Neuro/musculoskeletal

Temperature testing

- Equipment: two test tubes with hot or cold water; or two tuning forks (one cold, one hot) - Educate patient - Have patient close eyes, ask them to say whether the stimulus is cold or hot - Place tube/fork against patients skin; allow stimulus to remain for at least 2 seconds - Abnormal responses include an inability to discriminate between cold and hot or inability to sense the presence of the stimulus at all.

sensitivity to position

- Kinesthesia: Test the persons ability to perceive passive movements. - Move finger or toes up and down and ask pt to tell you which way you moved. - Hold finger by the sides!!

Quick Neuro Check

- LEVEL OF CONSCIOUSNESS - ORIENTATION TO TIME, PLACE, PERSON, AND SITUATION - MEMORY - EXTREMITY MOVEMENT - PUPILLARY RESPONSE - VITAL SIGNS

Romberg test

-ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds

Sensory Assessment

-patient's ability to see and hear -also includes tactile abilities

oculomotor abnormalities

-saccadic abnormalities -impaired VOR cancellation -direction changing nystagmus -down beating nystagmus -saccadic smooth pursuit

Posterior Column Tract

-vibration- use tuning fork. often, vibration is first sense lose -kinesthesia- move their finger up and down and ask to identify which way it moved -tactile discrimination (fine touch) -stereognosis - graphesthesia - two-point discrimination - extinction - point location

optic nerve testing

-visual activity: cover one eye, read smallest line at 20 ft away ; 20/20 numerator = distance, denominator = what line read -Confrontation test (peripheral vision): pencil brought into field of vision from 8 separate directions Visual acuity, field of vision, optic disc Sensory Use Snellen's Chart

Grading strength of muscle

0-unable to contact muscle in a gravity eliminated position 1-able to contract muscle slightly 2-move joint in a gravity eliminated position 3- move joint against gravity 4- move joint with some resistance through range of motion 5-move joint with full resistance through range of motion

cranial nerves

12 pairs of nerves arising from the brain

Normal and abnormal of GCS

15 alerts is normal <7 coma

How many bones are in human skeleton?

206

Trigeminal Nerve (CN V)

3 major branches: 1. Ophthalmic, S 2. Maxillary, S 3. Mandibular, B Both Motor and Sensory M - jaw clenching, chewing S - facial sensation

How many pairs of spinal nerves do humans have?

31 left-right

dual energy x-ray absorptiometry (DEXA)

A highly accurate method of measuring body composition and bone mass and density using multiple low-energy X rays.

skeletal muscle

A muscle that is attached to the bones of the skeleton and provides the force that moves the bones. (voluntary movements)

Heel-to-Shin (Test) (HTS)

A test of lower limb coordination and position sense; the subject places the heel of one foot on the opposite knee and then slides it distally along the skin to the opposite ankle.

facial nerve abnormal findings

Absent or asymmetric facial movement Loss of taste Bell's Palsy

Pathways of the Central Nervous System (CNS)

Ascending Tracts Sensory pathways that allow sensory data to become conscious perceptions Descending Tracts Descending pathways that transmit impulses from the brain to the muscles.

Motor strength

Ask patient to move muscles independently and then against resistance Normal Grade 5/5 and equal bilaterally

R.A.M.

Ask person to touch the thumb to each finger on the same hand starting with index finger Then reverse the direction You are assessing for quickness and accuracy!

Finger-to-Finger Test (Coordination and Skilled Movements)

Ask pt to touch their index finger to their nose and then to your finger. Pt's eyes are open RN should move their finger occasionally to different location Movement should be smooth and accurate

Finger to nose test

Ask the person to close their eyes and to stretch out the arms. Then ask person to touch the tip of their nose with each index finger, alternating hands and increasing speed.

CT scan

Assess bone, ligaments, joints, and axial skeleton when metal is in region of the body and a mri is not possible

Acoustic Neroma/Vestibular Schwannoma

Audiometry: This test presents various levels of sound tones to assess the hearing ability. CT scan: CT scan of the auditory canal is performed to determine the size and location of tumor. Magnetic resonance imaging (MRI): MRI scan of the head is performed to detect the presence of an acoustic tumor.

