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Neurological assessment Fall 07 _website verison

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  • 1. The Neurological System 1 Neurological Exam 5 Components Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory 2 Mental Status Examination Examination - ABCT Appearance Behavior Cognition Thought processes (thought content & perceptions) Glasgow Coma Scale 3
  • 2. Assessing LOC: Glasgow Coma Scale Eye opening Verbal responsiveness Motor responsiveness 4 Glasgow Coma Scale 5 Physical Examination Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when not stimulated Obtunded- sleeps most times, difficult to arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for arousal; responds to stimuli Coma- no response (Jarvis CH 2) 6
  • 3. Neurological: Physical Examination Sensory System Function With eyes closed Interpret sensations Discriminate side to side Examine in detail if: Reduced sensation Numbness or pain Motor or reflex abnormal Skin changes Be specific: “tell me where I touch” 7 Physical Examination Sensory Function Tests: Touch Light touch 1st then Pain & Temperature Vibration Kinesthesia/Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination 8 Sensory Function Tests: Sensory Exam: Light Touch 9
  • 4. Sensory Function Tests: Sensory Exam: Vibration 10 Sensory Function Tests: Proprioception: Position sense 11 Sensory Function Tests: Stereognosis 12
  • 5. Sensory Function Tests: Graphesthesia 13 Sensory Function Tests: Two-point discrimination 14 Motor Examination Symmetry, size, and presence of involuntary movements Full ROM of joints Check strength against resistance Neuro patients: Assess hand grips and foot pushes if bedridden 15
  • 6. Cerebellar Function 1. Gait and posture 2. More specific tests Heel to toe in straight line Walking on toes and heels Hop on one foot 16 Cerebellar Function, con’t Coordination of hands Rapid Alternating Movements 17 Cerebellar Function, con’t Coordination of hands Nose –to - Finger Test 18
  • 7. Cerebellar Function, con’t Coordination of legs Heel to Shin Test 19 Cerebellar con’t 3. Romberg: Stand upright, place feet together, then close eyes loss of balance means + Romberg test Be prepared to protect client from falling! 20 Reflexes Superficial (abdominal reflex, Cremasteric reflex) Cremastic Reflex Abdominal Reflex 21
  • 8. Reflexes-Cont: Visceral (pupillary response to light) PERRL/PERRLA 22 Reflexes-Cont: Pathologic + Babinski in adults Babinski’s Reflex (Adult) 23 Reflexes-Cont: Reflex Arc – Deep Tendon Reflexes 24
  • 9. Reflexes-Cont: Deep Tendon Reflexes Technique Position limb so muscle is slightly stretched Reflex hammer should strike tendon briskly to stretch tendon Get patient to relax 25 BRACHIORADIALIS BICEPS ACHILLES/PLANTAR TRICEPS PATELLAR 26 DEEP TENDON REFLEXES Grading of DTRs 4+ very brisk 3+ brisker than average 2+ average, normal 1+ diminished, low normal 0 no response 27

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