HA Lec

NEUROLOGIC ASSESSMENT

  • Overview of Nerve Regions:
      - Cervical Nerve Region:
        - Controls:
          - Head and Neck
          - Diaphragm
          - Arms and Hands
      - Thoracic Nerve Region:
        - Controls:
          - Chest Muscles
          - Breathing
          - Abdominal Muscles
      - Lumbar Nerve Region:
        - Controls:
          - Legs and Feet
      - Sacral Nerve Region:
        - Controls:
          - Bowel and Bladder Control
          - Sexual Functions

PERCEPTION AND COORDINATION ASSESSMENT

  • Key Considerations:
      - The client’s chief complaints
      - The client’s physical condition (Level of Consciousness, ability to ambulate)
      - The client’s willingness to cooperate

WHAT TO ASSESS

  • Assess the following areas:
      - Mental Status: Including Level of Consciousness (LOC)
      - Cranial Nerves
      - Reflexes
      - Motor Function
      - Sensory Function

EQUIPMENT FOR ASSESSMENT

  • Items needed include:
      - Sugar, salt, lemon juice, quinine flavors
      - Percussion hammer
      - Tongue depressors
      - Cotton balls
      - Optional: Test tubes of hot and cold water
      - Pins or needles for tactile discrimination

MENTAL STATUS ASSESSMENT

  • Purpose: Reveals the client’s general cerebral function.

  • Components:
      - Intellectual (cognitive): Assessment of memory and thought processes.
      - Emotional (affective): Evaluation of mood and affect.

LANGUAGE ASSESSMENT

  • To assess language capabilities, if difficulty speaking is noted:
      - Activities:
        1. Point to common objects and ask the client to name them.
        2. Ask the client to read words and match printed and written words with pictures.
        3. Request the client to respond to simple verbal and written commands.

  • Aphasia:
      - A defect or loss in the ability to express oneself via speech, writing, or sign language, or to comprehend spoken or written language due to disease or injury of the cerebral cortex.

  - Types of Aphasia:
    - Sensory or Receptive Aphasia: Loss of comprehension of written or spoken words.
      - AUDITORY/ACOUSTIC Aphasia: Loss of ability to understand sounds.
      - VISUAL Aphasia: Loss of ability to understand written text.
    - Motor or Expressive Aphasia: Loss of ability to express through writing, signs, or speech; inability to combine speech sounds into words.

ORIENTATION ASSESSMENT

  • Definition of Orientation: Ability to recognize persons, awareness of current location and time, and self-recognition.

  • Components to Assess:
      - Place of residence
      - Time of day
      - Date
      - Day of the week
      - Duration of illness
      - Names of family members

MEMORY ASSESSMENT

  • Types of Memory to Assess:
      - Immediate Recall: Ability to remember information presented seconds ago.
      - Recent Memory: Ability to remember events or information from earlier the same day.
      - Long-term Memory: Knowledge recalled from months or years ago.

ATTENTION SPAN AND CALCULATION

  • Measure the client’s ability to focus on and complete simple mental tasks.

LEVEL OF CONSCIOUSNESS (LOC)

  • Levels of LOC:
      1. Alert:
         - Oriented x3 (person, place, time)
         - Follows simple commands
         - Responds appropriately to stimuli
         - Does not require stimulation.
      2. Lethargic:
         - Drowsy, requires mild stimulation to remain oriented.
         - Sleeps immediately after being stimulated.
      3. Stuporous:
         - Requires significant stimulation; disoriented when awake.
      4. Semi-comatose:
         - Responds to painful stimuli only; no verbal response.
      5. Deep Coma:
         - Unaware of self/environment; may or may not respond to noxious stimuli. Areflexic (no gag reflex).

GLASGOW COMA SCALE

  • Purpose: Developed to predict recovery from a head injury and assess LOC

  • Components of Assessment:
      - EYE RESPONSE: score from 1-4
      - MOTOR RESPONSE: score from 1-6
      - VERBAL RESPONSE: score from 1-5

  • Scoring:
      - Maximum score: 15
      - Lowest possible score: 3
      - State of coma: 7 and below

CRANIAL NERVES (CN) ASSESSMENT

  • CN I (Olfactory):
      - Function: Smell
      - Type: Sensory
      - Test: Identify common smells (e.g., coffee/perfume).
      - Abnormal Findings:
        - Inability to smell indicates possible lesions or tumors.

