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Health Assessment > Week 4 - Neurological Assessment > Flashcards

Week 4 - Neurological Assessment Flashcards

1
Q

Central Nervous System (CNS)

A

brain and spinal cord

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2
Q

Meninges

A

protective layer over the CNS

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3
Q

Cerebrospinal fluid

A

clear fluid around brain and spinal cord (for cushioning protection)

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4
Q

Peripheral Nervous System (PNS)

A

12 cranial nerves, 31 spinal nerves and branches

Consists of:
- Sensory (afferent) messages to CNS

  • Motor (efferent) messages from CNS
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5
Q

Cerebral Cortex

A

CNS

Outer-layer of nerve bodies and cells, divided into right and left hemispheres (and 4 lobes)

Area of highest functioning (memory, reasoning, sensations, voluntary movement)

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6
Q

Basal Ganglia

A

CNS

  • Deep in hemispheres, associated with motor system
  • Automatic, involuntary movements (e.g., arm swing when walking)
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7
Q

Thalamus

A

CNS

  • “relay station”
  • Relays sensory information from the body to the cortex
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8
Q

Hypothalamus

A

CNS

  • “command centre”
  • Controls temp, HR, BP, regulates sleep
  • Houses pituitary gland producing many directive hormones
  • Under autonomic control (unconscious bodily functions)
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9
Q

Cerebellum (6)

A

CNS

  • At base of brain
  • Motor coordination of voluntary movement
  • Equilibrium
  • Muscle tone
  • Operates on unconscious level
  • Adjusts/corrects voluntary movements to coordinate and smooth them
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10
Q

Brain stem (in central core)

A

CNS

Consists of:

  • Midbrain
  • Pons
  • Medulla
  • Many fibre tracks relaying -information to-from brain
  • Plays a role in autonomic control as well
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11
Q

Spinal Cord

A

CNS

  • Continuous from brain stem into L1-L2
  • Major pathway for all ascending/descending tracts
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12
Q

4 Lobes of the Cerebral Cortex

A
  1. Frontal Lobe
  2. Temporal Lobe
  3. Parietal Lobe
  4. Occipital Lobe
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13
Q

Frontal Lobe

A

Personality, behaviour, emotional, intellectual functioning

  • Location of Broca’s Area (motor speech)
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14
Q

Temportal Lobe

A

Auditory, taste, smell

  • Location of Wernicke’s Area (language comprehension)
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15
Q

Parietal Lobe

A

Primary sensory area

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16
Q

Occipital Lobe

A

Visual

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17
Q

Broca’s Area

A
  • In Frontal Lobe
  • Regulates motor component of speech
  • If damaged, results in “expressive aphasia”
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18
Q

Wernicke’s Area

A
  • In Temporal Lobe
  • Processes language comprehension
  • damaged, causes “receptive aphasia”
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19
Q

Expressive Aphasia

A

Motor component of talking is impaired, can’t say what they want to say

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20
Q

Receptive Aphasia

A

Can hear but not understand language

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21
Q

Sensory Pathways of the CNS

A

Ascending (send info to the brain)

  • Spinothalamic tract
  • Posterior (dorsal) column
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22
Q

Spinothalamic tract

A

Ascending sensory pathway of CNS

Responsible for:

  • Pain
  • Temperature
  • Light (crude) touch
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23
Q

Posterior (dorsal) column

A

Ascending sensory pathway of CNS

Responsible for:

  • Proprioception
  • Vibration
  • Stereognosis (ability to identify an object without looking)
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24
Q

Motor Pathways of CNS

A

Descending (sending info from brain to periphery)

  • Corticospinal (Pyramidal) Tract
  • Extrapyramidal Tract
  • Cerebellar System
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25
Q

Corticospinal (Pyramidal) Tract

A

Descending sensory pathway of CNS

Responsible for:
- Skilled, purposeful voluntary movement

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26
Q

Extrapyramidal Tract

A

Descending sensory pathway of CNS

Responsible for:

  • Muscle tone
  • Gross body movements
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27
Q

Cerebellar System

A

Descending sensory pathway of CNS

Responsible for:

  • Coordinates movement
  • Maintains equilibrium
  • Posture
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28
Q

Upper Motor Neurons

A
  • Are Descending neurons
  • Located in CNS
  • Influence Lower Motor Neurons (LMN)
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29
Q

