Week 8: Neurological Assessment Flashcards
Three major parts of the brain
Cerebrum, Cerebellum, Brainstem
Parts of the cerebrum and their purpose (5)
- Central cortex: Highest level of functioning
- Frontal lobe: High-level cognitive functioning (reasoning, abstraction, concentration, storing information, voluntary eye movement)
- Parietal lobe: integrating sensory information
- Temporal lobe: interpreting smells, sounds, and language
- Occipital love: interpret visual stimuli and sense of light
Broca’s area: Location and purpose
Frontal love
- Motor control of speech
Wernicke’s area: Location and purpose
Temporal lobe
- Language comprehension
Cerebellum: Location and purpose
Back of brain
- Linking sensory input, coordination of speech/movement/senses
Brainstem: Location and purpose
- Posterior part of brain, connects cerebrum and spinal cord
- Central core of brain, controls involuntary behaviors, transmit impulses
Cranial nerve I: Name, function, assessment test
- Olfactory
- Sense of smell
- Have pt hold one nostril closed, identify a smell, switch nostrils and repeat
Cranial nerve II: Name, function, assessment test
- Optic
- Visual acuity and field
- Snellen chart
Cranial nerve III: Name, function, assessment test
- Oculomotor
- Eye movement, pupil size + reactivity, eyelid movement
- Penlight to assess PERRLA
Cranial nerve IV: Name, function, assessment test
- Trochlear
- Eye movement down + laterally
- Ask pt to follow movement of penlight down and sideways
Cranial nerve V: Name, function, assessment test
- Trigeminal
- Chewing and facial sensation
- Touch pt’s face with a cotton ball at different areas and say “now” when they feel
Cranial nerve VI: Name, function, assessment test
- Abducens
- Eye movement laterally
- Ask pt to follow penlight side to side + diagonally
Cranial nerve VII: Name, function, assessment test
- Facial
- Facial expressions
- Ask pt to make different faces
Cranial nerve VIII: Name, function, assessment test
- Vestibulo-cochlear
- Hearing, balance
- Ask pt to cover one ear and listen in the other, then repeat; ask pt to walk and assess gait
Cranial nerve IX: Name, function, assessment test
- Glossopharyngeal
- Gagging, swallowing
- Ask pt to say “ah” and yawn, assess movement of soft palate, ask pt to swallow
Cranial nerve X: Name, function, assessment test
- Vagus
- Pharynx + larynx sensation, swallowing
- Use something to touch posterior pharynx + observe for gag reflex and swallowing
Cranial nerve XI: Name, function, assessment test
- Spinal accessory
- Shoulder shrugging, head rotation
- Ask pt to shrug shoulders and push against your hands
Cranial nerve XII: Name, function, assessment test
- Hypoglossal
- Movement of the tongue
- Ask pt to stick out tongue and move side-to-side
Diagnostic tools and what they do (6)
- CT Scan: structural imaging study
- Electroencephalogram (EEG): measure electrical activity of the brain
- Lumbar puncture: withdraw CSF for analysis
- Magnetic resonance imaging (MRI): structural imaging study (clearer)
- PET scan: evaluate metabolism, blood flow, oxygen use, glucose metabolism, and chemical processes
- Cerebral angiography: assesses cerebral circulation
Nuchal rigidity
Neck pain and stiffness
Neuropathies
Occurs when motor or sensory nerves of the PNS are damaged. Symptoms may include tingling, numbness, a burning sensation, pain, inability to feel, or muscle weakness.
