The Neurological System

Neurological Exam 5 Components Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory

Mental Status Examination Examination - ABCT Appearance Behavior Cognition Thought processes (thought content & perceptions) Glasgow Coma Scale

Assessing LOC: Glasgow Coma Scale Eye opening Verbal responsiveness Motor responsiveness

Glasgow Coma Scale

Levels of Consciousness Physical Examination Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when not stimulated Obtunded- sleeps most times, difficult to arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for arousal; responds to stimuli Coma- no response (Jarvis CH 2)

Neurological: Physical Examination Sensory System Function With eyes closed Interpret sensations Discriminate side to side Examine in detail if: Reduced sensation Numbness or pain Motor or reflex abnormal Skin changes Be specific: “tell me where I touch” Check both sides

Sensory Function Tests: Touch Vibration Physical Examination Sensory Function Tests: Touch Light touch 1st then Pain & Temperature Vibration Kinesthesia/Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination

Sensory Function Tests: Sensory Exam: Light Touch

Sensory Function Tests: Sensory Exam: Vibration

Sensory Function Tests: Proprioception: Position sense

Sensory Function Tests: Stereognosis

Sensory Function Tests: Graphesthesia

Sensory Function Tests: Two-point discrimination

Motor Examination Symmetry, size, and presence of involuntary movements Full ROM of joints Check strength against resistance Neuro patients: Assess hand grips and foot pushes if bedridden

Cerebellar Function Gait and posture More specific tests Heel to toe in straight line Walking on toes and heels Hop on one foot Note width of gait

Cerebellar Function, con’t Coordination of hands Rapid Alternating Movements

Cerebellar Function, con’t Coordination of hands Nose –to - Finger Test

Cerebellar Function, con’t Coordination of legs Heel to Shin Test

Cerebellar con’t Romberg: Stand upright, place feet together, then close eyes loss of balance means + Romberg test Be prepared to protect client from falling!

Reflexes Superficial (abdominal reflex, Cremasteric reflex) Cremastic Reflex Abdominal Reflex

Reflexes-Cont: Visceral (pupillary response to light) PERRL/PERRLA

Reflexes-Cont: Pathologic + Babinski in adults Babinski’s Reflex (Adult)

Reflexes-Cont: Reflex Arc – Deep Tendon Reflexes

Reflexes-Cont: Deep Tendon Reflexes Technique Position limb so muscle is slightly stretched Reflex hammer should strike tendon briskly to stretch tendon Get patient to relax

BICEPS BRACHIORADIALIS ACHILLES/PLANTAR TRICEPS PATELLAR DEEP TENDON REFLEXES

Grading of DTRs 4+ very brisk 3+ brisker than average 2+ average, normal 1+ diminished, low normal 0 no response