Introduction to ArtificiaI Intelligence in Higher Education
central nervous system examination
1. Examination
Examination
of
cEntral
nErvous systEm
Dr. Shalu Jain
MD Scholar
Pt. Khushilal Sharma Govt. Auto. Ayurveda College And Institute, Bhopal (M.P.)
Examination
Examination
cEntral
nErvous systEm
Jain
MD Scholar
College And Institute, Bhopal (M.P.)
2. INTRODUCTION
The purpose of CNS examination is to determine
the presence or absence of disease in the nervous
system .
system .
These are involve in examining the neurological
& physical status of the patient as part of the
total physical assessment .
History taking
General examination
General examination
Systemic examination ( CNS )
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
The purpose of CNS examination is to determine
the presence or absence of disease in the nervous
These are involve in examining the neurological
& physical status of the patient as part of the
Systemic examination ( CNS )
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
3. Aspects of CNS Examination....
Higher Functions
Higher Functions
Cranial Nerves
Sensory System
Motor System
Reflexes
Reflexes
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Aspects of CNS Examination....
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
4. HIGHER FUNCTIONS
HIGHER FUNCTIONS
1. Consciousness
1. Consciousness
2. Orientation
3. Intelligences
4. Memory
5. Language and speech
5. Language and speech
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
HIGHER FUNCTIONS
HIGHER FUNCTIONS
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
5. CONSCIOUSNESS
Consciousness is a state of awareness of one’s self and
one’s environment.
one’s environment.
Level of consciousness:-
Sleep
Catatonia
Akinetic mutism
Drowsiness
Semicoma
Stupor
coma
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Consciousness is a state of awareness of one’s self and
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
6. ASSESSMENT OF LEVEL OF
ASSESSMENT OF LEVEL OF
CONSCIOUSNESS
CONSCIOUSNESS
Glasgow Coma Scale Abbreviated Coma Scale
Glasgow Coma Scale
(GCS)
GCS is useful in assessing level
of consciousness in a patient
with head injury.
Best Total sore - 15
Mild injury - 13 -15
Abbreviated Coma Scale
(AVPU)
A alert
V responds to vocal stimuli
P respond to pain
U unresponsive
Mild injury - 13 -15
Moderate injury 9 – 12
Severe injury 8
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
ASSESSMENT OF LEVEL OF
ASSESSMENT OF LEVEL OF
Abbreviated Coma Scale
Abbreviated Coma Scale
(AVPU)
alert
responds to vocal stimuli
respond to pain
unresponsive
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
7. ORIENTATION
Questions are put to the patients to test his
orientation to
orientation to
Time
Place
Person
TIME PLACE
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Questions are put to the patients to test his
PERSON
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
8. Memory
It is the power to retain and recall past experience.
It can be tested by mini mental state examination (MMSE)
It can be tested by mini mental state examination (MMSE)
Components of
memory
Reception
Registration
a. Immediate or short term
memory
Registration
Retention
Recall
b. Recent memory
c. Long term or secondary or
remote memory
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
It is the power to retain and recall past experience.
It can be tested by mini mental state examination (MMSE)
It can be tested by mini mental state examination (MMSE)
Immediate or short term
memory
Types of memory
Recent memory
Long term or secondary or
remote memory
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
9. Examination of Cranial nerves
Cranial nerves are a set of twelve nerves that
has a different function for sense or movement
1.
3
11
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Examination of Cranial nerves
that originate in the brain. Each
movement.
2
8
4
6
8
12
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
10. Olfactory nerve
Function: Smell
Optic nerve
Function:
eye to brain
Examination: Block one nostril.
Get patient to smell strong distinctive
smell (coffee, lemon, cinnamon).
Normal: If patient can identify
smell with both nostrils – olfactory
nerve intact.
Examination:
Acuity: Read
2. Visual
(for each
3. Pupillary
Normal:
both pupillary
light reflex
Palsy/Lesion: Unilateral
loss of smell – lesion Generally
from trauma, meningitis.
light reflex
Palsy
one or both
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Optic nerve
Function: Visual transmission –
brain
Examination: 1. Visual
Read snellen chart.
Visual fields – finger wiggle
each eye)
Pupillary light reflex
Normal: Consensual response to
pupillary light and swinging
reflex
reflex
Palsy: visual acuity is reduced in
one or both eyes
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
11. Oculomotor Nerve
Function: eye movement.
