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  • Neurological Assesment

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    Safiyamohammadi
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    This document outlines the components of a comprehensive physical examination, including: - Subjective assessment of demographic and historical information. - Objective assessment of physical attributes, including vital signs, neurological evaluation using cranial nerve tests and reflexes, and sensory and motor examinations. - Evaluation of mental status, including tests of cognition, memory, orientation and speech. - Grading scales for reflexes, muscle tone, and voluntary muscle control. - Tests of balance, coordination and range of motion. The examination is designed to gather both subjective and objective health information through observation, questioning, and physical assessment.

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    This document outlines the components of a comprehensive physical examination, including: - Subjective assessment of demographic and historical information. - Objective assessment of physical attributes, including vital signs, neurological evaluation using cranial nerve tests and reflexes, and sensory and motor examinations. - Evaluation of mental status, including tests of cognition, memory, orientation and speech. - Grading scales for reflexes, muscle tone, and voluntary muscle control. - Tests of balance, coordination and range of motion. The examination is designed to gather both subjective and objective health information through observation, questioning, and physical assessment.

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    19 views78 pages

    Neurological Assesment

    Uploaded by

    Safiyamohammadi
    This document outlines the components of a comprehensive physical examination, including: - Subjective assessment of demographic and historical information. - Objective assessment of physical attributes, including vital signs, neurological evaluation using cranial nerve tests and reflexes, and sensory and motor examinations. - Evaluation of mental status, including tests of cognition, memory, orientation and speech. - Grading scales for reflexes, muscle tone, and voluntary muscle control. - Tests of balance, coordination and range of motion. The examination is designed to gather both subjective and objective health information through observation, questioning, and physical assessment.

