neurologic physical exam

sensation/dermatomes, sensory integration, proprioception, coordination

what are the sensory components of a neurologic exam?

strength/myotomes

reflexes

tone

functional mobility

what are the motor components of a neurologic exam

diagnosis and reason for therapy

medical history

PLF, current level of function

what are considerations for a neurologic exam

allows us to control and adjust movement in response to the environment

injury prevention and minimization

what is the purpose of the somatosensory system?

somatosensory cortex, thalamus, tracts, receptors

what are the components of the somatosensory system?

muscles, joints, skin

where are the receptors for the somatosensory system

posterior afferent/sensory tracts

anterior: efferent/motor tracts

in the spinal cord the grey matter is central, what types of neurons are in the posterior horn? anterior?

nerve axons that make up the tracts

what is in the white matter in the spinal cord

the most proximal part of the PNS that connects to the SC

what is the nerve root?

higher levels of the CNS

where do most of the somatosensory tracts end?

proprioception, two pt discrimination, vibration, crude touch

what senses does the DCML sense?

1: cell body in DRG to the dorsal column

2: cell body in the dorsal column, ascends in the spinal cord, crosses in the closed medulla, to the thalamus

3: thalamus to the somatosensory cortex

what is the 1st, 2nd, and 3rd order neuron in the DCML

ipsilaterally

information from the DCML travels __________________ through the spinal cord and crosses in the closed medulla

spinothalamic tract

which tract of the ALS can we asses?

pain, temperature, crude touch, tickle, itch, sexual sensations

what modalities does the STT sense

1st: cell body in the DRG enters the SC and synapses in the dorsal horn

2nd: cell body in the dorsal horn crosses in the spinal cord to the opposite side and ascends to the thalamus

3rd: cell body in the thalamus to the cortex

what is the 1st, 2nd, and 3rd order neurons for the STT

contralaterally

information from the STT ascends through the spinal cord _______________________ in the anterolateral column

area of skin innervated by a single afferent neuron

what is a receptive field?

area of skin innervated by the axons of a single spinal dorsal root

what is a dermatome

light touch, sharp/dull, temperature

in what ways are dermatomes tested?

absent, diminished, normal, hypersensitive

how are dermatomes graded?

to determine the pt ability to percieve or integrate stimuli

what is the purpose of the somatosensory exam?

clean equipment

remove clothes and jewelry

drape

explain test

what is the procedure for a somatosensory exam?

light touch, pressure sense, sharp/dull, temperature, vibration

what can be done when testing for sensation?

posture, muscle tone, muscel bulk, tremors, muscle fasciculations

what can be observed when taking a history?

DCML

what tract is being assessed with light touch?

side to side

what should be compared when testing light touch?

work through the remainder of the dermatome having the pt indicate differences

what should be done where deficits are seen with light touch

STT/ALS

what tract is being assessed with pressure sense?

enough to indent the skin and stimulate deep receptors

when testing pressure sense, how firm should the pressure be?

STT

what tract is being assessed with sharp/dull testing?

ALS

what tract is being assessed with hot/cold testing?

vials with hot or cold water

what tool should be used for thermal sensation testing?

imply

it is important to not ____________ differences

DCML

what tract is being assessed when testing for vibration

over bony prominences

where should vibration be assessed?

latral malleoli, tibia, ankles/wrists, styloids, tuberosities

what are the bony prominences tested for vibration?

stopping the vibration before making contact with the pt

when testing vibration, what is a sham test

two pt discrimination

stereognosis

what tests can be done when testing sensory integration

organizing and interpreting sensory information in a meaningful way

sensory integration is...

cerebral cortex function

what does sensory integration require?

in areas that the pt has sensory function

where should sensory integration be performed?