Trochlear
Function:
Oblique
Examination: . Look for
ptosis, eye position and
nystagmus, inspect pupil for
PERRLA
Examination
Look for
nystagmus
PERRLA
Normal: Consensual pupil
responses No diplopia or
nystagmus
Palsy: Ptosis
PERRLA
Palsy
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Trochlear nerve
Function: Innervates Superior
Oblique
Examination: Examination:
Look for ptosis, eye position and
nystagmus, inspect pupil for
PERRLA
PERRLA
Palsy: Intorsion
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
12. Trigeminal nerve
Function:
Sensory to the face by ophthalmic,
maxillary, mandibular
Motor: Muscles of mastication
Examination: Point touch with cotton wool/
tissue, pain using a sharp point,
Corneal reflex: rapid blinking of the eye lids
Motor: Inspect. Palpate temporalis and masseters
clenches the jaw, pterygoids – mouth open against resistance, jaw
Normal: even feeling of sensation, both eyelids
reflex, able to clench jaw, no jaw jerk
reflex, able to clench jaw, no jaw jerk
Palsy: wasting of temporalis or masseter, unable
close mouth
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lids from a sudden stimulus
masseters as patient
mouth open against resistance, jaw jerk
eyelids respond to corneal
unable to resist pressure to
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
13. Facial nerve
Function: Sensory - Taste (Anterior 2/3 of the
of facial expression
Examination:
Sensory: Test Taste of distinctive flavours
test of olfactory).
Motor: 1) raise both eyebrows 2) screw eyes
muscular strength 3) smile 4) bare teeth (show
teeth) 6) puff out cheeks
Palsy: Bell’s Palsy (central/peripheral)
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
the tongue); Motor – Muscles
flavours (similar to the smell
eyes up, try to pull to test
(show both upper and lower
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
14. Vestibulocochlear nerve
Function: Hearing
Function: Hearing
Examination: 1) Whisper a number into patient’s
time. Ask the patient to repeat the numbers
2) Rinne Test 3) WeberTest
Normal: 1. Correct number 2. Air conduction louder than bone 3.
Hear the tuning fork in both ears equally
Palsy: in middle year disease bone conduction is better then air
conduction
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
patient’s ears. One at a
Normal: 1. Correct number 2. Air conduction louder than bone 3.
Palsy: in middle year disease bone conduction is better then air
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
15. Spinal
Function
SCM and
Function: Swallowing, Gag
Reflex
Glossopharyngeal ,
Vagus nerve
Examination:
patient
shrug
(against
Normal:
Symmetrical
movements
Reflex
Examination: Gag response
Palsy: Abnormal Cough on
swallowing
movements
Able
Palsy:
unable
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
SpinalAccessory
Function: Innervation to
SCM and Trapezius.
Examination: Ask
patient to turn head,
shrug shoulders
(against resistance).
Normal:
Symmetrical
movements performed.
movements performed.
Able to resist pressure
Palsy: Muscle wasting,
unable to resist pressure
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
16. Hypoglossal Nerve
Function: movement of tongue
Function: movement of tongue
Examination: Inspect for tongue fasciculations
atrophy. Ask patient to poke out their tongue
Normal: No deviation of the tongue on protrusion
Palsy: Will deviate ipsilateral to the paralysis and
contralateral to the lesion
contralateral to the lesion
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
fasciculations, asymmetry or
protrusion
to the paralysis and
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
17. Modalities of sensation to be tested :
Exteroceptive Senstion /Superficial sensation
Exteroceptive Senstion /Superficial sensation
Proprioceptive Sensations
Cortical sensations
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Modalities of sensation to be tested :-
/Superficial sensation
/Superficial sensation
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
18. Exteroceptive Senstion /Superficial
sensation
Touch
Fine touch – tested by cotton
Pain
Superficial pain:
Fine touch – tested by cotton
wool
Crude touch – by blunt object
Temperature Two test tubes one
containing hot water and the other
Superficial pain:
pin prick
Deep pain :
the calves,
containing hot water and the other
crushed ice is taken and placed on
all the parts of the body
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
/Superficial
Superficial pain:- tested with a
Superficial pain:- tested with a
pin prick
Deep pain :- tested by pressing
the calves, tendo achilis or testis.
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
19. Proprioceptive sensation/ Deep
sensation
Position sense
A part of limb / arm is placed in
Joint sense
Fixing
A part of limb / arm is placed in
definite position and then he is
asked to denote the position or
place the other limb in similar
position.
Fixing
moved
joint
holding
Patient
either
Vibration
Assessment of vibration sense by tuning fork(128 Hz) is
applied on bony prominences .