Lower Motor Neurons (LMN)

A
  • Located in Peripheral Nervous System (PNS)

- Final pathway

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30
Q

Example of Upper Motor Neuron Disorder

A

Stroke

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31
Q

Example of Lower Motor Neuron Disorder

A

Spinal lesion

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32
Q

Peripheral Nervous System (PNS)

A

Peripheral nerves are both afferent and efferent, and carry input to the CNS

PNS consists of:

  • 12 Cranial Nerves
  • 31 pairs of spinal nerves
  • Dermatomes
  • Reflex arcs
  • Autonomic Nervous System
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33
Q

12 Cranial Nerves

A 
I: Olfactory
II: Optic
III: Oculomotor
IV: Throclear
V: Trigeminal
VI: Abducens
VII: Facial
VIII: Acoustic
IX: Glossopharyngeal
X: Vagus
XI: Spinal Accessory
XII: Hypoglossal

3 Sensory
4 Motor
5 Mixed

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34
Q

Olfactory Nerve

A

CN: I

Type: Sensory

Function: Smell

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35
Q

Optic Nerve

A

CN: II

Type: Sensory

Function: Vision

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36
Q

Oculomotor Nerve

A

CN: III

Type: Mixed

Functions:

  • Motor: Extra-ocular movement (e.g., eyelids)
  • Sensory: pupil constriction, lens shape
37
Q

Trochlear Nerve

A

CN: IV

Type: Motor

Function: Down and inward movement of the eye

38
Q

Trigeminal Nere

A

CN: V

Type: Mixed

Functions:

  • Motor: muscles of mastication
  • Sensory: sensation of face, scalp, cornea, mucous membranes of mouth/nose
39
Q

Abducens Nerve

A

CN: VI

Type: Motor

Function: Later movement of the eye

40
Q

Facial Nerve

A

CN: VII

Type: Mixed

Functions:

  • Motor: facial muscles, closing eyes, labial speech, closing mouth
  • Sensory: taste on anterior two-thirds of the tongue
  • Parasympathetic: saliva and tear secretion
41
Q

Acoustic Nerve

A

CN: VIII

Type: Sensory

Function: Hearing and equilibrium

42
Q

Glossopharyngeal Nerve

A

CN: IX

Type: Mixed

Functions:

  • Motor: pharynx (phonation and swallowing)
  • Sensory: taste on posterior 1/3 of tongue, pharynx (i.e., gag reflex)
  • Parasympathetic: parotid gland, carotid reflex
43
Q

Vagus Nerve

A

CN: X

Type: Mixed

Functions:

  • Motor: pharynx and larynx (talking and swallowing)
  • Sensory: general sensation from carotid body, carotid sinus, pharynx, viscera
  • Parasympathetic: carotid reflex
44
Q

Spinal accessory nerve

A

CN: XI

Type: Motor

Function: Movement of trapezius and sternomastoid muscles

45
Q

Hypoglossal nerve

A

CN: XII

Type: Motor

Function: Movement of tongue

46
Q

4 types of reflexes

A
  1. Deep Tendon Reflexes (DTR)
  2. Superficial Reflexes
  3. Visceral Reflexes
  4. Pathologic Reflexes
47
Q

Example of Deep Tendon Reflex

A

Reflex hammer

48
Q

Example of Superficial Reflex

A

Corneal Reflex

49
Q

Example of Visceral Reflex

A

Pupillary response to light

50
Q

Example of Pathalogic reflexes

A

Unexpected reflexes with underlying nervous damage

51
Q

Reflex Arc

A

Afferent signal and motor response. Body reacts prior to cognition as a way of preventing injury.

