Quiz 3 NMS 1 Flashcards
How do you test for vibration?
- use a 128 or 256 Hz tuning fork and place on ankle with eyes closed and ask what they feel
- if they don’t feel move up to knee, if not felt move to hip
Loss of vibratory perception is referred to as….
pallanesthesia
Romberg Test
- patient stands looking straight ahead with eyes open
- feet are approximated and doc stands near pt.
- patient closes their eyes
Normal Romberg test
patient maintains posture
little or no swaying
abnormal Romberg
-patient takes a step to maintain posture or falls
Falls with eyes open or closed on Romberg test may indicate
-Cerebellar Deficit and/or vestibular mechanism deficit
fall with eyes closed only on romberg may indicate…
-dorsal column pathology
Hopping on one foot test
-pt. hops on one leg with eyes open and closed and then hops on the other leg with eyes open and closed
Normal hopping on foot test
-pt. maintains posture with eyes open and closed
Abnormal Hopping on foot test
-patient takes a step to maintain posture OR the patient falls
Falls with eyes open and closed on hopping on one foot test may indicate…
cerebellar deficit and/or vestibular mechanism deficit
Falls with eyes closed only in hopping on one foot test may indicate…
dorsal column pathology
Squatting on one foot test
- good way to find minor weakness in lower extremities
- patient squats on one leg with eyes open and closed and then squats on the other leg with eyes open and closed
Normal squatting on foot test
-patient maintains posture with eyes open and closed
Abnormal squatting one foot test
-patient takes a step tp maintain posture or falls
falls with eyes open and closed on squatting test may indicate…
-cerebellar deficit and/or vestibular mechanism deficit
falls with eyes closed only on squatting test may indicate…
-dorsal column pathology
Finger to nose test
-patient has their arms straight out to the side and attempts to touch the tip of his or her nose with the tip of his or her finger bilaterally with eyes open and closed
Normal finger to nose test
-should see smooth and accurate movement
Abnormal finger to nose test
- dyssynergia: uncoordinated movement
- dysmetria: inaccuracy in measuring distance
Finger to finger test
-patient has his or her arms straight out to his or her side and attempts to touch the tips of their index fingers, together, straight out in front of them with eyes open and closed
normal finger to finger
-should see smooth and accurate movement
abnormal finger to finger test
-dyssynergia and dysmetria
finger to nose to finger test
-Dr. stands with finger about 2 ft. from the patient and has the patient alternate touching his or her finger from their nose to the doctor’s finger, with the doctor constantly changing postitions of his finger. performed with eyes open only
Normal finger to nose to finger test
-should see smooth and accurate movement
Abnormal finger to nose to finger test
- dyssynergia
- CANNOT be done for dysmetria
Heel to shin test
-patient attempts to run his heel from one side down the anterior shin from the knee to the ankle of the opposite leg. performed bilaterally with eyes open and closed
abnormal heel to shin test
-dyssynergia and dysmetria
testing for ability to perform rapid alternating movements
- patting knees rapidly, tapping forefinger to thumb, pronation/supination of hands
- performed with eyes open and closed
normal rapid alternating movements
-diadochokinesia:performing actions properly
abnormal rapid alternating movements
-dysdiadochokinesia: inability to perform actions properly indicates possible cerebellar dysfunction
Holmes Rebound Phenomenon
-patient contracts flexors of the forearm against resistance by the doctor. doctor releases arm quickly. performed with eyes open and closed
Normal holmes rebound
-should see a normal “check reflex”
Abnormal holmes reflex
-dyssynergia and dysmetria
Tandem gait test
-patient walks along a straight line on the floor by placing one heel directly in front of the oppposite toe with eyes open and then again closed
abnormal tandem gait
-dyssynergia and dysmetria
joint position test
-Dr. examines digit of patient’s hand or foot by stabilizing the hand and /or foot and grabbing a single digit FROM THE SIDES and flex or extend that digit without placing any pressure on the top or bottom of digit. ask patient to inform you whether you are moving toe or finger up or down. eyes should be closed
abnormal joint position test
-patient cannot determine accurately whether his finger or toe is being moved up or down; would indicate possible posterior column disease (proprioception)
deep pain and pressure sensation is mediated by….
-dorsal columns
loss of pain sensation in tissue would be noted as…
positive
Abadie’s sign
pinching the achilles tendon
Pitres’ sign
-pinching testicles
Biernacki sign
-pinching or striking ulnar nerve
Deep pain can also be tested by…
-placing pressure on eyeball
multimodal sensation
-combined both superficial and deep sensations
stereognosis
-place a common object in patients hand while their eyes are closed. should be able to identify object without switching hands
barognosis
-patient assesses the relative weight of similarly sized and shaped objects that have dif weights
topognosis
touch pt. somewhere on skin and have them point to the area touched
graphognosis
test patient by writing a letter or number on their chest, back or palm of the hand and have them identify it
2 point discrimination
- distance varies considerably in dif parts of the body
- fingertips 2-4mm
- dorsum of fingers 4-6mm
- palm 8-12 mm
- dorsum of hand 20-30mm
somatognosis
-ability for patient to know a body part is his own body part. this is tested by placing your arm next to the patient’s arm and asking him to touch your own arm
nosognosis
-ability for patient to knjow that he is ill. in light of obvious and overwhelming evidence of neurological disease such as hemiplegia, the patient will deny that there is a problem
