Neuro anaphy reflexes

1. ASSESSMENT
OF THE
NEUROLOGIC
SYSTEM

2. ANATOMY AND
PHYSIOLOGY OF
THE NERVOUS
SYSTEM

3. Nervous system divided into 2 regions:
• 1.Central nervous system (CNS): brain and spinal cord
• 2.Peripheral nervous system (PNS): cranial nerves,
spinal nerves and autonomic nervous system
• Function of the nervous system are sensory
input, integration, motor output, homeostasis,
mental activity.

4. • Spinal Cord
• Brain

5. Peripheral Nervous System:
• spinal nerves,
cranial nerves
and their
branches

6. • Major regions are:
• Diencephalon
• Brainstem
• Cerebrum
• Cerebellum

7. • Thalamus – largest part, influences
mood and registers an unlocalized,
uncomfortable perception of pain.
• Epithalamus – small area superior and
posterior to the thalamus, involved in
the emotional and visceral response to
odors, pineal body
• Hypothalamus – most inferior part,
important in maintaining homeostasis,
plays a central role in the control of
body temperature, hunger and thirst

8. • Connects the spinal
cord to the remainder
of the brain
• Consists of the
medulla oblongata,
pons, and midbrain

9. • Most inferior portion of the brainstem
• Continuous with the spinal cord
• Extends from the level of the foramen
magnum to the pons
• CN 9, 10, 11, 12

10. • Immediately superior to the medulla
oblongata
• Means “bridge”
• CN 5, 6, 7, 8
• Lower part of the pons: breathing,
swallowing and balance

11. Brainstem : Midbrain
• Smallest region of the brainstem
• CN 3 and 4
• Found superior and inferior colliculus
• Superior colliculi – involved in visual reflexes,
turning the head, a sudden loud noise, bright
flash of light
• Inferior colliculi – major relay centers for the
auditory nerve pathways in the CNS

12. Largest part of the brain
Divided into left and right hemisphere
by a longitudinal fissures
The surface of each hemisphere is
wrinkled by presence of eminences
known as Gyri and furrows called
Sulci or Fissures

13. Each cerebral hemispheres is divided into lobes:
• Frontal lobe
• Principal motor area
• Important in the control of voluntary motor functions, motivation,
aggression, mood, and olfactory (smell) reception
• Brocas area – Brocas aphasia
• Parietal lobe
• Principal center for the reception and conscious perception of most
sensory information, such as touch, pain, temperature, balance and
taste
• Principal sensory area

14. Occipital lobe
Functions in the reception and perception of visual input
Principal visual cortex
Temporal lobe
Involved in olfactory (smell) and auditory (hearing) sensations and plays
an important role in memory
They associated in abstract thought and judgement
Primary auditory cortex
Wernicke’s area – wernickes aphasia

15. • Composed of gray matters
• Posterior and inferior to the cerebrum
• Involved in balance, maintenance of
muscle tone and coordination of fine
motor movements

16. • Spinal cord extends from
the foramen magnum to
the 2nd lumbar vertebra
below which is the cauda
equina
• It has a central gray part
organized into horns and a
peripheral white part
forming nerve tracts
• VERTEBRAL
COLUMN
• surrounds and
protects the spinal
cord
• 8 cervical, 12
thoracic, 5 lumbar,
5 sacral, coccyx

17. • Consists of the nerves and
ganglia located outside the
brain and spinal cord
• Divided into two groups:
• 12 pairs of CN
• 31 pairs of SN
Cranial Nerves
• 12 cranial nerves
• Designated by numerals
from I to XII
• General categories:
•Sensory •Motor

18. Cranial Nerves origin
Cranial nerves
• sensory–I,II,VIII
• motor–
III,IV,VI,XI,XII
• mixed – V, VII,
IX, X

19. • Arise along the spinal cord from
the union of the dorsal and
ventral roots
• They contain axons of both
sensory and somatic motor
neurons
• Categorized by the region of
vertebral column
• 31 pairs (c8, t12, l5, s5, c1)
• Organized into 3 plexuses

20. PHYSICAL EXAMINATION
5 categories:
1. Cerebral function-
LOC, mental status
2. Cranial nerves
3. Motor function
4. Sensory function
5. Reflexes

21. Level of consciousness
Pupillary size and
response
Verbal responsiveness
Motor responsiveness
Vital signs
NEURO CHECK

22. ASSESSMENT OF THE
NEUROLOGIC SYSTEM
HISTORY
A confused client becomes an unreliable
source of history
B. Physical assessment to collect objective
data
a. Unilateral neglect
b. Poor hygiene and grooming
c. Abnormal gait and posture
d. Emotional swings, personality changes
e. Masklike appearance on face
f. Apathy

23. Skull and spinal x-ray
identify fractures dislocation. Compression, spinal cord problem
CT Scan
detect intracranial bleeding, space occupying lesion, cerebral edema. Hydrocephalus, infarction
Magnetic Resonance Imaging
provides more detailed pictures
Patients with pacemakers, orthopedic metal prosthesis and implanted metal devices cannot undergo this
procedure

24. CEREBRAL
FUNCTION

25. GLASGOW COMA SCALE
HISTORY
- GCS was first published in 1974 at the University of
Glasgow
- It was developed by BRYAN JENNETT and GRAHAM
TEASDALE

