Neurology 2 Part 3

Assessing Motor System Muscle Strength Tone – Tension pressure when the muscle is at rest Spasticity – Increase muscle tone Rigidity – Resistance to passive stretch

Flaccidity – Decreased muscle tone Atrophy – Wasting away of muscle Hypotonia – Lose of tone or strength Atonia – No tone or strength

Hypertonia – Increased tone or strength Gait – Manner / style of walking Ataxia – Failure of muscle coordination, irregular voluntary muscle action Akinesia – Abnormal absence of movement Bradykinesia – Slow movement

Balance & Coordination Cerebellum assessment RAM – Rapid Alternating Movement Pronate / supinate

Point to Point

Heel to Shin

Heel to toe walking Hopping in place

Have the patient walk across the room under observation. Next ask the patient to walk heel to toe across the room, Then on their toes only, finally on their heels only.

Romberg – Stand feet together arms at side – Eyes open – Eyes closed seconds – Slight sway is normal

Assessing Reflexes Grading Scale 0 = No response + = hypoactive ++ = Normal +++ = More active ++++ = Hyperactive

Deep Tendon Reflexes Biceps 1.Thumb on the biceps tendon 2.Strike your thumb with hammer 3.Compare with other arm

Deep Tendon Reflexes Triceps 1.Strike the triceps tendon directly with the hammer while holding the patient's arm with your other hand. 2.Repeat and compare to the other arm.

Deep Tendon Reflexes Patellar

Deep Tendon Reflexes Achilles

Superficial Reflexes (protective reflexes) Corneal Reflex – Test using a clean cotton wisp, lightly touch the outer corner of each eye on the sclera – Normal: (+) elicits a blink – Abnormal: (-) no blink Eye protection Lubrication

Superficial Reflexes (protective reflexes) Gag reflex – Test: gently touch posterior pharynx with cotton applicator – Normal: (+) elevation of the uvula (gag) – Abnormal: (-) No gag NPO

Superficial Reflexes (protective reflexes) Plantar Reflex – Test: stroke the lateral side of the foot with tongue blade – Normal: (- Babinski) toe flexion (curl) – Abnormal: (+ Babinski) toe tanning

Superficial Reflexes (protective reflexes) - Babinski = Normal + Babinski = Abnormal

Vital Signs Temperature – With head trauma  increased

Vital Signs Pulse – Strength, rate rhythm – Bradycardia  indicative of Increased ICP

Vital Signs Respirations – Depth, rate, rhythm, effort – Ataxic Damage to medulla – Cheyne-stokes Lesion deep in both hemispheres, basal ganglia and upper brainstem – Hyperventilation Metabolic problems or brainstem

Vital Signs Blood Pressure – Right verses left – Lying verses standing – Difference in systolic by > 20mmHg  potential cerebral ischemia

Vital Signs Pulse Pressure formula: – Systolic – diastolic =? 80

Vital Signs Pulse Pressure – Systolic – diastolic =40 80 – Normal Pulse pressure = 40 – Widening pulse pressure = Increased ICP

Neuro Checks LOC Pupils – PERRLA Pupils Equal Round Reactive to Light Accommodation

Neuro Check Pupils – Anisocoria Inequality in the size of the pupils – Nystagmus – Progressive dilation  Increase ICP – Fixed & dilated Injury at level of midbrain

Brudzinski’s Flexion of the neck  pain and flexion of the knees Indicates – Meningitis No not perform if… – Neck or back injury

Kernig’s Pain with flexion of the hip and knee Indicates – meningitis

Cushing Sign Vital sign changes assoc. with Increased ICP – Increase in Systolic pressure – Widening pulse pressure – Bradycardia – Bradypnea (slight)