Neurology 2

Part 3

Assessing Motor System

Muscle Strength• Tone– Tension pressure when the muscle is at rest

• Spasticity– Increase muscle tone

• Rigidity– Resistance to passive stretch

• Flaccidity– Decreased muscle tone

• Atrophy– Wasting away of muscle

• Hypotonia– Lose of tone or strength

• Atonia– No 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 Scale0 = No response+ = hypoactive++ = Normal+++ = More active++++ = Hyperactive

Deep Tendon Reflexes

Biceps1. Thumb on the biceps tendon2. 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

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)