52
Q

NS Developmental Considerations for Infants (5)

A
  • Brain and NS are immature at birth, not fully developed
  • Dramatic growth and development of neurological system during 1st year of life
  • Initially, movements directed primarily by primitive reflexes
  • As cerebral cortex develops more, these more primitive reflexes become inhibited
  • If these reflexes persisted beyond a particular length of time, there would be concern about an underlying neurological disorder
53
Q

Sensory and Motor System development in infants

A

Develops during process of myelinization of the neuron:
- Cephalocaudal (head to toe) and proximal to distal (middle of body to periphery) order

E.g., first head and neck, then trunk, then control of extremities to crawl and walk

  • Develops from simple to complex to coordinated
54
Q

NS Developmental Considerations for Older Adults (4)

A
  1. General atrophy/loss of neurons in brain and spinal cord (15% decrease by age 90)
  2. Decrease in velocity of conduction in cranial/spinal nerves due to 10% decreased myelin)
  3. Motor systems atrophy (slowing down of movement and reaction times)
  4. Slowing of processing times, but cognitive function remains the same in the absence of neurodegenerative disorders
55
Q

Complications of neural atrophy in older adults

A
  • Loss of neurons in brain stem, cerebellum, cerebral cortex = impaired fine coordination and agility, correction, and balance.
56
Q

Complications of decreased cranial/spinal nerve conduction in older adults

A
  • Slows reaction time in some individuals due to delay in synapse time
  • Sensory changes (decreased taste, smell, pain perception)
57
Q

Complications of motor system atrophy in older adults

A
  • Result of progressive decreased cerebral blood flow and oxygenation
  • May cause dizziness, loss of balance
58
Q

Components of subjective neurological assessment

A

PQRSTU-AAA:

  1. Headache
  2. Head injury
  3. Dizziness and vertigo
  4. Seizures
  5. Tremors
  6. Weakness
  7. Coordination/balance
  8. Numbness or tingling
  9. Difficulty swallowing
  10. Difficulty speaking
  11. Significant past history/family history
  12. Environmental and occupational hazards
59
Q

Objective vertigo

A

Sensation that room is spinning but person is still

60
Q

Subjective vertigo

A

Sensation that person is spinning but room is still

61
Q

Dysphagia

A

Difficulty swallowing

62
Q

Paraesthesia

A

numbness/tingling

63
Q

Dysarthria

A

Difficulty forming words, muscles used for speech are weakened

(complication in Broca’s Area)

64
Q

Dysphasia

A

Difficulty with language comprehension or expression

complication in Wernicke’s Area

65
Q

Examples of significant neurological past and family history (5)

A
  • Stroke
  • Alzheimer’s, dementia
  • spinal cord injury
  • concussion
  • meningitis
66
Q

Examples of occupational hazards affecting neuro health (4)

A
  • Chemical exposures, like lead
  • Alcohol, drug, substance use
  • Inadequate sleep or nutrition
  • New medications
67
Q

Components of Physical Examination/Objective Assessment Sequence of completion (4)

A
  1. Cranial nerves (group together as much as possible)
  2. Motor system
  3. Sensory system
  4. Reflexes
68
Q

Assessment of Olfactory Nerve

A

CN I - Sensory

Assess:

  1. Patency:
    - Ask patient to occlude a nostril, sniff, and repeat on the other side.
  2. Sense of smell:
    - Close eyes, occlude nostril, present smell, ask them to say when they smell something and tell us what the smell is
69
Q

Assessment of Optic Nerve

A

CN II - Sensory

Assess:

  1. Visual Acuity: Snellen Chart
  2. Visual fields (peripheral vision): Confrontation test
  3. Fundus
70
Q

Assessment of Oculomotor, Trochlear, and Abducens nerves

A

CN II, IV, VI - Mixed, Motor, Motor

Assess:

  1. Palpebral fissures (eyelids)
    - Symmetry
    - Ptosis (drooping)
  2. Pupils
    - PERRLA: Pupils Equally Round Reactive to Light Accommodation
  3. Eye Movements
    - “Extra-occular movement” = unexpected
    - Nystagmus (oscillating of the eye, wiggling in place… injury to cerebellum and brain stem)
71
Q

Assessment of Trigeminal nerve

A

CN V - Mixed

Sensory:

  1. Assess light touch; assess corneal reflex only if necessary
  2. Ophthalmic, maxillary, mandibular areas
  3. Ask pt to tell you when they feel a piece of cotton
  4. If unable to feel, then test corneal reflex (blink)

Motor:

  1. Assess temporal and masseter muscles, lower jaw movement
  2. Palpate muscles of mastication below the ears; assess for equal strength on both sides
72
Q

Assessment of Facial nerve

A

CN VII - Mixed

Motor:

  1. Assess mobility & symmetry with facial expressions
  2. Ask client to smile, show teeth, squeeze eyes tight, puff cheeks - Look for symmetry

