Neurology 2

Part 3

Assessing Motor System

Muscle StrengthTone

Tension pressure when the muscle is at restSpasticity

Increase muscle toneRigidity

Resistance to passive stretch

FlaccidityDecreased muscle tone

AtrophyWasting away of muscle

HypotoniaLose of tone or strength

AtoniaNo 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 & CoordinationCerebellum 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 20-30

seconds Slight sway is

normal

Assessing Reflexes

Grading Scale

0 = No response

+ = hypoactive

++ = Normal

+++ = More active

++++ = Hyperactive

Deep Tendon Reflexes

Deep Tendon Reflexes

Biceps1. Thumb on the biceps tendon

2. Strike your thumb with hammer

3. Compare with other arm

Deep Tendon Reflexes

Triceps1. 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

120

------ = ?

80

Vital Signs

Pulse Pressure Systolic – diastolic120------ = 4080 Normal Pulse

pressure = 40 Widening pulse

pressure = Increased ICP

0

20

40

60

80

100

120

140

160

180

700 900 1100 1300 1500

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)

Day 2

Diagnostic tests