NEUROLOGICAL-AND-SPECIAL-ASSESSMENT

Romberg’s test

Test for equilibrium.

→ Patient stands with feet together, arms at side and eyes open then with eyes closed for 20 seconds

Coordination tests

Standing and hopping on 1 foot

• Finger to nose test

• Walk on heel to toe

Antalgic Limp

Patient limits the time of weight bearing on the affected leg to limit pain.

Tabetic Gait

Legs are positioned far apart lifted high and forcibly brought down with each step, the heel stamps on the ground

Sensation tests: • Stereognosis

→ With eyes closed. Ability to recognize solid object by touch

Sensation tests: • Graphesthesia

→ Ability to recognize writing on the skin purely by the sensation of touch

Increased ICP assessment: Manifestations: Decorticate posture

→ Pressure exerted in Midbrain

Increased ICP assessment: Manifestations: Decerebrate posture

→ Pressure on Upper pons

Nudge test

• Assesses risk of falling backward.

• Stand behind the client and put your arms around the client while you gently nudge the sternum.

Tinel’s sign

→ Elicited by tapping over the medial nerve (+) if with Tingling sensation

Phalen’s sign

→ Allow wrist to fall freely into maximum flexion and maintain the position for longer than 60 seconds.

→ (+) tingling sensation in the distribution of median nerve

Polydactyly

Extra finger

Syndactyly

Fused fingers

Swan Neck Deformity

Joint at the base of the finger bends in (flexes), the middle joint straightens out (extends)

Boutonniere deformity

Middle finger joint is bent in a fixed position inward (toward the palm) and the outermost finger joint is bent excessively outward (away from the palm).

Heberden’s node

Distal interphalangeal Swollen and tender and deformed joints

Bouchard’s node

Proximal interphalangeal Swollen and tender and deformed joints

Foot Drop

• Problem: Peroneal nerve

• Inability to lift front part of the foot

Kernig’s sign

→ Extend the leg while you keep the hip flexed

→ Pain and spasm in hamstring muscle and resists further extension

Nuchal rigidity

→ Passively flex the patient’s neck and touch his chin to the chest.

Brudzinski sign

→ Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Akinesia

Loss of voluntary movements

Aphasia

“Dysphasia”, Impaired ability to communication

Broca’s

> Frontal lobe damage

> Frequently speak in short phrases that makes sense but are produced with great efforts

> Patient: “walk dog”

> Appropriate: I will walk the dog

Global

> Extensive damage in the language center

> Limited ability to speak and comprehend language

Wernicke’s

> Left temporal lobe damage

> Speaks in long sentences with no meaning

> “jargon speech”

> E.g. You know the smoodle pinkered and that I want to get him round and take care of him.

Homonymous hemianopsia

→ Spatial perceptual problem

→ Blindness occurs in same half of the visual field of both eyes

Agnosia

→ Inability to recognize an object by sight, touch or hearing.

Other symptoms (CVA):

• Facial drooping

• Pupils unequal in size

• Sudden paralysis

• Paronchyia

Apraxia

→ Inability to carry out learned sequential movements on command

Micrographia

– Small, cramped handwriting

– Reduced arm swing on the affected side

Hypomimia

– Loss of facial expression due to rigidity of facial muscles

– “Masked like face”

Spinal Cord Injury Assessment:

• Diagnostics: X-ray, CT-Scan and MRI

Deep Tendon Reflex:

Assess integrity of Spinal Reflex (Sensory and Motor component).

Deep Tendon Reflex: Areflexia

0 → absent

Deep Tendon Reflex: Hyporeflexia

1 → Diminished

Deep Tendon Reflex: Normal

2 → Average

Deep Tendon Reflex: Brisk

3 → Exaggerated

Deep Tendon Reflex: Hypereflexia

4 → Clonus, Very brisk