NEURO EX IN PT Part 1

S1L1

Components of: NEURO 1

• CEREBRUM

• CN

• CEREBELLUM

Components of: NEURO 2

• SENSORY TESTING

• REFLEXES

Components of CEREBRUM EXAM

• MENTAL STATUS EXAMINATION

• COMMUNICATION

• BODY SCHEME

• PRAXIS

Components of a mental status examination

LOMA

• Arousal (Level of consciousness)

• Orientation

• Memory

• Attention and concentration span

4 Levels of consciousness

• COMA

• STUPOR

• OBTUNDED

• LETHARGIC

• ALERT

No response to any kind of stimuli

COMA (DEEP COMA)

Respond to painful stimuli (no response to loud sound)

STUPOR (SEMI-COMA)

Respond to loud voice and painful stimuli

OBTUNDED

Respond to loud voice only

OBTUNDED

Sleeps when not stimulated, drowsy and inattentive (responds to normal voice)

LETHARGIC

Aware of his environment

ALERT

Defined as awareness of person, place, time, situation

ORIENTATION

Considered to be the online or in-the-moment memory

WORKING / INTERMEDIATE

Involves testing a set of ideas registered with the patient, specifically queries by the examiner after several minutes of delay

SHORT-TERM

Can either represent a more prolonged delay in testing response to the task of

recollection or, in some other tasks, may instead represent long-term general or

autobiographical knowledge.

LONG-TERM

Test for intermediate memory

Say 3-5 common words/letters/numbers then ask pt to repeat

Test for short-term memory

Tell a short story then ask pt to repeat 3-5 words mentioned before

Test for long-term memory

Ask questions about pt

Ability to attend and focus on specific tasks in real-time

ATTENTION AND CONCENTRATION SPAN

Able to stack cups for 5/5 trials (attention)

3 concentration tests

• SERIAL

• REVERSE

• SPELLING

Communication examination

• COMPONENTS OF LANGUAGE

• EXAMINATION OF APHASIA

Components of Language

FPRNCRW

• Fluency

• Prosody

• Repetition

• Naming

• Comprehension

• Reading

• Writing

Ability of one individual to express him/herself w/o any hesitation; quality of speech

FLUENCY

Ability to differentiate declaration to interrogative; question VS command

PROSODY

Ability to repeat the words

REPETITION

Ability to understand or follow instructions

COMPREHENSION

Ability to identify objects

NAMING

Main components of language that are assessed by PTs

FCR

• FLUENCY

• COMPREHENSION

• REPETITION

TYPES OF SENSORY APHASIA

ACTIVe

• ANOMIA

• CONDUCTION

• TRANSCORTICAL SENSORY

• WERNICKE’S

TYPES OF MOTOR APHASIA

Tong si Broca Mamayang Gabi

• TRANSCORTICAL MOTOR

• BROCA’S

• MIXED TRANSCORTICAL

• GLOBAL

[what type of aphasia?]

i am fluent in speaking, can comprehend commands, and can repeat words.

ANOMIA

[what type of aphasia?]

i am fluent in speaking, can comprehend commands, but can’t repeat words.

CONDUCTION

[what type of aphasia?]

I am fluent in speaking and can repeat words, but I can’t comprehend commands.

TRANSCORTICAL SENSORY

[what type of aphasia?]

I am fluent in speaking, but I can’t repeat words and comprehend commands.

WERNICKE’S

[what type of aphasia?]

I can comprehend commands and can repeat words, but I am not fluent in speaking.

TRANSCORTICAL MOTOR

[what type of aphasia?]

I can comprehend commands, but I am not fluent in speaking and can’t repeat words.

BROCA’S

[what type of aphasia?]

I can repeat words, but I am not fluent in speaking and can’t comprehend commands.

MIXED TRANSCORTICAL

[what type of aphasia?]

I am not fluent in speaking, can’t comprehend commands, and can’t repeat words.

GLOBAL

[what type of body scheme (perceptual deficit)?]

Inability to register and integrate stimuli and perceptions from one side of the body.