Sensory:
1. Assess anterior 2/3 of tongue sense of taste (when suspect injury to CN VII)

Parasympathetic:
1. Saliva and tear secretion

73
Q

Assessment of Acoustic nerve

A

CN VIII - Sensory

  1. Assess hearing acuity
    - ability to hear regular conversation
    - Whispered voice test: Occulde one ear, stand 2ft behind, whisper simple sentence and ask them to repeat it
74
Q

Assessment of Glossopharyngeal and Vagus nerves

A

CN IX and X - Mixed

Motor:

  1. Assess movement of pharynx
    - Tongue blade, say “ahh”, watch soft pallet and uvula move upward in midline
  2. Assess for gag reflex (not routine)
    - Stick tongue depressor into back of throat

Sensory:
- Difficult to assess posterior 1/3 of tongue sense of taste

75
Q

Assessment of Spinal Accessory nerve

A

CN XI - Motor

Assess:

  1. Neck muscles for size and strength
  2. Movement of trapezial and sternal mastoid muscles
  3. Turn face against resistance of your hand
  4. Same with shoulders with equal strength on both sides
76
Q

Assessment of Hypoglossal nerve

A

CN XII - Motor

  1. Assess movement of the tongue (should be on midline) - “light, tight, dynamite”
  2. Assessing strength of voice, enunciation
77
Q

Components of Motor System Assessment (2)

A
  1. Muscles

2. Cerebellar function

78
Q

Assessment of muscles (4)

A

Part of the Motor System Assessment

Based on observation:

  1. Move head-to-toe and assess major muscle groups
  2. Assess for symmetry of size, strength, tone (passive ROM, move limb/joint for pt and note rigidity/resistance
  3. Look for involuntary movement (ticks, tremors, twitches)
    4 . Look for atrophy of muscle groups
79
Q

Assessment of cerebellar function

A

Part of the Motor System Assessment

Balance tests:

  1. Gait
  2. Tandem walking (heel-to-toe)
  3. Romberg test (stand with feet together and close eyes for 20s)

Coordination and Skilled Movements:

  1. Rapid-alternating movements
  2. Finger-to-finger test
  3. Finger-to-nose test
  4. Heel-to-shin test
80
Q

Ataxia

A

uncoordinated/unsteady gait

81
Q

Components of Sensory System Assessment (2)

A
  1. Spinothalamic Tract

2. Posterior Column Tract

82
Q

Assessment of Spinothalamic Tract (3)

A

Part of Sensory System Assessment

  1. Pain: random sites irregularly on body, poke with sharp and blunt tongue blade and to discriminate
  2. Temperature
  3. Light touch: cotton ball and ask them to tell us when they feel it
83
Q

Assessment of Posterior Column Tract (3)

A

Part of Sensory System Assessment

  1. Vibration: use tuning fork and place vibrating end on bony prominence on pt, ask them to tell us when they feel vibration and when it stops
  2. Position (kinesthesia):
  3. Fine touch (tactile discrimination)
  • Stereognosis: recognition of objects when eyes are closed (pen, paper clip)
  • Graphesthesia: ask pt to close eyes, draw letter or number on hand
  • 2-point discrimination: ability to decipher two simultaneous pinpricks on the skin and the ability to determine if it’s two or one point (use paperclip)
84
Q

Stereognosis

A

Recognition of objects when eyes are closed (pen, paper clip)

Part of fine-touch, assessment of posterior column tract

85
Q

Graphesthesia

A

Ask pt to close eyes, draw letter or number on hand

Part of fine-touch, assessment of posterior column tract

86
Q

Deep Tendon Reflex Testing

A

Test the reflex arc at a specific spinal level

  • Biceps (C5-C6)
  • Triceps (C7-C8)
  • Brachioradialis (C5-C8)
  • Quadriceps (patellar, knee jerk) (L2-L4),
  • Achilles (L5-S2)
87
Q

Superficial Reflex Testing

A

Sensory receptors in the skin rather than muscles

88
Q

Deep Tendon Reflex grade

A 
\+4 = Very brisk, hyperactive with clonus (rapid, rhythmic contraction of muscle)
\+3 =	Brisker than average
\+2 = Average, normal
\+1 = Diminished, low normal
0 = No response

Health Assessment (8 decks)

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