UQ Neuro Screen

UQ Dermatomes

C2-T1, pt sitting at edge of table, eyes closed

C2 dermatome

Suboccipital

C3 dermatome

Supraclavicular fossa

C4 dermatome

Upper trapezius

C5 dermatome

lateral antecubital fossa

C6 dermatome

Dorsal/palmar surface of thumb

C7 dermatome

Dorsal/palmar surface of 3rd digit

C8 dermatome

Dorsal/palmar surface of 5th digit

T1 dermatome

Medial antecubital fossa

How to document dermatomes

Intact, diminished, or absent

UQ myotomes

C1-T1, pt sitting at edge of table, test for 5 sec

C1 myotome

Cervical flexion
"tuck chin in"
push on pt's forehead

C2 myotome

cervical extension
"lift chin up"
push on posterior skull

C3 myotome

cervical side flexion
"bend your neck to the side"

C4 myotome

shoulder elevation
"shrug your shoulders"

C5 myotome

shoulder abduction
"raise your arms to the side"

C5-C6 myotomes

Elbow flexion
"bend your elbow"

C6 myotome

wrist extension

C7 myotome

elbow extension
"straighten your elbow"

C8 myotome

Finger flexion and thumb abduction

T1 myotome

finger abduction
"spread your fingers"

How to document myotomes

Intact, diminished, or absent

Reflex testing-DTR grading

0(R) no response even with reinforcements; always abnormal
0 no response; always abnormal
1+R slight but definitely present response even with reinforcement
1+ slight but definitely present response; may or may not be abnormal
2+ brisk response, normal
3+ very brisk response; may or may not be abnormal
4+ extremely brisk response with repeating reflex(clonus); always abnormal

C5 reflex

Biceps
pt position: sitting at edge of table, elbow flexed, arm supported

C6 reflex

brachioradialis
pt position: sitting at edge of table, elbow flexed to 90º, thumb pointing up

C7 reflex

Triceps
pt position: sitting at edge of table, upper arm supported at or near shoulder height in slight abduction and extension

Pathological reflexes

Clonus
Babinski
Hoffman's sign
Oppenheim

Clonus

Pt position: supine or sitting
place ankle in max plantarflexion, apply quick stretch into dorsiflexion
+ cyclical, spasmodic alternation of muscular contraction and relaxation
document number of beats or time needed for clonus to stop

Babinski

Pt position: supine or sitting
use fingernail or reflex hammer to stroke lateral aspect of plantar surface of foot and move medially across base of toes
+ extension and dorsiflexion of big toe with fanning of four lateral toes

Hoffman's sign

Pt position: supine or sitting
hold pt's hand and flick the distal phalanx of third finger on dorsal side, test bilaterally
+ flexion of thumb and/or index finger

Light touch

Purpose: to assess nerve integrity in response to light touch stimulation to the impaired area
Have patient say or point to where they feel the touch
closed eyes for involved side, can be open for non involved side
document as intact(5/5), impaired(1-4/5) or absent(0/5)

Pin Prick aka Pain: sharp/dull test

Purpose: to assess the nerve integrity in cortical nerve pathways in response to sharp/dull stimulation to the impaired area
have pt close their eyes and state if they feel sharp or dull when touched
document as intact(5/5), impaired(3-4/5 or 5/5 correct but reports feeling is "different" or absent(0-2/5)

Pain Pressure Threshold Assessment

Purpose: to assess for signs of central sensitization
place algometer on pt perpendicularly to area with most pain, apply gradual pressure
document location and measured amount of pressure applied prior to pain, compare bilaterally

Monofilament aka Protective Sensation

Purpose: to assess the ability to detect touch from monofilaments of various sizes
apply filament perpendicular to pt's skin with enough pressure for the filament to bow, maintain pressure for 1 sec, pt says "yes" when stimulus is felt; touch 3x per sensory site once without actually touching skin
document 2-intact(5/5), 1-impaired(1-4/5) or absent(0/5)

Hot: Cold aka Temperature

Purpose: to assess the ability to perceive the difference between hot and cold stimuli
pt's eyes closed place hot or cold test tube on uninvolved extremity and repeat for suspected areas with pt identifying stimulus as hot or cold
document as intact(5/5), impaired(3-4/5) or absent(0-2/5)

Vibration

Purpose: to assess the ability to detect vibration
demonstrate vibration in area of intact sensation, instruct pt to say when they feel a vibration and when it stops, eyes closed for affected side
document as normal:intact(5/5), impaired(3-4/5) or absent(0-2/5)

Proprioception aka Joint position

Purpose: to assess the nerve integrity of cortical pathways that identify joint position sense about each joint of the upper extremity
have pt close eyes and identify which direction their body part is moving by verbally responding or matching position with unaffected extremity
document as normal:intact(5/5), impaired(3-4/5) or absent(0-2/5)

Kinesthesia

Purpose: to assess the ability to detect movement in space
With pt's eyes closed passively move involved extremity and ask pt to match movement by actively moving uninvolved extremity
document as normal: intact(5/5), impaired(3-4/5) or absent(0-2/5)

Two point discrimination aka discriminative sensation

Purpose: to assess the ability to identify 1 or 2 points of stimulus presented simultaneously
have pt close eyes and alternate 1 and 2 point stimuli in random order to area being tested, pt should respond "one" or "two" based on stimulus they feel; start with 4mm and widen if pt can't distinguish
document as 2-intact(5/5), 1-impaired(0-4/5) or 0-absent(inability to feel anything)

Stereognosis

Purpose: to assess the ability to perceive and integrate a variety of sensory modalities and to interpret the stimuli to identify small objects placed in their hands
with pt's eyes closed place various objects in involved hand one at a time asking pt to identify each object, repeat at least 5 times
document as normal:intact(5/5), impaired(3-4/5) or absent (0-2/5)

Graphesthesia (part of discriminative sensation group)

Purpose: to assess the ability to use sensory input to identify a number or letter drawn onto the hand while vision is occluded
with pt's eyes closed draw a letter or number in their hand and ask them to identify each stimulus, repeat 3-5 times
document as intact(5/5), impaired(3-4/5) or absent(0-2/5)

Extinction (part of discriminative sensation group)

Purpose: to asses the ability to identify a double simultaneous stimulation
with pt's eyes closed touch with fine-tipped pencil on either right left or both sides simultaneously and ask them to identify left, right, or both
Document as normal:intact(5/5), impaired(3-4/5) or absent(0-2/5)