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NurseReview.Org - Proprioception & Cerebellar Function


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http://NurseReview.Org - Proprioception & Cerebellar Function

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NurseReview.Org - Proprioception & Cerebellar Function

  1. 1. Neurologic System The Motor System and the Cerebellar Function
  2. 2. Motor Pathways & Type of Movements <ul><li>Corticospinal or Pyramidal Tract </li></ul><ul><ul><li>Voluntary, skilled, discrete, purposeful (writing) </li></ul></ul><ul><li>Extrapyramidal Tracts </li></ul><ul><ul><li>Maintain muscle tone and control body movements (walking) </li></ul></ul><ul><li>Cerebellar System </li></ul><ul><ul><li>Coordinates movement, maintains equilibrium and posture….Operates on subconsious level </li></ul></ul>
  3. 3. Question for Thought <ul><li>Describe 3 major motor pathways in the CNS including the type of movements mediated by each? </li></ul>
  4. 4. Chapter 21 <ul><li>Cerebral Cortex </li></ul>Figure 21-1. p. 688.
  5. 5. Upper and Lower Motor Neurons <ul><li>Upper motor neurons </li></ul><ul><ul><ul><li>All descending motor neurons that impact on the lower motor neurons </li></ul></ul></ul><ul><ul><ul><li>Located in the CNS </li></ul></ul></ul><ul><ul><ul><li>Convey impulses from motor areas of cerebral cortex to lower motor neurons in the cord </li></ul></ul></ul><ul><ul><ul><li>Diseases = CVA, Cerebral palsy, Multiple sclerosis </li></ul></ul></ul>
  6. 6. Upper and Lower Motor Neurons <ul><li>Lower motor neurons </li></ul><ul><ul><ul><li>In the peripheral nervous system </li></ul></ul></ul><ul><ul><ul><ul><ul><li>12 cranial nerves </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>31 pairs of spinal nerves and all branches </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Final direct contact with the muscles </li></ul></ul></ul><ul><ul><ul><li>Movement translated into action </li></ul></ul></ul><ul><ul><ul><li>Reflex arc </li></ul></ul></ul><ul><ul><ul><li>Examples = cranial nerves, spinal nerves </li></ul></ul></ul><ul><ul><ul><li>Diseases = spinal cord lesions, poliomyelitis, ALS </li></ul></ul></ul>
  7. 7. Question for Thought <ul><li>Differentiate an upper motor neuron from a lower motor neuron? </li></ul>
  8. 8. Subjective Data <ul><li>In the Interview </li></ul><ul><ul><li>Any shakes or tremors in the hands or face? </li></ul></ul><ul><ul><ul><li>Worsen with anxiety, fatigue </li></ul></ul></ul><ul><ul><ul><li>Relieved with activity, alcohol </li></ul></ul></ul><ul><ul><ul><li>ADL’s affected </li></ul></ul></ul><ul><ul><li>Weakness </li></ul></ul><ul><ul><ul><li>Where? When? Why? </li></ul></ul></ul>
  9. 9. Subjective Data <ul><li>Incoordination </li></ul><ul><ul><ul><li>Balance, falling, </li></ul></ul></ul><ul><ul><ul><li>Legs give out </li></ul></ul></ul><ul><ul><ul><li>Clumsy </li></ul></ul></ul><ul><li>Numbness/ Tingling </li></ul><ul><ul><ul><li>Describe ( pins and needles) </li></ul></ul></ul><ul><li>Significant past history </li></ul><ul><ul><ul><li>TIA’s, Atrial Fib. </li></ul></ul></ul>
  10. 10. Assessment of Motor System <ul><li>Body position </li></ul><ul><li>Involuntary movements </li></ul><ul><li>Muscle size ( bulk) </li></ul><ul><li>Muscle tone </li></ul><ul><li>Muscle strength </li></ul>
  11. 11. Body Position <ul><li>Observe during movement </li></ul><ul><li>Observe at rest </li></ul>
  12. 12. Involuntary Movements <ul><li>Tremors, tics, fasciculations, myoclonus </li></ul><ul><li>Note: </li></ul><ul><ul><ul><ul><ul><li>Location </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Quality </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Rate </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Rhythm </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Amplitude </li></ul></ul></ul></ul></ul>