26. GLASGOW COMA SCALE
FUNCTION
 Used to described Level of consciousness
 Help to gauge severity of acute brain injury
GCS divides into 3 PARAMETERS
• Best Eye response (E)
• Best Verbal response (V)
• Best motor response (M)
• GCS BEST RESPONSE (15) E4V5M6
• Comatose client- 8 or less
• Totally Unresponsive- 3

28. Cranial Nerve I- Olfactory
CRANIAL NERVES
Check first for the patency of the nose
Instruct to close the eyes
Occlude one nostrils at a time
Hold familiar substance and asks for the
identification
PROBLEM- ANOSMIA- “loss of smell”

29. Cranial Nerve II- Optic
CRANIAL NERVES
Check the visual acuity with the use of
the Snellen chart
Check for visual field by confrontation
test
Check for pupillary reflex- direct and
consensual

31. Cranial Nerve III, IV and VI (Oculomotor,
Trochlear and Abducens)
CRANIAL NERVES
PROBLEMS:
Ophthalmoplegia- inability to move the eye
in a direction
Diplopia- complaint of double vision
- Assess simultaneously the movement of the
extra-ocular muscles
- Assess Gaze

32. Cranial Nerve V (TRIGEMINAL)
CRANIAL NERVES
Sensory portion- assess for sensation of the
facial skin
Motor portion- assess the muscles of
mastication
Assess corneal reflex

33. Cranial Nerve VII (FACIAL)
CRANIAL NERVES
Sensory portion- prepare salt, sugar, vinegar.
Place each substance in the anterior two
thirds of the tongue, rinsing the mouth with
Water
Motor portion- ask the client to make facial
expressions, ask to forcefully close the
eyelids
• Ask the client to smile, raise the eyebrows, frown, puff
out his cheeks, close his eyes tightly.

34. Cranial Nerve VIII ( Vestibulo- Auditory)
CRANIAL NERVES
• Test patient’s hearing acuity
• Observe for nystagmus and disturbed balance

35. Cranial Nerve IX, X ( Glossopharyngeal,
Vagus)
CRANIAL NERVES
Together with Cranial nerve 10 –vagus
Assess for gag reflex
Watch the soft palate rising after instructing
the client to say “AH”
The posterior one-third of the tongue is
supplied by the glossopharyngeal nerve

36. Cranial Nerve XI ( ACCESSORY)
CRANIAL NERVES
Press down the patient’s shoulder while he
attempts to shrug against resistance

37. Cranial Nerve XII ( HYPOGLOSSAL)
CRANIAL NERVES
Ask patient to protrude the tongue and note
for symmetry

38. ASSESS Motor function
● Assess muscle tone and
strength by asking
patient to flex or extend
the extremities while
the examiner places
resistance
● Grading of muscle
strength
Muscle Motor Grading:
● 5/5 – normal active
movement, full range of
motion against full resistance
● 4/5 – active movement, full
ROM against moderate
resistance
● 3/5 – active movement, full
ROM against gravity
● 2/5 – active movement, full
ROM w/ gravity
eliminated(horizotal/side to
side)
● 1/5 – palpable or visible
contraction 0/5 – no

39. Assessing the motor
function of the cerebellum
• Test for balance- heel to
toe
• Test for coordination- rapid
alternating
• movements and finger to
nose test
Assessing the motor
function of the brainstem
Test for the Oculocephalic reflex-
doll’s eye
• Normal response- eyes appear to
move opposite to the movement
of the head
• Abnormal- eyes move in the same
direction
• Test for the Oculovestibular
reflex
• Slowly irrigate the ear with cold
water and warm water
• Normal response- cOld-
OppOsite, wArM- sAMe

40. • Evaluate symmetric areas of the body
• Ask the patient to close the eyes while testing
• Use of test tubes with cold and warm water
• Use blunt and sharp objects
• Use wisp of cotton
• Ask to identify objects placed on the hands
• Test for sense of position

41. Assessing The Reflexes
● Deep tendon reflexes
● Biceps (C5-C6)
● Triceps (C6-C8)
● Brachioradialis (C5-C6)
● Patellar
● Assessing the sensory
function Achilles
● Superficial reflexes
● Abdominal (T9-T10)
● Cremasteric (L1-L2)
● Anal (S3-S5)
● Pathologic reflex
● Babinski- stroke the
lateral aspect of the
soles
● doing an inverted “J”

43. • Positive Brudzinski’s sign (pain, resistance,
flexion of hips and knees when head flexed to
chest with client supine)
• Positive Kernig’s sign (excessive pain and/or
resistance when examiner attempts to straighten
knees with client supine and knees and hips flexed)
indicates meningeal irritation

44. • Positive Babinski reflex (dorsiflexion of big toe with
fanning of other toes): UMN diseases of pyramidal
tract
• Decorticate posturing (upper arms close to sides,
elbows, wrists and fingers flexes, legs extended with
internal rotation, feet are flexed: body parts pulled into
core of body)
• Decerebrate posturing (neck extended with jaw
clenched, arms pronated, extended, close to sides, legs
are extended straight out and feet plantar flexed)