DTR Muscles

Biceps - bicep contraction & elbow flexion Triceps - extension of elbow Brachioradialis - flexion & supination of forearm Quadriceps/patellar- extension of the lower leg Achilles - plantar flexes against your hand Ankle clonus- no rapid contractions

Facial Nerve (VII)

Both Motor and Sensory M - facial expression, eye blink muscles S - taste, sensation in throat

Vagus nerve X (both)

Both Motor and Sensory M - muscles of phonation & swallowing S - muscles of pharynx

Glossopharyngeal nerve (IX)

Both Motor and Sensory M- pharynx (swallowing) S - tongue & pharynx

Neurological system consists of?

Brain Spinal Cord Complex network of neurons

Balance

CEREBELLAR - gait, balance, coordination

abnormal olfactory findings

Can't smell or ID a smell out of one or both nostrils

synovial joints

Capsule that keeps synovial fluid in the joint, Synovial fluid lubricates and provides nutrients to the joint.

spinothalamic tract

Contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch.

autonomic nervous system (ANS)

Controls involuntary actions, such as the beating of your heart, digestion, metabolism etc. Functions are to maintain and restore internal homeostasis Controls activities of smooth muscles Controls activities of the glands of internal organs and blood vessels Returns sensory information to the brain

Dianostic test of musculoskeletal system

Creatine Phosphokinase (CPK) X-Ray MRI CT DEXA

cerebral angiography

Dye is injected in the femoral arteries to assess cerebral circulation; used to detect stenosis, occlusions or aneurysms.

Trochlear Nerve (IV)

EOMs (inward eye movement) Motor

Kernig's sign

Flex the leg at both hip & knee then extend the knee Pain & increased resistance to extension is suggestive of meningeal irritation Positive Kernig's sign (abnormal)

Different types of joints

Fused, ball and socket, hinge, gliding, plane, and condyloid

Vagus Abnormalities

Gastroesophageal reflux disease Heart failure Failure of respiratory control Gastroparesis: This occurs when damage to a vagus nerve stops food from moving into your intestines from your stomach. This vagal nerve damage can result from diabetes, viral infections, abdominal surgery and scleroderma. Vasovagal syncope: Syncope is another word for fainting

Glossopharyngeal abnormalities

Glossopharyngeal neuralgia (GPN) is a rare condition that can cause sharp, stabbing, or shooting pain in the throat area near the tonsils, the back of the tongue or the middle ear.

Document Reflexes

Grade 0-no response Grade 1+-decreased, less active than normal Grade 2+ - normal usual response Grade 3+ more brisk than normal Grade 4+ Hyperactive, very brisk clonus (rhythmic contractions of the same muscle)

Subjective data for neuro

Headaches Head injury Dizziness/vertigo Seizures Tremors Weakness Altered coordination Numbness or tingling Difficulty swallowing Difficulty speaking Significant past hx Environmental/ occupational hazard

Lumbar puncture-

Insertion of a needle into the subarachnoid space of the vertebrae to withdraw cerebrospinal fluid for analysis, administer medications, or measure pressure of cerebrospinal fluid.

smooth muscle tissue

Involuntary muscle is found in the intestines where it pushes food along the digestive tract. Also found in arteries and veins.

cardiac muscle

Involuntary muscle tissue found only in the heart.

Nonsynovial joints

Joints that have no joint capsule, fibrous connective tissue, or cartilage in the uniting structure.

Behaviorism

LEVEL OF CONSCIOUSNESS FACIAL EXPRESSION SPEECH MOOD & AFFECT

Brain

Largest part of the CNS. Contains grey matter and white matter. Composed of four cavities known as ventricles.

Cerebrum

Largest part of the brain; responsible for voluntary muscular activity, vision, speech, taste, hearing, thought, and memory. Divided into 2 hemispheres Cerebral Cortex Outer covering of the cerebrum Center for humans' highest level of functioning Divided into 4 Lobes Frontal Lobe Parietal Lobe Temporal Lobe Occipital Lobe

Sequence of Neurological Assessment

Level of Consciousness and Mental Status Cranial Nerve Function Motor System Sensory System Reflexes

temporal lobe

Located below the frontal and parietal lobe Main function is interpretation of smell, sound and language. Wernicke's Area Critical for language comprehension.

parietal lobe

Located in the middle part of the brain Main function is to integrate sensory information.