Transient ischemic attack (TIA)
Temporary loss of blood flow to the brain
Types of headache, migraine: Definition and cause
- Throbbing or pulsating, episodic head pain often confined to one side of head with sensory sensitivity
- Dilation of blood vessels, neuronal activation, pain; dysfunction of Trigeminal nerve
Types of headache, tension: Definition and cause
- Mild to moderate bilateral tightening pain, feels like pressure around head WITHOUT sensory sensitivity, most common type of headache
- Unknown
Types of headache, cluster: Definition and cause
- Unilateral burning, stabbing, piercing pain; may have swelling around eye, usually at night 15-180 min
- Unknown
Types of headache, increased or decreased cerebral spinal fluid headache: Definition and cause
- Pressure, generalized headache; presents on waking + exhibits relief over day, visual disturbances present
- Benign lesion, inc ICP
Vertigo: Subjective vs objective
Sensation of moving in space vs objects moving around person
Dysphasia
Partial impairment of language and speech impacting the ability to communicate
Aphasia
Complete impairment of comprehension and expression in the verbal, written, and signed modalities
Receptive vs expressive aphasia
Damage to Wernicke’s area, inability to understand language vs Damage to Broca’s area, inability to communicate
Types of aphasia, visual-receptive: Definition and indication
- Disorder of central language processing, inability to recognize spoken words
- Injury to parietal-occipital area
Types of aphasia, expressive: Definition and indication
- Inability to express words, nonverbal
- Injury to interior frontal brain area
Types of aphasia, global: Definition and indication
- Impaired comprehension and expression of speech
- Commonly seen with left, middle cerebral artery infarction
Types of aphasia, apraxia: Definition and indication
- Partial or complete inability to use tongue, lips, and lower jaw when speaking
- Lesion in Broca’s area
Types of aphasia, dysphonia: Definition and indication
- Difficulty speaking; hoarseness or whisper
- Paralysis of soft palate
Types of aphasia, dysarthria: Definition and indication
- Inability to articulate
- Motor deficit of tongue or speech muscles
Overlapping systems: Cardiovascular considerations and their implications (3)
- Cerebral vascular accident (CVA): clots can cause strokes, or blood can leak into the brain
- Atrial fibrillation: increases risk for stroke
- Paresthesia: hands can change color or become numb due to an underlying neurological disease or injury
Cerebral vascular accident (CVA): Ischemic vs hemorrhagic stroke
Occlusion of blood flow vs leaking of blood into brain
Overlapping systems: Gastrointestinal considerations and their implications (2)
- Nausea/vomiting: can indicate increased ICP
- Loss of bowl/bladder function: can indicate spinal cord damage or a compressed nerve
Overlapping systems: Musculoskeletal considerations and their implications (3)
- Myasthenia: can be associated with neurological disorders
- Myasthenia gravis: caused by a chronic neuromuscular disorder
- Multiple sclerosis: caused by an immune-mediated process
Overlapping systems: Endocrine considerations and their implications (2)
- Diabetes: can increase the chance of peripheral neuropathies
- Low levels of thyroid hormone: can cause symptoms related to the neurological system
Overlapping systems: Hematological considerations and their implications
Blood disorders: coagulation disorders can cause the blood to thicken and increase the risk of strokes
Major categories of neurological assessment (5)
- Level of consciousness/mental status
- Cranial nerve function
- Motor system
- Sensory system
- Reflexes
Steps to assess level of consciousness and mental status
- Assess the pt’s ability to arouse and response
- Assess the pt’s orientation to person, place, time, and situation via asking questions
- Document
LOC abnormal findings: Lethargic
Difficulty maintaining mentation (or sluggish), but arousable and able to answer
LOC abnormal findings: Obtunded
Able to keep pt awake only by verbal or tactile stimuli, pt confused when awake
LOC abnormal findings: Stupor
Unresponsive to verbal stimuli with decreased responsiveness to painful stimuli, nonverbal if eyes open
LOC abnormal findings: Comatose
Lack of response to any stimuli
How the 4 areas of the nervous system work together in the motor system
- Cerebellar: posture and rhythmic movement
- Motor: muscle strength
- Sensory: position sense and vibrations
- Vestibular: balance and coordination
Steps to assess muscle strength of the upper and lower extremities
- Explain technique
- Ask pt to perform ROM activities of upper extremities with and without resistance
