PT EVAL _ 2.1 _ Neurologic Evaluation

Neurologic Evaluation

The assessment of the nervous system, including the brain, spinal cord, and nerves, to determine underlying problems causing impairments and activity limitations.

Mental Status Evaluation

The assessment of a patient's mental functions, including consciousness, orientation, motivation, impulse control, attention, memory, emotion, and perception.

Risk Factors for Impaired Mental Functions

Chronic illness, psychological or psychiatric diagnoses, medication side effects, and older age can all contribute to impaired mental function.

Consciousness and Arousal

The ability to respond to questions or commands, with different levels ranging from awake and alert to unconsciousness.

Glasgow Coma Scale (GCS)

A gold standard tool used to document the level of consciousness in acute brain injury, assessing eye opening, motor response, and verbal response.

Rancho Los Amigos Levels of Cognitive Functioning (LOCF)

A descriptive scale used to examine cognitive and behavioral recovery in patients with traumatic brain injury, with 8 categories describing different levels of cognitive and behavioral progress.

Autonomic Nervous System (ANS) Responses

The sympathetic and parasympathetic nervous systems work together to respond to stress and maintain homeostasis.

Cognition

The ability to comprehend and adjust oneself with regard to time, location, identity, and circumstances. Includes orientation and attention.

Sensory Testing

The assessment of sensory function, including purpose, procedure, types of sensory testing, and documentation.

Coordination Testing

The assessment of coordination, including purpose, types of coordination testing, and documentation.

Cranial Nerve Integrity/Testing

The assessment of cranial nerve function, including documentation and the identification of lesions and possible affected cranial nerves.

Reflex Testing

The assessment of reflexes, including deep tendon reflexes, superficial cutaneous reflexes, primitive and tonic reflexes, documentation, and grading.

Muscle Tone Evaluation

The assessment of muscle tone, including tone abnormalities, procedure, and the use of the Modified Ashworth Scale.

Pendulum Test (Special Test)

A procedure used to assess muscle tone and evaluate the response to passive movement.

Other Devices

Additional tools and devices used in neurologic evaluation.

Summary

A recap of the main components and purposes of neurologic evaluation.

Neurologic Evaluation

The process of assessing and evaluating the neurological function of a patient.

Documentation

The act of recording and documenting specific components of attention, such as slowness or hesitation in response, duration and frequency of episodes of inattention, environmental factors, and amount of redirection to the task.

Memory

The process of registration, retention, and recall of past experience, knowledge, and ideas.

Mini-Mental Status Examination (MMSE)

A cognitive screening tool used to assess memory and other cognitive functions.

Short-term memory (STM)

The ability to remember and recall information immediately after it is presented.

Long-term memory (LTM)

The ability to remember and recall events or information from the past, longer than a month or year.

Communication

The aspect of cognitive function that involves the ability to communicate and understand speech.

Word comprehension

The ability to understand and comprehend words and commands.

Repetition and naming

The ability to repeat words or commands and name objects or parts of a house.

Sensory Testing

The process of evaluating and assessing the sensory function of a patient.

Purpose of Sensory Testing

To determine the completeness of the injury, the existence of zones of partial preservation, the symmetry or asymmetry of the lesion, and the presence of sacral sensation below the neurological level of the lesion.

Superficial Sensory Testing

Testing the perception of pain, temperature, and touch awareness.

Deep Sensory Testing

Testing kinesthesia awareness, joint position sense, and vibration perception.

Combined Cortical Sensory Testing

Testing stereognosis perception, tactile localization, two-point discrimination, double simultaneous stimulation, graphesthesia, barognosis, and recognition of texture.

Documentation

Recording and documenting the modality tested, quantity of involvement or body surface areas affected, degree or severity of involvement, and localization of the sensory impairment.

Neurologic Evaluation

The process of assessing the function and integrity of the nervous system.

Coordination Testing

Assessing the ability to initiate, control, and terminate movement, as well as the timing, sequencing, and accuracy of movement patterns.

Gross Motor Tests

Assessing body posture, balance, and extremity movements involving large muscle groups.

Fine Motor Tests

Assessing the utilization of small muscle groups, such as finger dexterity.

Non-equilibrium

Movement Capabilities:Assessing alternate or reciprocal motion, movement composition or synergy, movement accuracy, and fixation or limb holding.

Progression of Difficulty of Coordination Tests

The order in which coordination tests are performed, starting with unilateral tasks and progressing to multilimb tasks.

Cranial Nerve Integrity/Testing

Assessing the function of the 12 pairs of cranial nerves, which control various sensory and motor functions in the head and neck.

Reflex Testing

Assessing involuntary, predictable, and specific responses to stimuli through the reflex arc.

Deep Tendon Reflexes

Assessing reflexes by tapping sharply over the muscle tendon using a reflex hammer.

Grading of Deep Tendon Reflexes

Assigning a grade to the reflex response based on the observed movement of the joint.

Superficial Cutaneous Reflexes

Assessing reflexes elicited by stroking the skin using blunt objects.

Plantar Reflex

Assessing the reflex response of flexion/plantarflexion of the great toe and sometimes the other toes when the lateral aspect of the sole of the foot is stroked.

Babinski Sign

An abnormal response in the plantar reflex characterized by extension/dorsiflexion of the great toe and fanning out of the other toes, indicating an upper motor neuron lesion.

Stroke

The act of gently rubbing or stroking the lateral ankle and lateral aspect of the foot.

Oppenheim technique

A technique where you stroke down the tibial crest to elicit a response in the toes.