DCML

what tract is being assessed when testing 2 pt discrimination

the palm/fingers will be better compared to larger body regions

normal distances of 2 pt discrimination vary between body parts, what parts of the body will have better 2 pt discrimination?

the pts ability to identify objects with their eyes closed

when testing stereognosis, what are we testing?

the affected side

which side is tested first when testing stereognosis

position sense, passive motion test, functional observation

what are the tests for proprioception

awareness of body position and movement without effort while performing tasks

what is unconscious proprioception

being aware of the body positions and movements

what is conscious proprioception

DCML

what tract is being assessed during proprioceptive testing

over a bony prominence

when testing position sense, where do you hold the pts limb?

relative to the previous

when testing position sense, we are asking the pt to identify their new position...

at least 6 movements, or may record a number out of 10

how many movements should be performed? how much should it be scored out of?

>3 incorrect responses

how many times can a pt get position sense wrong before their sense is thought to be impaired?

have their eyes closed and mimic the position of the extremity the PT is moving

what should the pt do during a passive motion sense test?

bed mobility, transfers, standing, gait, balance, stairs, squats jumping

what tasks are observed when observing functional movements

strength, reflexes, PROM, coordination

what things can be examined for a motor system examination

voluntary movement, reflexes and rhythmic movement patterns

healthy motor control includes

sensory

motor control has constant ______________ input

voluntary movement

what is the function of the CST

distal musculature

the lateral CST innervates....

axial muscles

the ventral CST innervates...

precise, voluntary motor control

what is the pyramidal system (CST) responsible for

posture, muscle tone, and smooth movements

what is the extrapyramidal system responsible for

weakness, disuse, no fasciculations, increased reflexes, increased spasticity and tone

what are UMN signs?

denervation atrophy, fasciculations, decreased reflexes, decreased tone

what are LMN signs

stroke, tumors, genetic disease, MS, ALS

what conditions can cause UMN signs

nerve root impingement, neuropathy, polio, west nile virus, ALS

what conditions can cause LMN signs

weakness, slowness, loss of dexterity, fatigability

what are UMN negative signs

proprioceptive and cutaneous

what are the types UMN positive signs

clasp-knife, exaggerated DTR, clonus

what are the proprioceptive reflexes?

flexor withdrawal, spasms, babinski response

what are the cutaneous reflexes

what is a myotome

myotomes

what is used to test strength?

they maintain homeostasis, carry out automatic actions, maintain balance and posture

what is the purpose of physiological reflexes?

it determines if the reflex arc is in tact

what is the purpose of testing DTRs

sensory neuron, interneuron, motor neuron

what are the reflex components

UMN lesion

what does a positive babinski response indicate?

fanning of the toes and extension of the big toe in response to the stimulus

what is a positive babinski sign

flexion/adduction of the thumb and flexion of the index finger in response to a flick on the 3rd DIP joint

what is the hoffmans sign

CST

a positive hoffmans sign is suggestive of what type of dysfunction

continuous passive partial contraction

it ensures stability and readiness for movement

what does muscle tone involve? what does it ensure

cortical modulation, chemical gradients within muscle, spinal control, mechanical properties of muscle or CT

what influences tone

decreased or absent muscle tone, no resistance to passive motion, absent reflexes

what is hypotonicity?

LMN and acute UMN

what type of injuries cause hypotonicity

abnormal increased resistance to passive stretch

what is hypertonicity

spasticity and rigidity

what are the types of hypertonicity

UMN and basal ganglia

what types of disorders are characterized by hypertonicity

resistance dependent on velocity

what is spasticity dependent on?

involuntary resistance to passive stretch in all directions not dependent on velocity

what characterizes rigidity

unwanted activity of antagonistic muscle group during voluntary agnostic movements

what is spastic co-contraction

alternating spasmodic contraction and relaxation in response to a sustained stretch of a spastic muscle

what is clonus

following an UMN injury

when are abnormal synergy patterns noted?

moving joints at a random or continuous rate looking for hypertonicity or hypotonicity

what is passive motion testing?

the modified ashworth scale

what is used to grade passive motion when testing for spasticity

putting a muscle into maximal shortened position and stretching over the span of 1 second

how do we test for spasticity

sensory, motor, and central processing

what needs to be integrated for coordination

decreased accuracy, smoothness or control of motion

what is ataxia

difficulty judging distance and direction of a movement usually resulting in straying from the intended path

what is dysmetria

inability to perform alternating movements

what is dysdiadochokinesia