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
sensation/ Deep
Joint sense
Fixing the joint, the finger/ toe is
Fixing the joint, the finger/ toe is
moved at terminal interphalangeal
, either up or down by
holding the sides of digits.
Patient to tell the direction i.e.
either up or down.
by tuning fork(128 Hz) is
College And institute, Bhopal (M.P)
20. Cortical Sensory Functions
Localzation Test
Touch a part of patient body with
his eyes closed
Ask him to open the eyes and
Two Point Discrimination Test
Ability to distinguish the
contact of two separate points
applied simultaneously to the
Ask him to open the eyes and
place his finger of that part
applied simultaneously to the
skin
Tactile Extinction Test
Tactile Extinction Test
When two stimuli are applied simultaneously
to two symmetrical portion of the body, the
patient neglect the one on the opposite side
the lesion,.
Though individually he appriciates the
stimulus on both side.
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Cortical Sensory Functions
Two Point Discrimination Test
Ability to distinguish the
contact of two separate points
applied simultaneously to the
applied simultaneously to the
simultaneously
the
of
the
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
21. Cont.
Graphasthesia
The ability to recognize a
number or letter written in the
Stereognosis
The
suitable object after careful
number or letter written in the
palm with closed eyes.
This ability is lost in sensory
cortex lesion
suitable object after careful
palpation.
This ability is lost in sensory
cortex lesion
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Stereognosis
The abilty to identify a
suitable object after careful
suitable object after careful
palpation.
This ability is lost in sensory
cortex lesion
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
22. Examination of Motor System
Motor system is examined under following headings. These
points are very useful in examine the
points are very useful in examine the
Hemiplegia
Nutrition
Tone
Power
Co-ordination
Co-ordination
Involuntary movements
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
System
system is examined under following headings. These
the patient of
the patient of
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23. Nutrition
Nutrition is tested by measuring circumference of muscles, at bulk
and comparing circumference of left and right
Circumference of muscle can be measured
distance from bony prominence.
For upper limb (arm & forearm) -10 cm above and below the
olecronon process.
For lower limb (thigh & calf region) -16 cm above
10 cm below the tibial tuberosity (knees)
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
by measuring circumference of muscles, at bulk
right side.
measured by fixing the
10 cm above and below the
16 cm above patela
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
24. Cont.
When circumference of both right and left
indicates nutrition of these muscles is normal.
When it abnormal it may
Atrophy or wasting of muscle is seen in LMN
myelitis
Hypertrophy of muscle is seen in UMN lesion
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
When circumference of both right and left sides is normal it
normal.
LMN lesion like polio
lesion
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
25. Tone
Its resistance offered by noramal muscle to passive
movements.
It is greatest in those muscles that maintain the body in
It is greatest in those muscles that maintain the body in
position.
Tone of the muscle is tested by 2 ways
By examining feel of the muscle
Tone can be seen by Resistance offered
Movements.
Normal feel is Elastic.
Hypertonia is seen in UMN lesion
Hypotonia is seen in LMN lesion
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
muscle to passive
It is greatest in those muscles that maintain the body in
It is greatest in those muscles that maintain the body in
ways
offered to passive
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
26. Power of Muscles
The power of all muscles should be tested at each joint in both the
upper and lower limb.
MRC (Medical Research Council) Scale for strength is a commonly
used scale for assessing muscle strength.
used scale for assessing muscle strength.
Grade 0 - No movements at all.
Grade 1 - Only flickering movement are visible but no movements
possible
Grade 2 - If movement is occurring horizontally but not
against gravity.
Grade 3 - If subject is able to lift up leg or hand,
gravity (compare the right and left side)
gravity (compare the right and left side)
Grade 4 - Patient is able to move his extremities
against resistance
Grade 5 - Patient is able to lift the extremities
against the good resistance applied by the
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
The power of all muscles should be tested at each joint in both the
for strength is a commonly
visible but no movements
If movement is occurring horizontally but not able to lift
to lift up leg or hand, against
his extremities
extremities
the doctor.
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
27. Cont.
Complete loss of power is called as
Complete loss of power is called as
typical feature of LMN lesion like
Partial loss of power is called as "paresis" which
typically seen in Hemiplegia or Paraplegia
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
as 'paralysis' which is
as 'paralysis' which is
lesion like polio myelitis
"paresis" which is
Paraplegia.
