to stick their tongue straight out
observe for tongue deviations (goes to weaker side)
press on side of cheek to provide resistance
document any observed weakness and which side
Neuroanatomy of tongue movement
CNXII, somatic motor
Coordination testing
Finger to nose (5x)
Heel to shin (5x)
Hands on lap (10s) = discoordination indicates cerebellum
Toe tapping (10s)
Finger Tapping (10s)
observe rhythm, accuracy, speed
document as intact or impaired
Neuroanatomy for coordination
cerebellum = overshoot/undershoot
basal ganglia = speed, amplitude
