Neurology 2 Part 3 Assessing Motor System

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Neurology 2 Part 3 Assessing Motor System

  1. 1. Neurology 2 Part 3
  2. 2. Assessing Motor System <ul><li>Muscle Strength </li></ul><ul><li>Tone </li></ul><ul><ul><li>Tension pressure when the muscle is at rest </li></ul></ul><ul><li>Spasticity </li></ul><ul><ul><li>Increase muscle tone </li></ul></ul><ul><li>Rigidity </li></ul><ul><ul><li>Resistance to passive stretch </li></ul></ul>
  3. 3. <ul><li>Flaccidity </li></ul><ul><ul><li>Decreased muscle tone </li></ul></ul><ul><li>Atrophy </li></ul><ul><ul><li>Wasting away of muscle </li></ul></ul><ul><li>Hypotonia </li></ul><ul><ul><li>Lose of tone or strength </li></ul></ul><ul><li>Atonia </li></ul><ul><ul><li>No tone or strength </li></ul></ul>
  4. 4. <ul><li>Hypertonia </li></ul><ul><ul><li>Increased tone or strength </li></ul></ul><ul><li>Gait </li></ul><ul><ul><li>Manner / style of walking </li></ul></ul><ul><li>Ataxia </li></ul><ul><ul><li>Failure of muscle coordination, irregular voluntary muscle action </li></ul></ul><ul><li>Akinesia </li></ul><ul><ul><li>Abnormal absence of movement </li></ul></ul><ul><li>Bradykinesia </li></ul><ul><ul><li>Slow movement </li></ul></ul>
  5. 5. Balance & Coordination Cerebellum assessment <ul><li>RAM </li></ul><ul><ul><li>Rapid Alternating Movement </li></ul></ul><ul><li>Pronate / supinate </li></ul>
  6. 6. <ul><li>Point to Point </li></ul>
  7. 7. <ul><li>Heel to Shin </li></ul>
  8. 8. <ul><li>Heel to toe walking </li></ul><ul><li>Hopping in place </li></ul>
  9. 9. <ul><li>Have the patient walk across the room under observation. </li></ul><ul><li>Next ask the patient to walk heel to toe across the room, </li></ul><ul><li>Then on their toes only, </li></ul><ul><li>finally on their heels only. </li></ul>
  10. 10. <ul><li>Romberg </li></ul><ul><ul><li>Stand feet together arms at side </li></ul></ul><ul><ul><li>Eyes open </li></ul></ul><ul><ul><li>Eyes closed 20-30 seconds </li></ul></ul><ul><ul><li>Slight sway is normal </li></ul></ul>
  11. 12. Assessing Reflexes <ul><li>Grading Scale </li></ul><ul><li>0 = No response </li></ul><ul><li>+ = hypoactive </li></ul><ul><li>++ = Normal </li></ul><ul><li>+++ = More active </li></ul><ul><li>++++ = Hyperactive </li></ul>
  12. 13. Deep Tendon Reflexes
  13. 14. Deep Tendon Reflexes <ul><li>Biceps </li></ul><ul><li>Thumb on the biceps tendon </li></ul><ul><li>Strike your thumb with hammer </li></ul><ul><li>Compare with other arm </li></ul>
  14. 15. Deep Tendon Reflexes <ul><li>Triceps </li></ul><ul><li>Strike the triceps tendon directly with the hammer while holding the patient's arm with your other hand. </li></ul><ul><li>Repeat and compare to the other arm. </li></ul>
  15. 16. Deep Tendon Reflexes <ul><li>Patellar </li></ul>
  16. 17. Deep Tendon Reflexes <ul><li>Achilles </li></ul>
  17. 18. Superficial Reflexes (protective reflexes) <ul><li>Corneal Reflex </li></ul><ul><ul><li>Test using a clean cotton wisp, lightly touch the outer corner of each eye on the sclera </li></ul></ul><ul><ul><li>Normal: (+) elicits a blink </li></ul></ul><ul><ul><li>Abnormal: (-) no blink </li></ul></ul><ul><ul><ul><li>Eye protection </li></ul></ul></ul><ul><ul><ul><li>Lubrication </li></ul></ul></ul>
  18. 19. Superficial Reflexes (protective reflexes) <ul><li>Gag reflex </li></ul><ul><ul><li>Test: gently touch posterior pharynx with cotton applicator </li></ul></ul><ul><ul><li>Normal: (+) elevation of the uvula (gag) </li></ul></ul><ul><ul><li>Abnormal: (-) No gag </li></ul></ul><ul><ul><ul><li>NPO </li></ul></ul></ul>