- Ask pt to perform ROM activities of lower extremities with and without resistance
- Document
Muscle strength abnormal findings: Hypotonia
Dec muscle tone (may be seen in NM disorders + cerebellar lesions)
Muscle strength abnormal findings: Flaccidity
Loss of muscle tone
Muscle strength abnormal findings: Hypertonia
Increased muscle tone (may be because of injury to upper motor neurons)
Muscle strength abnormal findings: Rigidity
Muscles contracted and/or tense (associated with Parkinson’s and NM injuries/diseases)
Muscle strength abnormal findings: Spasticity
Increased motor tone causing stiffness and tight muscles
Muscle strength abnormal findings: Hemiparesis
Loss of muscle tone and strength to one side of body (caused by stroke or NM injury/disease)
Muscle strength abnormal findings: Paraplegic
Loss or impairment of motor/sensory function in lower extremities (caused by spinal cord injury/lesion at or below thoracic spine level)
Muscle strength abnormal findings: Quadriplegic
Loss or impairment of motor/sensory function in upper AND lower extremities (caused by injury/lesion at or below cervical spine 1)
Muscle strength abnormal findings: Decorticate posturing
Internal rotation and adduction of arms with flection of elbows/wrists/fingers, plantar flexion of feet with internal flexion of legs, both legs stiffly extended (caused by severe brain injury)
Muscle strength abnormal findings: Decerebrate posturing
Arms stiffly extended, adducted, and hyperpronated with hyperextension of legs and plantar flexion of feet, legs stiffly extended (caused by more serious damage to midbrain and/or brainstem)
Steps to assess gait
- Explain to pt
- Identify distance you want the pt to walk, then ask to walk from you FIRST and then BACK to you (gait, balance, posture)
- Ask pt to walk on toes AWAY and return on heels (balance)
- Ask pt to walk heel-to-toe away from and back to you (muscular weakness)
- Ask pt to hop on one foot, then the other (position, cerebellar functioning)
- Ask pt to do shallow knee bend (muscle weakness)
- Document
Gait assessment abnormal findings: Ataxia
Defective muscle coordination (caused by drugs, alcohol, cerebellar disease)
Steps of the heel-to-shin test
- Explain to pt
- In supine position, ask pt to place heel of R leg to L knee and slowly run down shin to ankle (smoothness and coordination)
- Repeat
- Have pt close eyes and repeat
- Document
Steps of the finger-to-nose test
- Explain to pt
- Give pen cap to pt, hold the pen about 12in away from pt at eye level, ask pt to recap the pen using R hand, then repeat with L
- Hold index finger in front of pt at eye level, ask pt to touch the tip of your finger then touch tip of nose with R index finger, repeat several inches and move finger a few inches in different directions, repeat with L finger
- Document
Finger-to-nose test abnormal findings: Past pointing
Pt continuously overshoots the target
Finger-to-nose test abnormal findings: Dysmetria
Inability to perform point-to-point movements due to over or under projecting the finger
Steps to assess rapid alternating movements
- Explain to pt
- Ask pt to place both hands palm down on thighs, lift hands and place both hands palm up, ask pt to repeat the movements for 10sec
- Observe speed and smoothness, put on gloves
- Ask pt to rapidly pat your hand using the ball of R foot for 10 seconds + observe for speed and smoothness, repeat on L foot
- Document
Abnormal findings for assessing rapid alternating movements: Dysdiadochokinesis
Uncoordinated, slow, clumsy movements
Steps to assess pronator drift
- Explain to pt
- Ask pt to extend both arms out with palms up
- Ask pt to close eyes and observe arms for change in position for 20-30 seconds
- Document
Abnormal findings when assessing pronator drift: Positive pronator drift
Arm does not remain raised, palm may pronate or drop slightly
Steps for the Romberg’s test
- Explain to pt
- Ask pt to stand with feet together, arms at sides, looking straight ahead, for 30 seconds without support, assess for swaying or loss of balance
- Stand on side of pt and extend hands in front and back, ask pt to close eyes and observe for 30 seconds
- Document
Steps to assess graphesthesia
- Explain to pt
- Ask pt to extend right arm and turn palm to ceiling and close eyes, stimulate writing a letter or number on palm and ask pt to state what number/letter it was
- Repeat on left side
- Document
Steps to assess stereogneosis
- Explain to pt
- Ask pt to close eyes, place small object in right hand, ask to identify
- Repeat on left side with different object
- Document
Abnormal findings when assessing stereognosis: Tactile agnosia
Inability to process sensory information and perceive/recognize object by touch
F.A.S.T. mnemonic
Face, Arm, Speech, Time