Occipital Lobe

Located in the posterior lower aspect of the brain Main function is to interpret visual stimuli and sense of light.

Brainstem

Located in the posterior part of the brain Connects the cerebrum to the Spinal cord. Functions Central core of the brain Controls involuntary behaviors like breathing, heart rate, coughing, sleep and consciousness. Transmits impulses from spinal cord to brain

Abducens Nerve (VI)

Motor: lateral eye movement

Spinal Accessory (XI)

Motor: turn head, shrug shoulders, some actions for phonation

Abduction

Movement away from the midline of the body

Adduction

Movement toward the midline of the body

Tests for Meningeal Irritation

Nuchal rigidity: Flex neck. Resistance indicates irritation. Kernig's sign: Place patient supine, lift leg and flex knee, then try to extend knee. Positive if resistance/pain with extension Brudzinski's sign: Patient supine, flex neck. Positive if one or both legs flex.

frontal lobe

One of the 4 Lobes In The Cerebral Cortex Located in the Front part of the brain Main function are to control emotions and perform high-level cognitive functions such as reasoning, abstraction and concentration. Broca's Area Critical for motor control of speech.

Superficial reflexes examples

Plantar - plantar flexion of the toes (plantar response), inversion & flexion of the forefoot Abdominal- abd. muscles contract; umbilicus deviates toward stimulated side Cremasteric- scrotum elevates on stimulated side

skeletal system

Protects and supports body organs and provides a framework the muscles use to support movement. Made up of bones and joints

Neurological system is responsible for?

Sending, receiving, and interpreting messages.

Pain sensation test

Sensation testing for pain -Use a paper clip -Person responds with "sharp" or "dull" -Scoring: S+ (correct response), D+, D (wrong one), S, S-, or D- (do not feel stimulus)

Electroencephalogram (EEG)-

Sensors are attached to the head to measure electrical activity of the brain; used to diagnose seizure activity and neurological disorders.

extension

Straightening a joint or increasing the angle between two bones

Magnetic resonance imaging (MRI)-

Structural imaging study, creates a clearer picture of the tissue; used for diagnosing neurological diseases, traumatic brain injury, bleeding, spinal cord injuries and cerebral infarction.

computed tomography (CT)

Structural imaging study; used to diagnose cerebral hemorrhage, abnormal fluid build up, tumors and inflammatory disorders.

autonomic nervous system (ANS) is Composed of 2 Divisions:

Sympathetic Nervous System Controls the excitatory response "fight or flight" Parasympathetic Nervous System Controls visceral functions "rest-and-digest

Short bones of the ankle, foot, and toes

Talus, calcaneus, navicular, cuneiform, cuboid, metatarsal, phalanx

Mini-Cog Test

Test for dementia that asks clients to draw a clock face indicating a particular time

Vibration Test

Testing the persons ability to feel ______ of a tuning fork over the body prominences. Strike the turning fork with the heel of your hand and place it on the person's fingers or great toe. Normal Finding: Feels buzzing sensation on these distal areas, you may assume proximal spots are normal and move on.

Brudzinski

Watch hips & knees as you flex the neck Pain & flexion of hips & knees is abnormal Positive Brudzinki's (abnormal)

spinal cord

a part of the Central Nervous System Primary connection between the brain and the body. Measures approximately 45 cm long Surrounded by cerebral spinal fluid that cushions the vertebrae

Trigeminal nerve abnormalities

absent touch and pain, parasthesia, no blink, weakness of masseter or temporalis muscle

Acoustic nerve abnormalities

acoustic neuroma

A-B-C-T

appearance, behavior, cognition, thought process

light touch test

apply a wisp of cotton to the skin; brush it over the skin in a random order of sites and at irregular intervals; include the arms, forearms, hands, chest, thighs, and legs; ask the person to say "now" or "yes" when touch is felt

Rapid Alternating Movements (RAM)

ask the person to pat the knees with both hands, life tup, turn hands over, and pat knees with the backs of the hands, then faster, usually with equal turning and quick rhythmic pace

X-ray

assess bone and boney structure

magnetic resonance imaging (MRI) for musculoskeletal

assess soft tissue to determine the nature and severity of the injury to the tendons, ligaments, bone, and soft tissue

