Other CNS exams

Includes coordination, stance and gait, deep tendon reflexes

How is the rebound phenomenon for coordination test?

Ask patient so trench arms out in front and hold position, push wrist quickly do wards and observe returning movement

What is the finger-nose test for coordination?

Ask patient to touch nose with tip of forefinger then reach out to touch your fingertip and hold within patients arms reach, ask patient to repeat as quickly as possible

How can you make the finger nose test more sensitive?

Move target just as patients finger leaves nose

What position must the patient be in for the heel-shin test?

Supine/lying on back and facing up

What is the heel-shin test for coordination?

Ask patient to raise one leg and place heel on opposite knee, then slide heel up and down the skin between knee and ankle

What is the rapid-alternating movement test for coordination?

Demonstrate repeatedly patting palm of 1 hand with palm and back of other hand as quickly/regularly as possible, ask patient to copy and repeat

How can patients stance be assessed?

Ask patient to stand up straight, feet close together and eyes open

What does swaying/lurching when assessing gait suggest?

Cerebellum problem

What is the Rombergs test for stance?

Ask patient to close eyes and repeatedly falling is positive and indicates sensory ataxia

How is gait assessed?

Ask patent to walk 10metres, turn and return and record time taken, arm swing, stride length, steadiness, limping or other issues

Why is tandem gait assessed for gait?

Walking heel to toe in straight line emphasises gait instability

What are some general considerations for deep tendon reflexes?

always compare 1 side to another, let hammer fall by gravity, don’t keep hammering if there is no response

How is the supinator/brachioradialis assessed?

Find radial nodule and go 2-3 nodule above that, hold patients elbow at 90 degrees, hand should be pronated (thumb in arc of flexion) and resting on pelvis, hammer falls on distal end of radius

What is the biceps deep tendon reflex test?

Patients elbow still at 90 degrees, relaxed, testers finger placed over bicep tendon and hammer falls on testers finger

How is the triceps tested when seated?

Tell patient to hold arm crossed over onto chest and hammer is held vertically, with mallet at bottom and swung into triceps tendon

How is the triceps tested when supine?

Tell patient to hold arm crossed over onto chest and hammer held with testers hand over hip and mallet at elbow, swung into triceps tendon

How are the fingers reflexes tested?

Tell patient to hold their hand palm up, slightly flexed fingers, testers finger pads are placed over patients finger pads and hammer taps the testers fingers

What is a supine test for knee reflexes?

Tester lifts both knees with one arm, flexing legs slightly and hammer falls on patellar tendon

What is the seated test for the knees reflex?

Tell patient to cross their legs, leg being tested must not touch floor, tester holds hammer with mallet at bottom and lets it swing into patellar tendon

What is the supine, heel on shin method to test ankle reflexes?

Tell patient to place heel on opposite shin, if tester standing on R side of patient, tester holds hammer in left hand and grasps end of foot with right hand to maintain foot angle and swings to tap Achilles tendon

What is the patient kneeling on bed method for ankle reflexes?

Patients right ankle and knee joint at 90 degrees, with leg resting on bed, from right side of best, tester holds right foot and index finger over tibialis anterior tendon, ensure foot is relaxed enough, thumb wrapped underneath, swing to tap Achilles tendon, move to end of bed and repeat for left leg

What is the patient kneeling on bed method for ankle reflexes?

Patient kneels on bed with feet dangling over edge of bed, making ankle/knee 90 degrees, tester grasps end of foot being tested to stabilise, patellar hammer with mallet at bottom and taps Achilles tendon

How do you test for plantar reflex?

Tell patient what you’re going to do, patient must be barefoot, use key to stroke from heel, up lateral sole then medically across to ball of foot, normal response is flexion of big toe