Neurological System

Deep tendon reflex tested by striking Achilles tendon; normal response is plantar flexion.

achilles reflex

Stroking sole causes toes to fan (normal in infants, abnormal in adults = upper motor neuron lesion).

Babinski Reflex

Toes fanning in adults when stroking the sole of the foot is considered…

abnormal

Tap forearm near wrist—normal response is elbow flexion and supination.

brachioradialis reflex

What shows a positive brachioradialis reflex?

elbow flexion, arm supination

Tap biceps tendon—normal response is elbow flexion.

biceps reflex

What shows a positive Biceps reflex?

elbow flexion

Rapid, rhythmic muscle contractions indicating hyperreflexia (often with CNS disease).

clonus

12 pairs of nerves controlling sensory and motor functions of the head and neck.

cranial nerves

Area of skin supplied by a single spinal nerve.

dermatome

Difficulty swallowing

dysphagia

Difficulty speaking or understanding language.

dysphasia

Manner or pattern of walking.

gait

Reflex contraction of throat muscles when touched; tests CN IX and X.

gag reflex

Ability to recognize writing on the skin by touch.

graphesthesia

Infant startle reflex—arms extend and then flex; disappears around 4–6 months.

moro reflex

Infant grasps finger placed in palm; disappears around 4–6 months.

palmar grasp reflex

“Knee jerk”; extension of lower leg when patellar tendon is tapped.

patellar reflux

Infant toes curl around object placed under toes.

plantar grasp reflex

Involuntary, predictable motor responses to stimuli.

reflexes

Infant turns head toward cheek stimulation; helps with feeding.

rooting reflex

Tests balance; patient stands with eyes closed—positive if swaying/falling.

Romberg test

Ability to identify objects by touch with eyes closed.

stereogonsis

Infant sucks when lips or mouth area is touched.

sucking reflex

Tap triceps tendon—normal response is elbow extension.

tricep reflex

which 2 cranial nerves are tested with the gag reflex?

IX, and X

Moro reflex and palmar grasp reflex dissapear around ____-____ months.

4, 6

Romberg test is positive if patient is…

swaying or falling

What are the 10 components of a neurological exam?

mental status, level of consciousness, speech, cranial nerve functions, gait, muscle strength and tone, cerebellar function, sensory function, deep tendon reflexes, and glasgow coma scale

awake, responds appropriately, normal interaction

alert

drowsy but able to respond, slow answers

lethargic

very sluggish responses, needs repeated stimulation

obtunded

requires painful stimulation to respond minimally

stuporous

responds only to strong, painful stimulation, no verbal response

semicomatose

no purposeful response to any situation

comatose

What are the 6 levels of conciousness?

alert, lethargic, obtunded, stuporous, semicomatose, and comatose

What 3 things are assessed in a neuro exam (Orientation/Memory)?

orientation, short term memory, long term memory

Oriented x3 (______, ______, and ______)

• “what is your name?”

• “where are you right now?”

• “what day/month/year is it?”

person, palce, time

What should you ask to assess short-term memory? 

what did you eat for breakfast? 

What can you ask to assess long-term memory?

what city were you born in?

How do you assess cognitive function? 

• assess ability to _______ __________

• assess ability to _______ __________

• _________

• _________

answer questions, follow directions, reasoning, attention

How do you assess Cerebellar function?

• ________ _____

• _____ to ______ test

• _____________ (overshooting indicated in the question example)

observe gait, heel, shin, coordination

How do you assess changes in LOC? (3)

evaluate responsiveness, alertness, and orientation

How do you assess Motor Function? (4)

assess muscle strength, movement, symmetry, and tone

How do you assess Sensory Function? (4)

light touch, pain, vibration, and temp

How do you assess Deep Tendon Reflexes?

test reflex arc function

What are the 5 deep tendon reflexes tested for in an assessment?

biceps, triceps, brachioradialis, patellar, and achilles

Deep Tendon Reflex Grade Score 

• 0 ____ ________

• 1+ ___________, low normal

• 2+ _________

• 3+ _________ than normal

• 4+ hyperactive, _______ present

no response, diminished, normal, bisker, clonus

Where is the Biceps Reflex located?

antecubital fossa

Where is the triceps reflex located?

above elbow on posterior arm

Where is the Brachioradialis reflex located?

1-2 inches above wrist (radial side)

Where is the patellar reflex located?

below patella

Where is the achilles tendon located?

back of ankle

What are the 2 superficial and pathological reflexes?

babinski reflex and ankle clonus

Plantar/Babinski Reflex

• located on bottom of foot

• stroke _______ edge of heel to ____ of foot

lateral, ball

Ankle Clonus

• located on the ankle

• test with ______ ____________

• positive: __________, ______________ contractions

rapid dorsiflexion, rhythmic, involuntary

What are the 5 Discriminative Sensations?

Proprioception, stereognosis, graphesthesia, distinction, and two-point discrimination

How do you test for Proprioception?

move patients finger and ask direction

How do you test Stereogonsis?

place familiar object in hand and have patient identify it

How do you test for Graphesthesia?

draw letter on palm, have patient identify

How do you test for Two-point discrimination?

• use ________ or paperclip

• determine _________ distance where patient feels ___ points, not ____.

calipers, smallest, 2, 1

When testing discriminative sensations patients eyes must be ______.

closed

What scale determines objective level of consciousness?

glasgow coma scale (GCS)

The glasgow coma scale assesses… (3)

motor, verbal response, and eye opening

Higher glasgow score means….

better neurologic functions

Neurological findings in Elderly patients?

• _________

• decline in ________

• changes in ______ ___________

• decline in _____ ability

• __________

• _____

• inc. _____ use

dementia, memory, mental functioning, ADL, incontinence, falls, med

A patient has a cerebellar deficit. Which finding indicates cerebellar dysfunction?

heel overshoots shin and oscillates

mechanisms that facilitate or impair neurological function

intracranial regulation

CNS

• protective _________

• ______________ fluid and ___________ _____________ system

• _______: cerebrum, diencephalon, basa ganglia, brainstem, and cerebellum

structures, cerebrospinal, cerebral ventricular, brain

Peripheral Nervous System consists of… (4)

spinal cord, cranial nerves, spinal nerves, and reflex arc

Disorders of the CNS

• Multiple __________

• __________

• __________

• spinal cord _______

• head injury

• ___________ disease

• ________________ accident

sclerosis, meningitis, encephalitis, injury, parkinson, cerebrovascular

What are 2 peripheral nerve disorders?

myasthenia gravis, and guillain-barre syndrome