The Neurological System 2 Neurological Exam 5 Components

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The Neurological System 2 Neurological Exam 5 Components

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

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