1. QUICK NEURO QUIZ

2. PARKINSONS * Name 4 signs

3. UMN AND LMN LESIONS Name 4 differences

4. GAIT & POSTURE Describe…. Decerebrate vs decorticate Ataxic gait Parkinsonian gait Hemiplegic gait

5. SHOW ME... Decerebrate posture Decorticate posture Resting tremor Intention tremor Ataxic gait Foot drop

6. LEVELS OF POWER Describe the levels 0-5

7. REFLEXES Perform on your neighbour and describe the nerve root tested… Triceps Biceps Knee Ankle

8. DERMATOMES Mark on your neighbour with a post-it…. C3 C4 C5 C6 C7 C8 L2 L3 L4 L5 S1 S2 http://www.apparelyzed.com/_images/content/spine/dermatome-chart.jpg

9. CEREBELLAR SIGNS Name and describe

10. WHAT IS…(AND WHAT DOES IT SHOW) Kernigs sign

11. DESCRIBE GCS What is the breakdown? How would you score someone who is mumbling incoherent words, opening eyes to voice and withdrawing normally to pain but not following commands?

12. PARKINSONS Name 4 signs 1.hypokinesia ( poverty of movement) 2.bradykinesia (slowness of movement) 3.rigidity 4.rest tremor

13. UMN AND LMN LESIONS LMN weakness of the muscles innervated prominent muscle wasting - slight or absent in upper motor neurone disease absent or reduced reflexes - there are increased reflexes in upper motor neurone disease hypotonicity fasciculations – flexor or absent plantar responses UMN weakness - the extensors are weaker than the flexors in the arms, but the reverse is true in the legs muscle wasting is absent or slight - muscle wasting is prominent in a lower motor neurone lesion hyper-reflexia and clonus - reflexes are absent or reduced in a lower motor neurone lesion spasticity no fasciculations extensor plantar responses

14. GAIT & POSTURE Decerebrate - coma where there is extension of the arms and legs, which is often asymmetrical. It results from loss of midbrain tone over muscle control Decorticate- A decorticate posture is one of flexion of the arms at the elbows, and occurs secondary to bilateral hemispherical dysfunction Ataxic gait- broad base, unsteady, uncoordinated walk Parkinsonian gait- shuffling gait Hemiplegic gait http://www.youtube.com/watch?v=y160w4sAQNw&list=PLD7497 2DCFB2D58C8

15. LEVELS OF POWER Describe the levels 0-5 0 - complete paralysis 1 - flicker of contraction possible 2 - movement is possible when gravity is excluded 3 - movement is possible against gravity 4 - movement is possible against gravity + some resistance 5 - normal power

16. REFLEXES Perform on your neighbour and describe the nerve root tested… Triceps Biceps Knee Ankle

17. DERMATOMES C4 shoulder tip C5 outer part of the upper arm C6 lateral aspect of the forearm and the thumb C7 middle finger C8 little finger T1 medial aspect of the upper arm For reference, more caudally: T7 xiphisternum T10 level of umbilicus L2 upper thigh L3 around the knees L4 medial aspect of the leg L5 lateral aspect of the leg, medial side of the dorsum of the foot S1 lateral aspect of the foot, the heel and most of the sole S2 posterior aspect of the thigh S3, S4, S5 concentric rings around the anus, the outermost of which is S3

18. CEREBELLAR SIGNS DANISH- Disdiadokokinesis Ataxia Nystagmus Intention tremor and past-pointing Staccato speech Hypotonia

19. WHAT IS…(AND WHAT DOES IT SHOW) Kernigs -should be tested for if meningitis is suspected. Each hip is flexed in turn, and then attempt to straighten the knee while keeping the hip flexed. In a meningitis, this movement is greatly limited by spasm of hamstrings - which in turn causes pain - due to inflammatory exudates around the roots of the lumbar theca.

20. DESCRIBE GCS What is the breakdown? best motor response - 6 grades best verbal response - 5 grades eye opening - 4 grades How would you score someone who is mumbling incoherent words, opening eyes to voice and withdrawing normally to pain but not following commands?

21. MOTOR grade 6 - obeying command: the examiner asks the patient to do simple tasks be careful not to accept a grasp reflex for this grade grade 5 - localising response to pain: this is the purposeful movement of a limb to remove a painful stimulus applied supra-orbitally grade 4 - withdrawal response to pain: pain in a limb results in purposeful withdrawal of the limb grade 3 - abnormal flexor response to pain: pain in a limb results in reflex flexion-withdrawal of the limb grade 2 - extensor posturing to pain: pain in a limb results in abnormal extension in the upper limb this involves adduction, internal rotation of the shoulder and pronation of the forearm grade 1 - no response to pain

22. EYES RESPONSE grade 4 - spontaneous eye opening grade 3 - eye opening in response to speech: the patient will open his eyes in response to speech or shouting from the examiner eye opening need not occur in response to a command to open the eyes grade 2 - eye opening in response to pain: the patient opens eyes in response to pain e.g. applying pressure to the patient's finger nailbed with a pencil grade 1 - no eye opening

23. VERBAL grade 5 - oriented - the patient is oriented in time, person and place grade 4 - confused conversation - the patient can respond to questions in a conversational manner but is disoriented and confused grade 3 - inappropriate speech - there is no conversational exchange but the patient makes random or exclamatory articulated speech grade 2 - incomprehensible words - the patient makes moaning sounds but no words grade 1 - no vocalisation