  19. 20. Superficial Reflexes (protective reflexes) <ul><li>Plantar Reflex </li></ul><ul><ul><li>Test: stroke the lateral side of the foot with tongue blade </li></ul></ul><ul><ul><li>Normal: (- Babinski) toe flexion (curl) </li></ul></ul><ul><ul><li>Abnormal: (+ Babinski) toe tanning </li></ul></ul>
  20. 21. Superficial Reflexes (protective reflexes) <ul><li>- Babinski = Normal </li></ul><ul><li>+ Babinski = Abnormal </li></ul>
  21. 22. Vital Signs <ul><li>Temperature </li></ul><ul><ul><li>With head trauma  increased </li></ul></ul>
  22. 23. Vital Signs <ul><li>Pulse </li></ul><ul><ul><li>Strength, rate rhythm </li></ul></ul><ul><ul><li>Bradycardia  indicative of Increased ICP </li></ul></ul>
  23. 24. Vital Signs <ul><li>Respirations </li></ul><ul><ul><li>Depth, rate, rhythm, effort </li></ul></ul><ul><ul><li>Ataxic </li></ul></ul><ul><ul><ul><li>Damage to medulla </li></ul></ul></ul><ul><ul><li>Cheyne-stokes </li></ul></ul><ul><ul><ul><li>Lesion deep in both hemispheres, basal ganglia and upper brainstem </li></ul></ul></ul><ul><ul><li>Hyperventilation </li></ul></ul><ul><ul><ul><li>Metabolic problems or brainstem </li></ul></ul></ul>
  24. 25. Vital Signs <ul><li>Blood Pressure </li></ul><ul><ul><li>Right verses left </li></ul></ul><ul><ul><li>Lying verses standing </li></ul></ul><ul><ul><li>Difference in systolic by > 20mmHg  potential cerebral ischemia </li></ul></ul>
  25. 26. Vital Signs <ul><li>Pulse Pressure formula: </li></ul><ul><ul><li>Systolic – diastolic </li></ul></ul><ul><ul><li>120 </li></ul></ul><ul><ul><li>------ = ? </li></ul></ul><ul><ul><li>80 </li></ul></ul>
  26. 27. Vital Signs <ul><li>Pulse Pressure </li></ul><ul><ul><li>Systolic – diastolic </li></ul></ul><ul><ul><li>120 </li></ul></ul><ul><ul><li>------ = 40 </li></ul></ul><ul><ul><li>80 </li></ul></ul><ul><ul><li>Normal Pulse pressure = 40 </li></ul></ul><ul><ul><li>Widening pulse pressure = Increased ICP </li></ul></ul>
  27. 28. Neuro Checks <ul><li>LOC </li></ul><ul><li>Pupils </li></ul><ul><ul><li>PERRLA </li></ul></ul><ul><ul><ul><li>Pupils </li></ul></ul></ul><ul><ul><ul><li>Equal </li></ul></ul></ul><ul><ul><ul><li>Round </li></ul></ul></ul><ul><ul><ul><li>Reactive to </li></ul></ul></ul><ul><ul><ul><li>Light </li></ul></ul></ul><ul><ul><ul><li>Accommodation </li></ul></ul></ul>
  28. 29. Neuro Check <ul><li>Pupils </li></ul><ul><ul><li>Anisocoria </li></ul></ul><ul><ul><ul><li>Inequality in the size of the pupils </li></ul></ul></ul><ul><ul><li>Nystagmus </li></ul></ul><ul><ul><li>Progressive dilation </li></ul></ul><ul><ul><ul><li> Increase ICP </li></ul></ul></ul><ul><ul><li>Fixed & dilated </li></ul></ul><ul><ul><ul><li>Injury at level of midbrain </li></ul></ul></ul>
  29. 30. Brudzinski’s <ul><li>Flexion of the neck  pain and flexion of the knees </li></ul><ul><li>Indicates </li></ul><ul><ul><li>Meningitis </li></ul></ul><ul><li>No not perform if… </li></ul><ul><ul><li>Neck or back injury </li></ul></ul>
  30. 31. Kernig’s <ul><li>Pain with flexion of the hip and knee </li></ul><ul><li>Indicates </li></ul><ul><ul><li>meningitis </li></ul></ul>
  31. 33. Cushing Sign <ul><li>Vital sign changes assoc. with Increased ICP </li></ul><ul><ul><li>Increase in Systolic pressure </li></ul></ul><ul><ul><li>Widening pulse pressure </li></ul></ul><ul><ul><li>Bradycardia </li></ul></ul><ul><ul><li>Bradypnea (slight) </li></ul></ul>
  32. 34. Day 2 Diagnostic tests

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