Dorsiflexion

bending of the foot or the toes upward

plantar flexion

bending of the sole of the foot by curling the toes toward the ground

creatine phosphokinase

blood test used to measure the level of creatine phosphokinase, an enzyme of heart and skeletal muscle released into the blood after muscle injury or necrosis

normal olfactory

can smell and ID the smell

midbrain function

center for cerebral hemisphere and lower brain and as the center for auditory and visual reflexes

3 parts of the brain

cerebrum, cerebellum, brain stem

Positron Emission Tomography (PET)

computer based nuclear medicine imaging study to evaluate the brain's function by evaluating metabolism, blood flow, oxygen use, glucose metabolism and chemical processes within the brain; a dye is injected with radioactive tracers; useful for early detection of dementias, Parkinson's disease and amyotrophic lateral sclerosis (ALS)

Peripheral Nervous System (PNS)

cranial nerves spinal nerves Autonomic nervous system

Optic nerve abnormalities

defect or absent central vision, hemianopsia, absent light reflex, papilledema, optic atrophy, retinal lesions

Hypoglossal abnormal findings

deviates to side, slowed rate of movement

The shaft of a long bone is called

diaphysis

The end of bones is called?

epiphyses

Glasgow Coma Scale (GCS)

eye opening, verbal response, motor response

Abducens nerve abnormalities

failure to move laterally, diplopia on lateral gaze

Trochlear nerve abnormalities

failure to turn eye down or out

Acoustic Nerve (VIII)

hearing and balance (sensory) Whispered words test Weber test Rinne test Ability to hear normal conversation

Joint functions

hold bones together, allow for mobility

Long bones provide the framework for the arm and leg including the?

humerus, Ulna, Tadius, Femur, Tibia, Fibula

superficial reflexes

initiated by gentle cutaneous stimulation

Deep tendon reflexes (DTR)

involuntary muscle contraction in response to striking muscle tendon with reflex hammer; test used to determine whether muscles respond properly

Two or more bones coming together?

joint

Brainstem parts

midbrain, pons, medulla oblongata

mental status assessment tools

mini mental state examination glasgow coma scale

Hypoglossal Nerve (XII)

motor: muscles of the tongue

Pronation

movement that turns the palm down

Supination

movement that turns the palm up

Oculomotor Nerve (III)

narrows pupil and focuses lens Eyelid movement, EOMs, & convergence/accomodation Motor

Mini-Mental State Examination (MMSE)

orientation to time, registration, naming, reading

COGNITIVE FUNCTIONS

orientation, attention span, recent memory, remote memory, new learning, judgement,

5 P's

pain, pallor, pulselessness, paresthesia, paralysis

Short bones of the hand and wrist

phalanges, metacarpals, carpals

appearance

posture, body movements, dress, grooming and hygiene

motor system assessment

posture, gait, muscle tone and strength, coordination and balance

irregular or short bones

provide structure for the ankle, foot, and toes, hands fingers

Elevation

raising a body part superiorly

olfactory

relating to the sense of smell roman numeral I sensory

Pons function

relays message between the cerebrum and the cerebellum contains pneumotaxic center that controls respiratory function

Spinal Accessory abnormalities

results in diminished or absent function of the sternocleidomastoid muscle and upper portion of the trapezius muscle.

Function of skeletal system

support, protection, movement, storage, blood cell production

Cerebellum

the "little brain" at the rear of the brainstem; functions include processing sensory input and coordinating movement output and balance Responsible of movement, speech and senses If cerebellum is damaged, a person experiences problems with balance and coordination.

tactile discrimination

the ability to distinguish relative degrees of roughness and smoothness, for example, on a tooth surface, using an explorer or a periodontal probe, also called tactile sensitivity

The skeleton is divided into two parts

the axial (skull, ribcage, vertebral column) and appendicular skeletal (arms, legs, pelvic girdle) systems.

Thought processes and perceptions

though processes, though content, perceptions, screen for suicidal ideation

Flexion

towards body

medulla oblongata function

transmit information for coordination of head and eyes movement, contains centers for cardiac, digestion, vasomotor, and respiratory system.

Inversion

turning inward

Eversion

turning outward

Optic Nerve (II)

vision (sensory)

Abnormal findings in levels of consciousness

´Alert ´Lethargic (somnolent) ´Obtunded ´Stupor or semi-coma ´Coma ´Acute confusional state (delirium)