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OLFACTORY
what is CN I
OPTIC
what is CN II
OCULOMOTOR
what is CN III
TROCHLEAR
what is CN IV
TRIGEMINAL
what is CN V
ABDUCENS
what is CN VI
FACIAL
what is CN VII
ACOUSTIC / VESTIBULOCOCHLEAR
what is CN VIII
GLOSSOPHARYNGEAL
what is CN IX
VAGUS
what is CN X
SPINAL ACCESSORY
what is CN XI
HYPOGLOSSAL
what is CN XII
Cranial Nerve
III
IV
VI
XI
XII
What are the Motor impulse
Cranial Nerve
I
II
VIII
What are the Sensory impulse
Cranial Nerve
V
VII
IX
X
What are both Sensory/Motor impulse
CN I: Olfactory
Carries smell impulses from nasal mucous membrane to brain
CN II: Optic
Carries visual impulses from eye to brain Visual Acuity, Visual Fields, Fundoscopic Exam
CN III: Oculomotor
Contracts eye muscles to control eye movements (interior lateral, medial, and superior), constricts pupils, and elevates eyelids
CN III: Oculomotor
Cardinal Field of gaze (EOM), eyelid elevation, pupil reaction, doll's eye phenomenon
CN IV: Trochlear
Contracts one eye muscle to control inferomedial eye movement EOM
CN V: Trigeminal
Carries sensory impulses of pain, touch, and temperature from the face to the brain
CN V: Trigeminal
Influences clenching and lateral jaw movements (biting, chewing)
CN V: Trigeminal
Motor: Strength of temporalis and masseter muscles
Sensory: light touch, superficial pain and temperature to face, corneal reflex
CN VI: Abducens
Controls lateral eye movements
CN VII: Facial
Sensory
Taste, anterior 2/3 of tongue Stimulates secretions from salivary glands (submaxillary and sublingual) Stimulates tears from lacrimal glands
CN VII: Facial
Motor
Facial movement Facial expressions (smiling, frowning, closing eyes)
CN VIII: Acoustic / Vestibulocochlear
Contains sensory fibers for hearing and balance
Cochlear
Gross hearing, Weber and Rinne tests
Vestibular
Vertigo, equilibrium, nystagmus
CN VIII: Cochlear
Gross hearing, Weber and Rinne tests
CN VIII: Vestibular
Vertigo, equilibrium, nystagmus
CN IX: Glossopharyngeal
Sensory
Taste, posterior 1/3 of tongue
Sensory fibers of the pharynx that result in the gag reflex when stimulated
CN IX: Glossopharyngeal
Motor
Provides secretory fibers to parotid salivary glands
Promotes swallowing movements
CN X: Vagus
Carries sensations from the throat, larynx, heart, lungs, bronchi, gastrointestinal tract, and abdominal viscera
CN X: Vagus
Promotes swallowing, talking, and production of digestive juices
CN XI: Spinal Accessory
Innervates neck muscles (sternocleidomastoid and trapezius) that promote movement of the shoulders and head rotation
CN XI: Spinal Accessory
Promotes some movement of the larynx
CN XII: Hypoglossal
Innervates tongue muscles that promote the movement of food and talking
optic disc
1.5 mm
round or slightly oval
well-defined margins
creamy pink with paler physiologic cup
Ptosis
drooping of the eyelid
Level of Consciousness
Alert
Lethargic
Stuporous
Comatose
Alert
Follows commands in a timely fashion
Lethargic
Appears drowsy, may drift off to sleep during examination
Stuporous
Requires vigorous stimulation (shaking, shouting) for a response
Comatose
Does not respond appropriately to either verbal or painful stimuli
Glasgow Coma Scale
eye opening response
most appropriate verbal response
most integral motor response (arm)
Eye Opening Response
Spontaneous Opening 4
To Verbal Command 3
To Pain 2
No Response 1
Most Appropriate Verbal Response
Oriented 5
Confused 4
Inappropriate Words 3
Incoherent 2
No Response 1
Most Integral Motor Response (arm)
Obeys Verbal Commands 6
Localized Pain 5
Withdraws From Pain 4
Flexion (decorticate rigidity) 3
Extension (decerebrate rigidity) 2
No Response 1
AGNOSIA
Visual
Tactile
Auditory
ASTEREOGNOSIS
Inability to correctly identify objects
AKINESIA
Complete or partial loss of voluntary muscle movement
APHASIA
Absence or impairment of ability to communicate through speech, writing, or signs
APRAXIA
Inability to carry out learned sequential movements or commands
CIRCUMLOCUTION
Inability to name object verbally, so patient talks around object or uses gesture to define it
DYSARTHRIA
Defective speech; inability to articulate words; impairment of tongue and other muscles needed for speech
DYSPHASIA
Impaired or difficult speech
DYSPHONIA
Difficulty with quality of voice; hoarseness
NEOLOGISMS
Made-up, nonsense, meaningless words
PARAPHRASIA
Loss of ability to use words correctly and coherently; words are jumbled or misused
TREMORS
Involuntary movement of part of body
INTENSION TREMOR
Involuntary movement when attempting coordinated movements
FASCICULATION
Involuntary contraction or twitching of muscle fibers
REFLEXES 0
No response
REFLEXES 1+
Decreased and less active than normal
REFLEXES 2+
Normal usual response
REFLEXES 3+
More brisk or active than normal but not indicative of a disorder
REFLEXES 4+
Hyperactive, very brisk, clonus, abnormal and indicative of a disorder
Brachioradialis Reflex
Flex elbow with palm down
Find the tendon above the radius (usually 2 inch above the wrist)
Strike with the hammer (flat)
Repeat on the other side
Evaluates spinal levels C5 & C6
Biceps Reflex
Partially bend arm at elbow with palm up
Place your thumb over the biceps tendon
Strike your thumb with the pointed side of the reflex hammer
Repeat on the other side
Evaluates the function of spinal levels C5 and C6
Triceps Reflex
Ask client to hang arm freely support it w/ non-dominant hand
Find tendon above the olecranon process
Tap it with the hammer (flat)
Repeat on the other side
Evaluates the function of spinal levels C6, C7, and C8
Patellar Reflex
Both legs hang freely off the side of the examination table
Find the patellar tendon (below patella)
Strike with hammer (flat)
Repeat on the other side
Gently flex the knee and strike the patella (client’s who cannot sit up)
Evaluates the function of spinal levels L2, L3, and L4
Achilles Reflex
Both legs hang freely off the side of the examination table, dorsiflex the foot
Strike the Achilles tendon with hammer (flat)
Repeat on the other side
Flex one knee and support that leg against the other leg, dorsiflex the foot, tap the tendon using the flat side (client’s who cannot sit up)
Evaluates the function of spinal levels S1 and S2
Plantar Reflex
Stroke lateral aspect of the sole from heel to ball of foot
Use the end of the hammer
Repeat on the other side
Evaluates the function of spinal levels L4, L5, S1, and S2
Abdominal Reflex
Lightly stroke the abdomen on each side, above and below the umbilicus
Evaluates the function of spinal levels T8, T9, and T10 with the upper abdominal reflex
Spinal levels T10, T11, and T12 with the lower abdominal reflex
Cremasteric Reflex
Lightly stroke the inner aspect of the upper thigh
Evaluates the function of spinal levels T12, L1, and L2
Test for MENINGEAL IRRITATION
Supine
Place hands behind the patient’s head and flex the neck forward until the chin touches the chest
Brudzinski’s Sign
As you flex the neck watch the clients hips and knees in reaction to your maneuver
Kernig’s Sign
Flex the client’s leg at both hip and the knee, then straighten the knee