NEUROLOGICy.ppt

Copyright © 2007 Lippincott Williams & Wilkins.
NCM 101.1

– Neurological system consists of
• Central nervous system (CNS): brain
and spinal cord
• Peripheral nervous system (PNS):
somatic and autonomic divisions

• CNS: covered by meninges; bathed by
cerebrospinal fluid
– Brain: located in cranial cavity; 4 major
divisions
• Cerebrum divided into R and L
hemisphere; consists of 4 lobes (frontal,
parietal, temporal, occipital)

• Brain
– Brain stem: consists of
• Midbrain (relay center)
• Pons (links brain structures)
• Medulla oblongata (controls respiratory
function, heart rate and force, blood
pressure)

• Brain
– Cerebellum: located behind brain stem
under cerebrum; divided into R & L
hemisphere; functions
• Coordination and smoothing of
voluntary movements; maintenance of
equilibrium and muscle tone

• Spinal cord
– Located in vertebral canal; extends from
medulla oblongata to L1 (first lumbar
vertebra); IS NOT AS LONG AS SPINAL
CANAL
– Functions: conducts impulses;
responsible for simple reflex activity

• Neural pathways
– Sensory impulses (originate in afferent
nerve fibers of peripheral nerves; are
carried through posterior [dorsal] root into
spinal cord)
– Motor impulses (conducted to muscles by
2 descending pathways: pyramidal and
extrapyramidal)

• Peripheral Nervous System (PNS)
– Carries information to and from CNS
– Consists of 12 pairs of cranial nerves
– PNS somatic fibers carry CNS impulses
to skeletal muscles
– PNS autonomic fibers carry CNS
impulses to smooth, involuntary muscles
(ex. heart and glands)

• PNS: Cranial Nerves
– I Olfactory – smell
– II Optic- vision & visual field
– III Oculomotor-pupils
– IV Trochlear-follow moving objects
– V Trigeminal-sensations

– VI Abducens-move eye laterally
– VII Facial-taste
– VIII Acoustic (vestibulocochlear)-tuning
fork
– IX Glossopharyngeal-gag & swallowing
– X Vagus – throat muscle

– XI Spinal accessory-
sternocleidomastoid & trapezius
– XII Hypoglossal-stick out tongue

• Collecting subjective data
– Interview approach
• History of current health problem
• Past and family histories
• Lifestyle and health practices

• Collecting objective data
– Client preparation
– Equipment and supplies
• Cranial nerve exam
• Motor and cerebellar exam
• Sensory and reflex exams

• Key Assessment points
– Identify structures and functions of CNS
and PNS
– Understand meaning of mental status and
LOC
– Correctly apply and interpret mental
status exam and Glasgow coma scale
(GCS)

• Key Assessment points
– Identify 12 cranial nerves and their
sensory and motor functions
– Thoroughly assess: movement, balance,
coordination, reflexes

• Physical Assessment
– Mental Status and LOC
• Observe: appearance and behavior;
mood, feelings, expressions; thought
processes and perceptions; cognitive
abilities; orientation; concentration

– Mental Status and LOC
• Observe: recent and remote memory;
use of memory to learn new
information; abstract reasoning;
judgment; visual, perceptual, and
constructional abilities

– Test cranial nerves
– Assess condition and movement of
muscles, and test balance and
coordination
– Assess sensations and reflexes

– Perform Brudzinski’s sign and Kernig’s sign
– Brudzinki’s sign-involuntary flexion of the
arm, hip & knee when the neck is passively
flexed; it occurs in patients with meningitis
– Kernig’s sign- a diagnostic sign for
meningitis marked by a loss of the ability of
a supine patient to completely straighten the
leg when it is fully flexed at the knee & hip

Kernig’s Sign

• Validation and Documentation of findings

NEUROLOGICy.ppt

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