Aware of the affectation (they don’t deny it), but sometimes they forget about it

UNILATERAL NEGLECT TESTING

Neglect of environment

HEMISPACE

Neglect of BODY

BODY NEGLECT

[what type of body scheme (perceptual deficit)?]

Denial and lack of awareness of the presence or severity of one’s paralysis.

ANOSOGNOSIA

Testing precedure for UNT

Observing the performance and changes in patients’ responses during basic activities of daily living, such as bed mobility, or instrumental activities of daily living, such as pushing a chair.

Testing precedure for ANOSOGNOSIA

The patient is asked what happened to his/her arm or leg, whether he or she is paralyzed, how the limb feels, and why it cannot be moved.

[what type of body scheme (perceptual deficit)?]

Lack of awareness of the body structure and the relationship of body parts to oneself or to Others.

SOMATOAGNOSIA

[what type of body scheme (perceptual deficit)?]

Ability to identify the right and left sides of one’s own body.

RIGHT AND LEFT DISCRIIMINATION

[what type of body scheme (perceptual deficit)?]

Ability to visually distinguish a figure from the background in which it is embedded.

FIGURE-GROUND DISCRIMINATION

Testing procedure for SOMATOAGNOSIA

The patient is requested to point to body parts named by the therapists, on himself or herself, on the therapist, and on a picture of a human figure.

Testing procedure for R & L DISCRIMINATION

The patient is asked to point to body parts on command, such as the right ear, left foot, right arm, and so forth.

Tip: ask muna the part without laterality (somatoagnosia) then ask a part with laterality (R&L discrimination)

Testing procedure for FIGURE-GROUND DISCRIMINATION

Function-Based Test: A white towel can be placed on a white sheet, and the patient is asked to find the towel.

[what type of body scheme (perceptual deficit)?]

Ability to accurately judge the direction, distance, and depth

DEPTH AND DISTANCE PERCEPTION

[what type of body scheme (perceptual deficit)?]

Ability to perceive the relationship of one object in space to another object or oneself.

SPATIAL RELATIONS

[what type of body scheme (perceptual deficit)?]

Ability to perceive what is vertical.

VERTICAL ORIENTATIONS

[what type of body scheme (perceptual deficit)?]

Ability to understand and remember the relationship of one location to another.

TOPOGRAPHICAL ORIENTATION

Testing procedure for DEPTH AND DISTANCE PERCEPTION

For Depth Perception

• The patient can be asked to fill a glass of water.

For Distance Perception

• The patient is asked to take or grasp an object on a table. The object may also be held in front of the patient, in the air, and the patient is again asked to grasp it.

Testing procedure for SPATIAL RELATIONS

• The patient is asked to get the object that is in the “front,” “back,” or “top” of another object.

• To can use the following functional outcome measure tools to test spatial relation:

• Rivermead Perceptual Assessment Battery or Arnedotirr OT-ADL Neurobehavioural Evaluation (A-ONE)

Testing procedurefor VERTICAL ORIENTATION

The therapist holds a cane vertically and then turns it sideways to a horizontal plane. The patient is handed the cane and asked to return it to its original position.

Testing procedure for TOPOGRAPHICAL ORIENTATION

The patient is asked to describe or draw a familiar route.

Ability to perform skilled actions

PRAXIS

3 types of apraxia

AII

• APRAXIA

• IDEOMOTOR APRAXIA

• IDEATIONAL APRAXIA

Even with intact sensation, strength and coordination, the pt cannot perform skilled actions

APRAXIA

Upon commandment, the pt cannot perform the action but eventually does it later

E.g. Asking the patient to comb their hair but the patient did not do the action. 

They cannot do the action upon command but they will still do the action afterwards.

IDEOMOTOR APRAXIA

Even with/without command or instruction they cannot do the action.

Inability to understand the purpose of an object or manipulate it.

IDEATIONAL APRAXIA

Testing procedures for PRAXIS

Testing for praxis comprises universally known movements such as brushing teeth, combing hair, shaving, standing up, etc. Ask the patient to do the following movements above.

test for ADLs