Neurologic Assignment - Health Data

Frontal Lobe

Directs voluntary, skeletal action (Left side of the lobe controls the right side of the body). Also influences communication (talking and writing), emotions, intellect, reasoning ability, judgment, and behavior. Contains Broca area, which is responsible for speech.

Parietal Lobe

Interprets tactile sensations, including touch, pain, temperature, shapes, and two-point discrimination.

Occipital Lobe

Influences the ability to read with understanding and is the primary visual receptor center.

Temporal Lobe

recieves and interprets impulses from the ear. Contains Wernickle area, which is responsible for interpreting auditory stimuli.

How to Assess Muscles

Assess condition and movement of the muscles.

Assess the size and symmetry of all muscle groups.

Assess the strength and tone of all muscle groups.

Normal Findings, muscles.

Muscles are fully developed and symmetric in size (bilateral sides may vary 1 cm from each other).

Relaxed muscles contract voluntarily and show mild, smooth resistance to passive movement.

All muscle groups are equally strong agist resistance, without flaccidity, spasticity, or rigidity.

How to assess Movements

Note any unusual involuntary movements, such as fasciculations (irregular movements on the surface of the muscle), tics, or tremors

Normal Findings, Movements

No fasciculations, tics, or tremors are noted.

How to assess Gait and Balance

Ask the client to walk naturally across the room. Note posture, freedom of movement, symmetry, rhythm, and balance. (its best to observe gait when the client is not aware you are assessing their gait.)

Normal Findings, Gait and Balance

Gait is steady, opposite arm swings. Client maintains balance with tandem walking. Walks on hells and toes with little to no difficulty.

How to preform the Romberg Test

ask the client to stand erect with arms at the side and feet together. Note any unsteadiness or swaying. Then with the client in the same position, ask the client to close their eyes for 20 seconds. Again, note any imbalances or swaying. Then ask the client to stand on one foot and to bend the knee of the leg the client is standing on. Ask the client to hop on that foot. Repeat on the other foot.

Normal findings, Romberg Test

Client stand erect with minimal swaying, with eyes open and closed. Bends knee while standing on one foot; hops on each foot without losing balance.

How to assess Coordination

Demostrate the finger-to-nose test to assess accuracy of movements, then ask the client to extend and hold arms out to the side with eyes open. Instruct the client to “touch the tip of your nose first with your index finger. then with your left index finger. repeat this three times.” Next, ask the client to repeat these movements with eyes closed.

Normal findings, Coordination.

Client touches finger to nose with smooth, accurate movements, with little hesitation.

How to assess for Rapid Alternating Movements

have the client sit down. First, ask the client to touch each finger to the thumb and to increase the speed as the client progresses. Repeat with the other side. Next, ask the client to put the palms of both hands down on both legs, then turn the palms up, and then down again. ask the clients to increase the speed. Lastly, preform the heel-to-shin test; ask the client to lie down (supine position) and to slide the heel of the right foot down the left shin.

Normal Findings, Rapid Alternating Movements

Client touches each finger to the thumb rapidly, client rapidly turns palms up and down, and client can run each heel smoothly down each shin.

how to assess Light touch, pain, and temperature

ask clients to chose both eyes and tell you what they fell and where they feel it. Scatter stimuli over the distal and proximal parts of all extremities and the trunk to cover most of the dermatomes. It is not necessary to cover the entire body surface unless you identify abnormal symptoms such as pain, numbness, or tingling.

-to test light touch: use a wisp of cotton to touch the client

-to test pain sensation- use the blunt and sharp ends of a paper clip

-to test temperature sensation- use test tubes filled with hot and cold water.

Normal findings, light touch, pain, and temperature

client correctly identifies light touch. client correctly differentiates between dull and sharp sensations and hot and cold temperatures over various body parts.

how to assess Vibratory

strike a low-pitched tuning fork on the heel of your hand and hold the base on the distal radius, forefinger tips, medial malleolus, and the last tip of the great toe. ask the client to indication what they feel. Repeat on the other side.

Normal findings, Vibratory

Client correctly identifies sensation.

How to assess Position

ask the client to close both eyes. Then hold the clients toe or finger on the lateral sides and move it up or down. Ask the client to tell you the direction it is moved. Repeat on the other side.

Normal Findings, Position

Correctly identifies directions of movements.

How to assess tactile discrimination (fine touch)

Remember that the client should have eyes closed. To test stereognosis, place a familiar object such as a quarter, paper clips, or a key in the clients hand and ask the client to identify it. repeat with another object in the other hand.

Normal Findings, tactile discrimination (fine touch)

Correctly identifies object.

how to assess Point localization

Briefly touch the client and ask the client to identify the points touched.

Normal findings, Point localization

correctly identified areas touched.

How to assess Graphesthesia

use a blunt instrument to write a number, such as 2,3, or 5, on the palm of the clients hand. ask the client to identify the number. repeat with another on the other hand.

Normal Findings, Graphesthesia

Correctly identifies number written.

Eye Tic

Tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Causes include Tourette syndrome and drugs such as phenothiazines and amphetamines.

Choreiform movements of the hand

Choreiform movements are brief, rapid, jerky, irregular, and unpredictable. They occur at risk or interrupt normal coordinate movements. unlike Tics, they seldom repeat themselves. The face, head, lower arms, and hands are often involved. Causes include Sydenham chorea (with rheumatic fever) and huntington disease.

Resting (static) tremors

These tremors are most prominent at rest and may decrease or disappear with voluntary movement.

Postural Tremor

These tremors appear when the affected part is actively maintaining a posture. examples include the fine, rapid tremor of hyperthyroidism, the tremors of anxiety and fatigue, and benign essential (and sometimes familial) tremor. Tremor may worsen somewhat with intention.

Intention tremor of a pointed finger

Intention tremors, absent at rest, appear with activity and often get worse as the target is neared. Causes include disorders of cerebellar pathways, as in MS.

Athetosis

Athetoid movements are slower, more twisting and writing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Athetosis is often associated with spasticity. Causes include cerebral palsy.

Cerebellar Ataxia

Wide-based, staggering, unsteady gait. Romberg test results are positive (client cannot stand with feet together). Seen with cerebellar diseases or alcohol or drug intoxication.

Parkinsonian Gait

shuffling gait, turns accomplished in very stiff manner. Stooped-over posture with flexed hips and knees. Typically seen in Parkinson disease and drug-induced parkinsonian because of effects on the basal ganglia.

Scissors Gait

Stiff, short gait; thighs overlap each other with each step. seen with partial paralysis of the legs.

Spastic Hemiparesis

Flexed arm held close to body while client drags toe of leg or circles it stiffly outward and forward. Seen with lesions of the upper motor neurons in the cortical spinal tract, such as occurs in stroke.

Footdrop

Client lifts foot and knee high with each step, then slaps the foot down hard on the ground. Client cannot walk on heels. Characteristic of diseases of the lower motor neurons.