  13. 13. Involuntary Movements <ul><li>Note the involuntary movement in relation to : </li></ul><ul><ul><ul><li>Posture </li></ul></ul></ul><ul><ul><ul><li>Activity </li></ul></ul></ul><ul><ul><ul><li>Fatigue </li></ul></ul></ul><ul><ul><ul><li>Emotion </li></ul></ul></ul><ul><ul><ul><li>Other factors </li></ul></ul></ul>
  14. 14. Terms to Describe Movement <ul><li>Flexion </li></ul><ul><li>Extension </li></ul><ul><li>Abduction </li></ul><ul><li>Adduction </li></ul><ul><li>Pronation </li></ul><ul><li>Supination </li></ul>
  15. 15. More Terms for Movement <ul><li>Circumduction </li></ul><ul><li>Inversion </li></ul><ul><li>Eversion </li></ul><ul><li>Rotation </li></ul><ul><li>Protraction </li></ul>
  16. 16. Terms of Movement Continued <ul><li>Retraction </li></ul><ul><li>Elevation </li></ul><ul><li>Depression </li></ul>
  17. 17. Muscle Size <ul><li>Compare size and contour </li></ul><ul><ul><li>Atrophy </li></ul></ul><ul><ul><ul><li>Unilateral/bilateral </li></ul></ul></ul><ul><ul><ul><li>Proximal/distal </li></ul></ul></ul>
  18. 18. Muscle Tone <ul><li>A relaxed muscle maintains a slight residual tension referred to as muscle tone. </li></ul><ul><li>Hypo tonic, Flaccidity. </li></ul><ul><li>Spasticity. </li></ul><ul><li>Lead-pipe rigidity. </li></ul>
  19. 19. Muscle Strength <ul><li>Test muscle strength by asking the client to move actively against your resistance or to resist your movement. </li></ul><ul><li>A muscle is strongest when shortest and weakest when longest. </li></ul>
  20. 20. Terms to Describe Strength <ul><li>Weakness (paresis) </li></ul><ul><li>Paralysis (plegia) </li></ul><ul><li>Hemiparesis </li></ul><ul><li>Hemiplegia </li></ul><ul><li>Paraplegia </li></ul><ul><li>Quadriplegia </li></ul>
  21. 21. Grading Muscle Strength <ul><li>Scale 0-5 </li></ul><ul><li>0 - no muscular contraction </li></ul><ul><li>1 – slight contraction </li></ul><ul><li>2 – Full ROM, gravity eliminated </li></ul>
  22. 22. Grading Muscle Strength <ul><li>3 – Full ROM against gravity </li></ul><ul><li>4 – Full ROM against gravity, some resistance </li></ul><ul><li>5 – Full ROM against gravity full resistance without evident fatigue = Normal Muscle Strength </li></ul>
  23. 23. Cerebellar Function <ul><li>Balance tests </li></ul><ul><ul><li>Gait </li></ul></ul><ul><ul><ul><li>Observe normal walk </li></ul></ul></ul><ul><ul><ul><li>Tandem Walking ( heel – to- toe ) </li></ul></ul></ul><ul><ul><ul><li>Romberg Test (stand, feet together, arms at side, close eyes) </li></ul></ul></ul><ul><ul><ul><li>Shallow knee bend or hop on one leg </li></ul></ul></ul><ul><li>What findings would you expect to see when assessing gait and balance in an older adult? </li></ul>
  24. 24. Cerebellar Function <ul><li>Coordination and Skilled Movements </li></ul><ul><ul><li>RAM ( Rapid alternating movements) </li></ul></ul><ul><ul><ul><li>Pat Knees </li></ul></ul></ul><ul><ul><ul><li>Thumb to each finger </li></ul></ul></ul><ul><ul><ul><li>Finger to finger </li></ul></ul></ul><ul><ul><ul><li>Finger to nose </li></ul></ul></ul><ul><ul><ul><li>Heel to shin </li></ul></ul></ul>
  25. 25. Question for Thought <ul><li>List and describe 3 tests of cerebellar function? </li></ul>
  26. 26. Charting Sample <ul><li>For Normal Muscle Strength (objective) </li></ul><ul><ul><li>Able to maintain flexion against resistance and without tenderness </li></ul></ul><ul><li>For Motor ( objective) </li></ul><ul><ul><li>No atrophy, weakness or tremors. Gait smooth and coordinated, able to tandem walk, negative Romberg. RAM, finger-to-nose smoothly intact </li></ul></ul>