2. Clinic 5 Practicum Assignment Go see your staff doctor this week –Schedule your hours 2 Hours per week –Activate your patient file

3. Dermatomes & Myotomes

4. Dermotomes Each pair of spinal nerves monitors the sensory information of a specific region of the body surface An injury to the spinal nerve or the dorsal root ganglion will produce a loss of sensation to a specific patch of skin

5. Dermotomes Dermotomes: Areas of the body are tested for their response to differing sensations including: 1. Light Touch 2. Sharp - Dull 3. Hot - Cold

10. Gowning Proper gowning of patient. –Male patients should wear shorts with or without a gown. If the male patient is comfortable in shorts without a gown then the gown should be put on the examination table so that when he lies down his skin does not touch table. –Female patients should wear shorts and needs to have a gown on.

11. Dermatomes Have patient seated on table palms up, sleeves rolled up, shorts pulled up on legs as far as possible. Using pinwheel begin to check the patients sensation in each dermatome and compare it with the opposite extremity. Hold pinwheel loosely between thumb and index finger. Do not hold like a pizza cutter where you would be applying downward pressure.

12. Pinwheels

13. Myotomes Group of muscles all innervated by the same nerve root Certain motor deficits are related to the level of injury to the spinal cord. In paraplegics the lower limbs are affected and in quadriplegics, the upper and lower limbs are affected

14. Myotomes: Certain motions are associated with different spinal levels. Patients are asked to resist the motion (ie. elbow flexion) if they fail, it is an indication of a problem at the corresponding spinal level. Motions and spinal levels are described in the following slides

15. C1  Neck Flexion C2  Neck Extension C3  Lateral Flexion(neck) C4  Shoulder Elevation C5  Shoulder Abduction C6  Elbow Flexion/ Wrist Extension C7  Elbow Extension/ Wrist Flexion C8  Finger Flexion T1  Finger Abduction ADduction

16. L2  Hip Flexion L3/L4  Knee Extension L4  Dorsiflexion & Inversion of Ankle L5  Hallucis Extension S1  Plantarflexion & Eversion of Ankle S1/S2  Plantarflexion

17. Cerebellar Test

18. Cerebellar Testing The cerebellum fine tunes motor activity and assists with balance. Dysfunction results in a loss of coordination and problems with gait. The left cerebellar hemisphere controls the left side of the body and vice versa.

19. Finger to nose testing With the patient seated, position your index finger at a point in space in front of the patient. Instruct the patient to move their index finger between your finger and their nose. Reposition your finger after each touch. Then test the other hand.

21. Finger to nose testing With the patient seated and both arms outstretched at their sides have them bring their index finger of one hand to their nose and repeat same movement with the opposite hand. Repeat procedure with eyes closed. The patient should be able to do this at a reasonable rate of speed, trace a straight path, and hit the end points accurately. Missing the mark, known as dysmetria, may be indicative of disease.

22. Rapid Alternating Hand Movements Direct the patient to touch first the palm and then the dorsal side of one hand repeatedly against their opposite hand or their thigh. Then test the other hand. The movement should be performed with speed and accuracy. Inability to do this is known as dysdiadokinesia and may be indicative of cerebellar disease.

23. Rapid Alternating Movement

24. Romberg’s Test Have the patient stand in one place. Make sure that you are in position to catch and support them if they fall. This is a test of balance, incorporating input from the visual, cerebellar, proprioceptive, and vestibular systems. If they are able to do this, have them close their eyes, removing visual input. This is referred to as the Romberg test. Loss of balance suggests impaired proprioception, as it is this pathway which should provide input that allows the patient to remain stably upright.

25. Romberg’s

26. Heel to Toe Walking Ask the patient to walk in a straight line, putting the heel of one foot directly in front of the toe of the other. This is referred to as tandem gait and is a test of balance. Realize that this may be difficult for older patients (due to the frequent coexistence of other medical conditions) even in the absence of neurological disease.

28. Toe Walk -- S1

29. Heel Walk -- L4-Mostly w/some L5

40. Cervical Nerve Roots