Abdominal reflex

A reflex test where a brisk light stroke is made over each quadrant of the abdominals from the periphery to the umbilicus, and the expected response is a localized contraction causing the umbilicus to move toward the stimulus.

Primitive and Tonic Reflexes

Reflexes that are present during infancy but should be integrated by the central nervous system in early stages. If these reflexes are still present in adulthood, they indicate neurological involvement.

Flexor withdrawal

A type of primitive reflex where a stimulus causes a withdrawal or flexion response in the limb.

Traction

A type of primitive reflex where a stimulus causes a grasping or pulling response.

Grasp

A type of primitive reflex where a stimulus causes a grasping or gripping response.

Tonic neck

A type of primitive reflex where a stimulus causes a turning or rotation of the head and neck.

Tonic labyrinthine

A type of primitive reflex where a stimulus causes a change in muscle tone and posture in response to changes in head position.

Positive support

A type of primitive reflex where a stimulus causes a stiffening or support response in the legs.

Documentation

The process of recording specific reflexes tested, degree of abnormality observed, associated signs, and factors that modify reflexes.

Grading

A system of assigning a numerical value to the degree of abnormality observed in reflexes, ranging from 0 (absent) to 4+ (obligatory and sustained movement).

Muscle Tone

The resistance of a muscle to passive elongation or stretch, representing a state of slight residual contraction in normally innervated resting muscle.

Hypertonia

Increased muscle tone or spasticity, characterized by velocity-dependent increase in muscle tone and resistance to stretch, usually associated with upper motor neuron lesions.

Hypotonia

Decreased muscle tone or flaccidity.

Rigidity

A hypertonic state characterized by constant resistance throughout the range of motion, independent of velocity of movement. Can be lead pipe rigidity or cogwheel rigidity.

Dystonia

A prolonged involuntary movement disorder characterized by twisting or repetitive movements and increased muscular tone. Can be focal or segmental.

Decorticate Rigidity

Sustained contraction and posturing of the upper limbs in flexion while the lower limbs are in extension, indicating a corticospinal tract lesion at the level of the diencephalon.

Decerebrate Rigidity

Sustained contraction and posturing of the trunk and limbs in a position of full extension, indicating a corticospinal lesion in the brain stem between the superior colliculus and the vestibular nucleus.

Modified Ashworth Scale

A clinical scale used to assess muscle spasticity, graded from 0 (no increase in muscle tone) to 4 (affected part(s) rigid in flexion or extension).

Pendulum Test

A special test used for the lower limbs to assess muscle tone and spasticity.

Isokinetic dynamometer

A device used to quantify the pendulum test by measuring muscle strength and resistance.

Electrogoniometer

A device used to quantify the pendulum test by measuring joint angles and range of motion.

Computerized Video Equipment

A device used to quantify the pendulum test by recording and analyzing the movement of the leg.

Spasticity

Abnormal muscle stiffness and resistance to movement.

Rigidity

Abnormal muscle stiffness without the characteristic "catch" seen in spasticity.

UMN syndrome

Upper motor neuron syndrome, characterized by increased muscle tone, hyperreflexia, and abnormal reflexes.

Electromyography (EMG)

A diagnostic test that measures the electrical activity of muscles and nerves.

Myotonometer

A device used to measure muscle tone and stiffness by applying pressure to the muscle.

CNS

Central Nervous System, which includes the brain and spinal cord.

Impairments

Functional limitations or abnormalities caused by damage or injury to the CNS.

Activity limitation

Restrictions in performing specific tasks or activities due to CNS impairments.

Participation restriction

Limitations in engaging in social or daily life activities due to CNS impairments.

Mental Status Assessment

Evaluation of cognitive functions such as orientation, attention, memory, language, and praxis.

Mini-Mental Status Evaluation

A brief assessment tool used to evaluate cognitive functions.

Sensory Testing

Evaluation of sensory functions such as touch, pain, temperature, and proprioception.

Coordination Testing

Assessment of motor coordination and balance.

Muscle Tone Assessment

Evaluation of muscle stiffness, spasticity, or rigidity.

Reflex Testing

Assessment of reflexes to evaluate the integrity of the nervous system.

Cranial Nerve Assessment

Evaluation of the function of the cranial nerves, which control sensory and motor functions of the head and neck.

Sensory Testing

The evaluation of superficial sensations such as light touch, pain, and pressure.

Superficial Sensations

Sensations that are felt on the surface of the skin, including light touch, pain, and pressure.

Pain Perception

The ability to perceive and identify pain sensations.

Light Touch

The ability to perceive and identify sensations of light touch on the skin.

Pressure

The ability to perceive and identify sensations of pressure on the skin.

Proprioception

The sense of the position and movement of one's own body parts.

Kinesthesia

The sense of the movement of one's own body parts.

Stereognosis

The ability to recognize the form of objects by touch.

Neurologic Evaluation

The process of assessing the function and abilities of the nervous system.

Barognosis

The ability to detect and differentiate between different weights of objects.

Graphesthesia

The ability to recognize letters, numbers, or designs "written" on the skin.

2-point Discrimination

The ability to perceive two points applied to the skin simultaneously.

Non-equilibrium Coordination Test

A test to assess coordination and motor control without maintaining balance.

Finger-to-nose

A coordination test where the patient is asked to touch the tip of their nose with their index finger.

Finger-to-therapist's finger

A coordination test where the patient is asked to touch the tip of their index finger to the therapist's index finger.

Finger-to-finger

A coordination test where the patient brings both hands toward the midline and approximates the index fingers from opposing hands.