Transcript Neurology 2 - Porterville College

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 & Coordination
Cerebellum 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
Biceps
1. Thumb on the biceps tendon
2. Strike your thumb with hammer
3. Compare with other arm
Deep Tendon Reflexes
Triceps
1.
2.
Strike the triceps tendon
directly with the hammer
while holding the patient's
arm with your other hand.
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
= Abnormal
• - Babinski
= Normal
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 – diastolic
120
-----=
40
80
– 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)