NEUROLOGIC EXAMINATIONPART 2NEUROBEHAVIOR AND SENSE SYSTEMACADEMIC YEAR 2006 - 2007

GENERAL OBJECTIVEAt the end of skills practice, the student will be able to demonstrate:EXAMINATION OF MOTOR FUNCTIONEXAMINATION OF SENSORY FUNCTIONEXAMANATION OF MENINGEAL SIGN

SPECIFIC OBJECTIVETHE EXAMINATION OF MOTOR FUNCTION:Inspection: wasting, fasciculation, involuntary movement.Strength and tones of limbs: elevate and contract of muscle against resistance.Percussion for detecting fasciculationUpper and lower extremitiesTwo side should be equal

The strength of limbsGrade 0: total paralysisGrade 1: move the fingersGrade 2: move the limbs over the bedGrade 3: against the gravitation resistanceGrade 4: against light resistanceGrade 5: against the full resistance (normal)

The tone of muscleRelax the muscle of the limbsThe examiners flex and extend passively the patients joint and felt the muscle resistanceAbnormal: tonicity of muscle

The fasciculationPercuss on one area of limbsNotice the fasciculation moving of the muscles on the area of examination

EXAMINATION OF SENSORY FUNCTIONExteroception sensory xamination:Light touchPain and temperaturePropioception sensory examinationPosition senseVibration sense

Light touchThe patients sits or lies with hand supinated and close the eyes, instruct to answer yes when the stimulus appreciated.The examiner takes a wisp of cotton and applies it lightly to the skin, alternate between two sides, examining the homotopic area

The cotton is applied to the skin of the neck beginning in the C3 dermatome on each side shoulder lateral arm, forearm, finger medial arm, forearm, chest.Same examination for the lower limbs.

Pain and temperature sensationPain tested with pinwheel/needleTemperature tested with glass tube filled with hot/iced water

Propioception sensory examinationPosition sesn:The patient is asked to closed the eyesThe examiner grasps the terminal phalanx in the sides and gentle moves it a few degrees in an upward/downward directionAsked the patient to indicate the digit is moved up / down.

Vibration senseThe patients is asked to close the eyesThe examiner places the base of a tuning fork over a bony prominenceAsked to indicate the sensation of vibration.

Meningeal signs examinationNeck stiffness/nuchal rigidity:Flexes the patients head until the chin contacts the chestAbnormal response: the examiner felts the resistance of head movement and the patient shows painful expression.

Brudzinskis sign:Flex the patients head and notice the flexion movement of the leg.The examiner elevates one leg of patient upright, and notice the flexion movement in another onesThe examiners press the lower part of abdomen, and notice the flexion movement of the leg

Lasiques sign:The examiner elevates the leg of patients uprightAbnormal response: the patient felt painful at the leg angle less than 700

Kernigs sign:The examiner elevates the aptients leg and flex 900 at hip and knee joints, then extend the lower limb at knee jointAbnormal rsponse: felts painful at knee angle less than 1300