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    of 78

    Subjective assesment

    • Demographic data
    • Name
    • Age
    • Sex
    • Gender
    • Occupation
    • Dominance
    • Chief complaint
    • Present history
    • Past history
    • Present medical history
    • Personal history
    • Family history
    • Socioeconomic history
    Objective assement
    • On observation
    • Built
    • Posture
    • Attitude
    • Wasting
    • Edema
    • Scar
    • Pressure sores
    • External appliances
    On palpation
    • Tone
    • wasting
    • Tenderness
    • Edema – pitting, non pitting
    • Limb length measurements
    • Scar – measurement, adherence
    General physical examination
    • Blood pressure
    • Pulse rate
    • Respiratory rate
    • Temperature
    On examination
    • Higher mental function examination
    • Level of consciousness
    • Orientation
    • Memory
    • Behavior
    • Intelligence
    • Speech
    • Level of consciousness-
    assessed by GCS
    Alert, lethargic, obtunded, stupor
    (semicoma) and coma
    • Intelligence- by asking questions related
    to occupation
    • Memory – short term memory,
    long term memory
    • Amnesia – retrospective and
    anterrospective
    • Orientation – time , place person
    • Behaviour –
    • Speech – motor and sensory
    • Aphasia – Brocas
    Wernickes and
    Global
    Cranial nerve examnation
    • There are 12 pairs of cranial nerves
    1. Olfactory
    2. Optic
    3. Occulomotor
    4. Trochlear
    5. Trigeminal
    6. Abducent
    7. Facial
    8. Vestibulocochlear
    9. Glossopharengeal
    10.Vagus
    11.Spinal accessory
    12.Hypoglossal
    Olfactory nerve
    • Anosmia – total absense of smell
    • Paraosmia – who feels each odour is
    similar and unpleasant
    • Hyposmia – decreased sense of smell
    Purpose of the test
    • Visual aquity
    • Field of vision
    • Colour of the vision
    • Snell's chart
    • Visual Confrontation test
    • Ishihara's chart
    3, 4 , 6 th nerves
    Light reflex
    Accommodation reflex
    Trigeminal nerve
    • Mixed nerve
    • Both sensory , and motor
    • Sensory – from the face
    • Motor- muscles of mastication
    Facial nerve
    • Mixed nerve
    • Sensory – ant two third of the tongue
    • Motor – muscles of facial expression
    Bell’sphenomenon
    Vestibulocochlear nerve
    Webers test
    Glossopharangeal nerve
    • Glossopharyngeal and Vagus Nerves
    • CN IX and CN X nerves can be assessed
    together:
    • Ask the patient to cough (assessing CN X)
    • Ask the patient to open the mouth wide and say
    ‘ah’, using a tongue depressor to visual the
    palate and posterior pharyngeal wall
    (assessing CN IX and X)
    – The soft palate should move upwards centrally
    – Gag reflex
    – Special sensation- posterior 1/3 rd of the tongue
    Spinal accessory
    • Motor
    • Supplies to sternocleidomastoid and
    trapezius muscles
    • Check the MMT of both the muscles
    Hypoglossal nerve
    • Motor nerve
    • Supplies to the muscles of tongue
    • Movemements of the tongue should be
    checked
    • Waisting of tongue, deviation of tongue,
    involuntary movements of tongue muscle
    to be checked
    Reflex examination
    • Types of Reflexes
    • Superficial reflexes:Plantar response,
    abdominal reflex,cremastic reflex,corneal
    reflex
    • Deep reflexes: Biceps, Brachioradialis,
    Triceps, Knee jerk, and ankle jerk.
    Streach reflex
    Superficial reflexes
    Deep tendon reflexes
    • Reflexes tested include the following:
    • Biceps (innervated by C5 and C6)
    • Radial brachialis (by C6)
    • Triceps (by C7)
    • Distal finger flexors (by C8)
    • Quadriceps knee jerk (by L4)
    • Ankle jerk (by S1)
    • Jaw jerk (by the 5th
    Grading of reflexes
    • 0 No evidence of contraction
    • 1+ Decreased, but still present (hypo-reflexic).
    Hyporeflexia is generally associated with a lower
    motor neuron deficit (at the alpha motor neurons
    from spinal cord to muscle) eg Guillain–Barré
    syndrome
    • 2+ Normal
    • 3+ Super-normal (hyper-reflexic) Hyperreflexia is
    often attributed to upper motor neuron lesions eg
    Multiple sclerosis
    • 4+ Clonus: Repetitive shortening of the muscle after
    a single stimulation
    Sesory system examination
    1.Superficial (Exteroceptive) sensation
    • Pain Perception Temperature Awareness Touch
    Awareness
    2.Proprioceptive(deep) sensation
    • Pressure Perception,
    • Kinesthesia Awareness
    • Vibration Perception
    3.Combined cortical sensations.
    • Stereognosis Perception
    • Tactile Localization
    • Two-Point Discrimination
    • Graphesthesia
    • Barognosis
    Motor examination
    • Tone - hypotonicity
    • Hypertonicty – two types rigidity ,
    spasticity
    • Difference between spasticty and rigidity
    Spasticty
    • Pyramidal tract lesion
    • One group of muscle involved
    • Velocity dependent
    • Claspknife phenomenon present
    • Seen in stroke
    Rigidity
    • Extra pyramidal lesion , involvement of
    basal ganglia
    • Both the group of muscles are involved
    • Velocity independent
    • two types – lead pipe and cog wheel
    • Seen in Parkinson’s disease
    Assement of spasticity
    • Modified Ashworth Scale (MAS)
    • 0 No increase in tone
    • 1 -slight increase in tone giving a catch when slight
    increase in muscle tone, manifested by the limb was
    moved in flexion or extension.
    • 1+ slight increase in muscle tone, manifested by a catch
    followed by minimal resistance throughout (ROM )
    • 2- more marked increase in tone but more marked
    increased in muscle tone through most limb easily
    flexed
    • 3 -considerable increase in tone, passive movement
    difficult
    • 4- limb rigid in flexion or extension
    • Tightness /contractures/deformity
    • ROM- active and passive
    • Muscle strength- MMT/ voluntary control
    grading
    Voluntary control grading
    • Grade-0 no contraction
    • 1- flcker contraction in synergy
    • 2. half ROM in synergy
    • 3. full ROM on synergy
    • 4. intiate the movement without synergy ,
    ending with synergy
    • 5.full ROM without synergy, on resistance
    synergy
    • 6 normal
    • If voluntary control
    grading -6 then only
    MMT can be done
    • Balance and co ordination
    • Balance - static and dynamic
    • Co- ordination - equilibrium tests and non
    equilbrium tests
    • Non equilibrium tests- finger – nose,
    finger –finger , finger to therapists finger,
    alternate supination and pronation , heel to
    shin
    • Equilibrium tests – standing on one leg
    • Tandem standng,
    • tandem walking
    • Walking on straight line
    Side walking
    standing with both the feet together
    walking in circular manner

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