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
28. Co-ordination of Muscles
Co-ordination means the smooth recruitment interaction and co
operation of separate muscle or group of muscles in order to
operation of separate muscle or group of muscles in order to
accomplish a definite motor act.
If it is imperfect it is called ataxia that means the motor action
becomes difficult and impossible.
Causes of ataxia
cerebellar
Sensory
Labyrinthine
Labyrinthine
Central
How to test- all test of co-ordination performs first with eyes open
and then with eyes close.
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Muscles
ordination means the smooth recruitment interaction and co-
operation of separate muscle or group of muscles in order to
operation of separate muscle or group of muscles in order to
If it is imperfect it is called ataxia that means the motor action
ordination performs first with eyes open
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
29. Co-ordination Tests
Romberg’s test Finger nose test
Tandem walking Knee heel test
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Finger nose test
Postural holding
Postural holding
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
30. Cont.
If patient walks correctly with open eyes, but looses balance with
If patient walks correctly with open eyes, but looses balance with
closed eyes - It indicates damage lies in dorsal column tract (which
is called as sensory ataxia)
If patient is not able to walk with open or closed
cerebellum (it is cerebellar or Motor ataxia)
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If patient walks correctly with open eyes, but looses balance with
If patient walks correctly with open eyes, but looses balance with
It indicates damage lies in dorsal column tract (which
to walk with open or closed eyes damage is in
ataxia)
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31. Involuntary Movements
An involuntary movements occur when you move your body in an
uncontrollable and intended way.
uncontrollable and intended way.
These movements can be anything :-
Tremors
Chorea
Athetosis
Hemibellismus
Dystonia
Dystonia
Fasciculation
fibrillation
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Movements
An involuntary movements occur when you move your body in an
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
32. Tremors
These are unintentional rhythmic muscle contraction movement.
It is most common in all involuntary movements and can affect the
hands, arms, head , face, voice, trunk and leg.
• Fine Tremors – In
Thyrotoxicosis, Tachycardia,
weight loss, Intolerance to heat
atmosphere ,Feeling excessive
heat all the time.
• Pin rolling tremors at rest
In Parkinsonism
• Action
• Action
diseases
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
These are unintentional rhythmic muscle contraction movement.
It is most common in all involuntary movements and can affect the
hands, arms, head , face, voice, trunk and leg.
Pin rolling tremors at rest –
In Parkinsonism
Action tremor - In cerebellar
Action tremor - In cerebellar
diseases
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
33. Reflexes
It is an involuntary and nearly instantaneous movement in response
It is an involuntary and nearly instantaneous movement in response
to stimuli
In Superficial Reflexes - receptors are in skin or
In Deep Reflexes -receptors are in muscles
By convention the deep tendon reflexes are graded as follows:
0 = No Response (Absent)
1+ =Hypoactive
1+ =Hypoactive
2+ = A Brisk Response (Normal)
3+ = Hyperactive Without Clonus
4+ = Hyperactive Without Clonus
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It is an involuntary and nearly instantaneous movement in response
It is an involuntary and nearly instantaneous movement in response
skin or mucous membrane
muscles or tendons
By convention the deep tendon reflexes are graded as follows:
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
34. Superficial Reflexes
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
35. Plantar Reflex
The normal plantar
The normal plantar
reflex consists of flexion of
the great toe or no response.
With dysfunction of the
corticospinal tract, there is a
positive Babinski sign, which
consists of dorsiflexion of the
great toe with an associated
fanning of the other toes.
fanning of the other toes.
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
36. Deep Tendon Reflexes
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
37. Cont.
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
38. Gait
Circumduction gait –paralysis
Gait is a person’s pattern of walking. Walking involves
muscles that the body is propalled forward in arhythm
There are numerous possibilities that may cause
Circumduction gait –paralysis
Diplegic gait /scissor gait –
cerebral palsy
Neuroplegic gait- peroneal
nerve palsy
Fascinating gait –
parkinsonism
Cerebellar gait/ ataxic gait
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
involves balance and co-ordination of
arhythm is called stride.
an abnormal gait.
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
39. Sign of Meningeal Irritation
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Irritation
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40. Summary & Conclusion
Central Nervous System Examination
Higher Function
Cranial Nerves
Motor System
Consciousness
Orientation
Memory
Nutrition
Tone
Power
Co-ordination
Involuntary
Movement
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Central Nervous System Examination
Motor System
Sensory System
Reflexes
ordination Touch
Pain
Temperature
Jointsense
Superficial
Deep
Jointsense
Position Sense
Vibration
Tactile L
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
41. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)