PTE Neuro done Flashcards
Clinical Neuro Examination• This is used to get a
a general idea where the patient stands. It is similar to a basic examination, but the PT is looking atthe neuro integrity of the patient
General Neurologic S&S’s
- Confusion
- Depression
- Weakness
- Change in memory
- Altered sensation
- Change in muscle tone
- Irritability
- Blurred vision
- Balance/coordination problems
• Observation
- Look at Posture
- Look for synergy patterns
- Observe for gait dysfunctions
• Palpation
• Tone assessment
• Sensory
• Superficial and deep sensation assessment
• ROM
• ROM restrictions and Tone
• Motor Testing
- Is the patient’s strength pure? Are they using a synergyor a substitution (secondary muscle) pattern?
- Neurological vs non neurological causes of weakness
• Special Tests
- Cranial Nerve testing
* Functional scales (Berg, Dynamic gait index, TUGS, etc)• Coordination Testing
Functional Tests
- Bed Mobility
- Sit to stand
- Transfers from w/c to and from bed• Gait
- Stairs
• Balance Testing
• Static and dynamic testing•
Using disability scales
What are the different components of the sensory examination?
- Accuracy of cortical perceptions
- Able to localize and recognize
- Joint position sense
- Perception of movement in the extremities • Superficial sensory capabilities
• Superficial sensation
- (tested 1st)
- Responsible for superficial sensation
- Receive info from the external environment
- Responsible for perception of pain, temperature,light touch and pressure
Deep sensation (tested 2nd)
Responsible for deep sensation
• Receive stimuli from the muscles, tendons, liga-
ments, joints and fascia
• Responsible for position sense and awareness of joints at rest, movement awareness (Kinesthesia)and vibration
Combined cortical sensations
- (tested last)
- Combo of both deep and superficial
- Responsible for stereognosis, two point discrimina-tion
Pain
• Test
Use a sharp object that does not pierce the skin
• Should be cleaned before hand
• Response
• Ask when the pt verbally feels the stimulus
Temperature• Test
2 test tubes of different color. Cold (41-50oF) and Heat (104-113oF)
• If too cold or too hot, it may cause pain response• Pt indicates if they feel cold or heat
Light touch• Test
Use a piece of a cotton to the area to be tested
• Response
• With eyes close, pt indicates when they are beingtouched 1,
Pressure• Test
PT presses down until there is a indent into thept’s skin
• Response
• Pt tells PT when they feel that they are being
touched
Difference betweeen propioception and kinesthesia?
Propioception is the static position and kinesthesia is the dynamic position.
Deep sensational testing are
- Kinesthesia
* Proprioception• Vibration
Difference between superficial and deep swnsation?
Pressure is still part of superficial testing because the sensation is coming from the outside workd, and deep, the information is coming in from the inside world, the muscle movements and the vibration from the muscles.
Vibration• Test
Test • Use a tuning fork at 128 Hz • Place the tuning fork on a bony prominence • Response • Ask the pt if the tuning fork is vi-brating or not
Proprioception• Test
- Test joint position
- Passively move the joint into a position with a minimal grip• Response
- Ask the pt what position is the joint is in
Kinesthesia• Test
• Test awareness of movement
• With minimal pressure, the PT lightly grabs a pt’s joint, and they pas-sively moves the joint thru the range, back and forth.
• This is done thru a small range
• Response
• Pt is instructed to tell the PT when they feel what direction is the
joint moving in
• For larger proximal joints, it is done thru a quicker ROM
What is tone?
- Defined as the resistance of muscle to passive elonga-tion or stretch
- Hypertonia = increased
- Hypotonia = decreased
What types of hypertonia is there?
• Spasticity
Rigidity
What is spasticity?
• Increase resistance to motion with an increase in
speed
• Associated with injury to the corticofugal pathways (pyramidal tracts)
Variations of spasticity
• Clasp knife response, Initial stretch produces high resistance, followed by a sudden letting go
• Clonus, Cyclical, spasmodic alternations of ms contrac-tion and relaxation
• Babinski sign, Ext of great toe with stimulation of the lateral
sole of the foot
Rigidity is?
- Resistance to passive movement involving both agonist and antagonist muscles
- Due to lesions to the basal ganglia
- Variations
- Cogwheel - rachetlike
- Leadpipe – constant rigidity
Components of Tone Assessment are?
• Observation
Palpation
• PROM
Observation portion of tone assessment
- Observe to see if a pt is fixed in to certain pos-tures
- Ie. LE fixed into ext, add, and pf
- If a limb is floppy, it will look lifeless, and the LE’s roll ou
Palpation portion of tonal assessment
• Hypotonic muscles will feel soft and flabby• Hypertonic muscles will feel taut and
harder than normal
PROM portion of tonal assessment
- Move the limb in all directs
- Detect if any resistance, in order to check for rigidity
- Then proceed with quicker speeds to check for spasticity
Hypertonic state, we do not do _________ test.
Strength
Why do we not do strength test when we notice a person in a hypertonic state?
Its just tone, an inaccurate reading.
What is the main question that we ask when we perform the motor assessment?
If there is weakness, then why is this person in this regards.
What two super major superficial things can cause muscle weakness?
Is it the neuro diagnosis, or is it other stuff.
Difference between primary and secondary weakness?
The broken ankle, it gets weak because of pain and maybe because of damaged nueral connections, but the knees and hips will get weak because of disuse due to the pain at the ankle, and this is now secondary.
PT is good for the primary neural issues or is it good for the secondary atrophy disuse and improper motor movement issues?
The secondary issues
Movement starts where?
Brain… Motor cortex.
Parietal does what?
Sensory
