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Remaining Neurologic System. Review of Systems  Decreased LOC  Confusion  Headache/Pain  History of head injury or major trauma  Clumsiness/decreased.

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Presentation on theme: "Remaining Neurologic System. Review of Systems  Decreased LOC  Confusion  Headache/Pain  History of head injury or major trauma  Clumsiness/decreased."— Presentation transcript:

1 Remaining Neurologic System

2 Review of Systems  Decreased LOC  Confusion  Headache/Pain  History of head injury or major trauma  Clumsiness/decreased coordination or balance  Seizures  Fainting spells  Dizziness  Physical disability  Numbness or tingling  Sudden change in vision or hearing  Behavioral changes Attention, mood, speech, insight, judgment, orientation, or memory  Psychiatric symptoms  Aphasia

3 Complete Neurological Assessment  Cerebral Function Mental Status  Cranial Nerve Function  Sensory Function  Motor Function  Reflexes

4 Sensory Function

5 Sensory Function- A&P Review

6 Common Sites for Referred Pain © Pat Thomas, 2006.

7 Dermatomes  A band of skin innervated by the sensory root of a single spinal nerve

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9 Sensory Function- Spinothalamic Tract  Superficial sensation Pain  Assess sharp and dull  Allow at least 2 sec between Temperature  Test only when pain sensation abnormal Light (crude) touch  Apply wisp of cotton to arms, forearms, hands, chest, thigh, an legs Sharp and dull and light touch intact

10 Sensory Function- Spinothalamic Tract  Scatter stimuli so as to sample most dermatomes and peripheral nerves Both shoulders (C4) Inner and outer aspects of forearm (C6, T1) Thumbs and little finger (C6, C8) Front of both thighs (L2) Medial and lateral aspects of both calves (L4, L5) Little toe (S1) Medial aspect of each buttock (S3)

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12 Sensory Function- Posterior Column Tract  Deep sensation Vibration  Use low pitch tuning fork (128 0r 256Hz)  Place over bony surface of fingers and great toe Vibration intact Position (Kinesthesia)  Move finger or big toe up or down and ask which way move Kinesthesia intact

13 Sensory Function- Posterior Column Tract  Discriminatory sensations Stereognosis  Recognize objects Stereognosis intact. Graphesthesia  Read number traced on hand Graphesthesia intact Two-point discrimination  Distinguish separation of two stimuli No longer perceives two separate points at ___mm

14 Motor Function

15 Motor Function- A&P Review

16 Motor Function- Muscles  Muscle size & symmetry Palpate major muscle groups of arms & legs  Muscle Tone While at rest and with passive movement  Normal, flaccid, spastic, or rigid

17 Muscle Strength  Muscle Strength Testing Arm Flexion & Extension Grip Strength Hip Flexion & Extension Thigh Adduction and Abduction Knee Flexion & Extension Ankle Dorsiflexion & Plantar Flexion  Ask to lift extremity against gravity and the against resistance 5/5- Full ROM against gravity, full resistance 4/5- Full ROM against gravity, some resistance 3/5- Full ROM with gravity 2/5- Full ROM with gravity eliminated (passive) 1/5- Slight contraction 0/5- No contractionNo atrophy, weakness,or tremors

18 Motor Function- Cerebellar Function  Balance tests Gait  Walk feet, turn, and walk back the other way Gait smooth & coordinated  Tandem walk Able to tandem walk Romberg Test  Feet together, arms at side, and eyes closed and hold 20 seconds  No swaying = negative Romberg

19 Motor Function- Cerebellar Function  Coordination & Skilled Movements Rapid alternating movements (RAM)  Patient pats knees with front and back of hands quickly Rapid alternating movements quick and accurate Finger-to-finger test  Touch thumb to each finger on same hand quickly  Watch for cerebellar tremor (intention tremor) Tremor of extremity that occurs at end of purposeful mvmt. Caused by lesion/damage to cerebellum from stroke, tumor, MS, inherited degenerative disorders Finger to finger test smooth and accurate

20 Motor Function- Cerebellar Function Touch thumb to each finger on same hand Thumb opposition quick and accurate Finger-to-nose test  With eyes closed patient touches tip of his/her nose quickly with index finger, alternating hands Finger to nose smooth and accurate re=related

21 Reflexes

22 Reflexes- A&P Review

23 Reflexes  Deep Tendon Reflexes (DTR) Biceps (C5-C6) Triceps (C7-C8) Brachioradialis (C5-C6) Quadriceps (Patellar) (L2-L4) Achilles (L5-S2)  Superficial Reflexes Plantar Reflex/Babinski (L4-S2) Abdominal Reflexes (Upper T8-T10) (Lower T10-T12) Crematic Reflex (L1-L2)

24 Biceps Reflex  Place your thumb or finger firmly on the biceps tendon.  Strike with the reflex hammer so that the blow is aimed through your thumb toward the biceps tendon  Observe flexion at the elbow, and watch for and feel the contraction of the biceps muscle Biceps reflex 2+ bilaterally

25 Triceps Reflex  Strike the triceps tendon above the elbow  Watch for contraction of the triceps muscle and extension at the elbow Triceps reflex 2+ bilaterally

26 Brachioradialis Reflex  Strike forearm approximately 2-3cm above radial styloid process  Watch for flexion and supination of the forearm Brachioradialis reflex 2+ bilaterally

27 Quadriceps (Patellar) Reflex  Briskly tap the patellar tendon just below the patella  Note contraction of the quadriceps with the extension at the knee Patellar reflex 2+ bilaterally

28 Achilles Reflex  Dorsiflex the foot at the ankle  Have the patient relax  Strike the Achilles tendon  Watch and feel for plantar flexion at the ankle Achilles reflex 2+ bilaterally

29 Plantar Reflex  Stroke the lateral aspect of the sole from the heel to the ball of the foot, curving medially across the ball  Note movements of the toes, normally plantar flexion Plantar reflex with down going toes/Negative Babinski

30 Basic Neurological Exam/Recheck  Affect  Level of Consciousness Degree of wakefulness/ responsiveness to environment  Orientation  Speech Pattern  Facial Symmetry  Ability to Follow 1 Step Commands  Direct & Consensual Pupillary Response & Accomodation  Hand Grasps & Foot Pushes

31 Testing for Meningitis  Kernig’s sign In supine position flex knee and hip of one leg to 90 degrees, then gently try to straighten leg.  Positive if pain in low back and hamstring and of knee won’t straighten more than 135 degrees Negative Kernig’s sign  Brudzinski’s sign In supine position place one hand behind patient’s neck and lift off of bed trying to touch chin to chest.  Positive if hips and knees involuntarily flex  Negative Brudzinski’s sign


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