Assessment Of The Nervous System: Physical Assessment

neurologic assessment-also involves phyerical assessmentnumologic assessment 18 divided into 5 components: (phymoonente)1. consuousness and cognition2. cramal names3. motor system4. sensony system5. reflexes1.cerebral alterations can result in distarbances of mental status, intellectualb thought content, emotional Status. +language alterationslifestyne alterationsmental statusobserve appearance behanor dress, groming personal hygeine ,Posture, gesture,movements faulal expressionsAOX. - status.Intellectual functioning10. (re peat digits and cite to digits backwards)Senal 715. (100,93, etc)abstract reasoningrelogme similaritiesmake judgementsThought content -are - thoughts spintaneous, natural, Clear, relevant, coherent?emotional Statusaffect IS congment T mood?moldsmitch.?Language ability -read/wnre can understand /communuate approprately.aphasia: deficiency in language function.Impact on lifestyle. patients role in society, family and community Vloc - patients wakefulness and ability h respond to environment.*most sensitive indicator of neurologi functionobsemedlertness and ability to billow commands.funable: assess eye opening Verbal/motor response tostmuli.2.Namal hemesCRANIAL NERVES ASSESSMENT Cheat SheetNameFunctionNumberAssessment:(Mnemonic)(Mnemonic)OlfactorySmellIHave patient identify(Oh)(Some)scent with eyes closedHave patient performEIIOpticVisual acuity & fieldconfrontation visual field test(Oh)& Snellan chart visual acuityFP(Say)TOZtestLPEDEye & EyelidUse penlight toOculomotorIIIMovement: Pupil sizeAssess for(Oh)& reactivityPERRLA.(Marry)Eye MovementAsk patient to followIVTrochlearPenlight MovementDown & Lateral(To)With eyes move(Money)Down & laterallyHave pt close eyes.Chewing & FacialTouch checks. chin &VTrigeminalSensationForehead with cotton ball(Touch)(But)Ask patient to notify youWhen they feel any sensationLateral EyeAsk patient to followVIAbducensMovementpenlight movement with(And)(My)Eyes: move laterally & DiagonallyFacialFacial ExpressionsAsk patient to: fromVIISmile. raise eyebrows.(Feel)(Brother)Puff cheeks. close eyes tightlyAsk patient to occlude one ear.Vestibulo-VIIIcochlearHearing & BalanceWhisper phrase in other ear & ask(Very)(Says)Patient to repeatAssess gait for balanceGlosso-Gagging &Assess for upward movementyawnIXOf soft palate during yawn andPharyngealSwallowingSaying "Ahhh"(Good)(Big)Assess swallowingPharynx / LarynxUse tongue blade to touchXVagusSensation / GagPosterior Pharynx observe(Veins)(Brains)For gag reflex followed by SwallowingSpinalHead & ShoulderAsk patient to shrugXIaccessoryMovementshoulders & turn head(Such)(Matter)against resistanceXIIHypoglossalTongue MovementAsk pt to stick out tongue(Heaven)(More)& move tongue side to sideS = Sensory: M MotorB Both3.Examining motor systemmotor ability walk accress the room lobsume posture/gait)lelent har She sumitm (note. his /tromarc) your "muscle toneabnormal muscle tone: spastility muscle tone)rigidity (resistance to passnic smetch)blaceditymuscle strength -assessing abilityto flex/extend extremities againstresistance tests for muscle strength.- compare R/1 sides fonstrength (ex: l arm vs Dam )- -dnft-subtle weakness(standing T/both arms out with palms up. - If me palm monates=dnbt.5 point scall to rate muscle strength5:fwe power4. fair but 4 full3. subjicient strength to overome granty/mod meanness)2. movement present but canmot orenome1. minimal contractile power (omovement) severe weaknessD. 0 movementBalance and coordination- hands lupper extremities tested by performing rapid, alternating,movements and point to-point testing.(pat hand, touch each finger to tumb, touch examinosbinger and then own wife.- - lover-extremities: run heel down tibiaataxid: incoordination of voluntary musul actionTremors = ploblems In anatomic aneas responsible for balance/coordination.* Romberg Test: tests balancecan be done sittinglstandingfeet together lams at sidiclose eyesswaying if its SLIGHT IS normal but IFof balance = abnormal.loss of balance (+)Romburg Test0 loss of barance Iswaying = (-) Test4.examining sensory systemmore complex than motor- : Dationt Noncentional over WHOtest for tactile sensation, superficial pain, temperature, vibration,possible sense (proploception)eyes ane closed during assessment.Tactile: touch cotton wisplangerito oncorresponding areas of bidy.paintemp. only meed to assess for pain b/c temp istransmitted through same way, 80 if pain present = temppresentshave object (dull ends of broken wooden cotton0 safity pin. - blc cam break Skin integrater.vibration funning bork.proploception: ask pt 70 close wys indicate whether great tot I or Index finger18 moved upldown or what direction?(IF lost Vibration and sensation are usually lost together.)Integration of sensation in the brain:does lot recommen 2 objects memingthe skin a the same time ,as 2 objects or 1?If only one side of body recognized the one I recognised IS Saed to demonstrateextructiontactile Identification placing object inpersons hand- IS it recognization'(tactile - means pt can 0 identify an object by towels.)agmosia: the general loss of ability to Identify oun object through aparticular sensory system.visual agnosia: canmot name object that isvisually seen.5. examming the reflexesreflexes are involuntary contractions of muscles or muscle groups Inresponse to a stimulican be1. deep tendon2. superficial3. pathalogiDeep Tendon Reflexesellated by reflex hammer.extremity is positioned sothat the tendon IS slightly stretched.struck briskly and compared to orgosite side.valid findings depend onproper Use of hammerproper pisitioning of extremityrelaxed pt.nhe1- accounce on 10responses usually graded on a scale of 0-4t ( 2t considered hmmal.)-some examiners prefer : "present, absent, dimimsheel" to record findingsex:Blceps repluxtriceps reflexbrachioradianis reflexPatchar reflexachilles reflex (sometimes absent in older adults.)Clonus -reflexes that are to beat 2-3 x/s beforeIt settles into aposition of rest.sustained Clomus: does 090 back to rest.9999The Taylor Reflex Hammer Is A Classic Diagnostic NeurologicalInstrument used To Test Joint Reflexes Or Bone FracturesIn The Joints.DDP00009999 superioval reflexes:(men only)include: comeal, parpebral, gaglupperllower abdominal, cremastene,and penamal.results are (t) or (-) - & # Scale.comeal -touching comer of eye to elicit blinkcommonly testedgag - touching back of throat results in gayplantarpathalogi Reflexes: seen in the presence of numologic disease.often represent emergence of canler reflexes that disappered Tmatunty of the NS.(basically reflex you had earlier in life 1but that ment away when you gotolder - bur are back non.)Babinski reflex - sole of the foot strokednormal response: toes contract & draw together.abnormal response: toes fan out and draw back(H) BabinskiNfiesnormal in kids but =CNS disease in admitsSuck reflex (sucking monon in response to touching the 11ps)snour (lip pursing in response to touchins (IPS)palmar (grasy In response to smoking palm)palmomental (contraction of facial muscle in response to stimulationof the thenar emi hence near the thems)all signify progressive NS degeneration.