  • CN II (Optic):
      - Function: Sight
      - Type: Sensory
      - Test: Assess vision using Snellen chart.
      - Abnormal Findings:
        - Difficulty reading; presbyopia is common with aging.

  • CN III (Oculomotor):
      - Function: Eye movements
      - Type: Motor
      - Test: Check pupil constriction and eye movement.

  • CN IV (Trochlear):
      - Function: Superior oblique movement
      - Type: Motor
      - Test: Assess ability to look downward and inward.

  • CN V (Trigeminus):
      - Function: Mastication, facial sensation, corneal reflex
      - Type: Both Sensory and Motor
      - Test: Assess clenching jaw and facial response to touch.

  • CN VI (Abducens):
      - Function: Facial movements, expression
      - Type: Motor
      - Test: Assess lateral deviation of the eye.

  • CN VII (Facial):
      - Function: Facial expressions and taste (anterior 2/3)
      - Type: Both Motor and Sensory
      - Test: Observe ability to smile, raise eyebrows, and check taste on the anterior 2/3 of the tongue.

  • CN VIII (Vestibulo-cochlear):
      - Function: Auditory and balance
      - Type: Sensory
      - Test: Whisper, watch tick test, and assess lateralization (Weber) and air/bone conduction (Rinne).

  • CN IX (Glossopharyngeal):
      - Function: Taste (posterior 1/3) and swallowing
      - Type: Both Motor and Sensory
      - Test: Swallowing and checking taste of posterior 1/3 of the tongue.

  • CN X (Vagus):
      - Function: Swallowing, vocalizations
      - Type: Both Motor and Sensory
      - Test: Gag reflex.

  • CN XI (Spinal Accessory):
      - Function: Shoulder shrugging
      - Type: Motor
      - Test: Partner induces resistance to shoulder shrugging.

  • CN XII (Hypoglossal):
      - Function: Tongue movement
      - Type: Motor
      - Test: Ask the patient to stick out their tongue.

REFLEXES

  • Definition: An automatic response to stimuli.

  • Deep Tendon Reflex: Activates muscle contraction when a tendon is tapped.

  • Assessment Scale:
      - 0: None
      - 1+: Hypoactive
      - 2+: Normal
      - 3+: Mildly hyperactive with clonus
      - 4+: Hyperactive with clonus

MOTOR FUNCTION

  • Components: Evaluate proprioception and cerebellar function:
      - Proprioceptors
      - Posterior columns of the spinal cord
      - Cerebellum
      - Vestibular apparatus in the inner ear

SENSORY FUNCTION

  • Components:
      - Touch
      - Pain
      - Temperature
      - Position
      - Tactile discrimination

  • Abnormal Responses:
      - Anesthesia: Loss of sensation
      - Hyperesthesia: Increased sensation
      - Hypoesthesia: Decreased sensation
      - Paresthesia: Abnormal sensations such as burning or electric shock.

GAIT ASSESSMENT

  • Normal Findings:
      - Posture is upright and steady
      - Balanced gait with opposing arm swing

  • Abnormal Findings:
      - Poor posture or unsteady gait
      - Specific patterns such as waddling, propulsive, scissors, spastic, or steppage gait.

ROMBERG TEST

  • Normal Findings: Negative Romberg allows for slight swaying while upright.

  • Deviation from Normal: Positive Romberg indicates inability to maintain stance, resulting in needing a wider foot placement or inability to maintain balance.

FINE MOTOR TESTS

  • Performance through:
      - Finger-to-nose test
      - Alternating hand motions
      - Movement accuracy involving touching fingers.

LIGHT-TOUCH SENSATION

  • Normal Findings: Light stimulating sensations are felt.

  • Deviation from Normal: Indications of abnormal sensations like anesthesia or paresthesia.

PAIN AND TEMPERATURE SENSATION

  • Normal Findings: Ability to discern sharp and dull sensations or discriminate temperature.

  • Deviation from Normal: Areas of lost or altered pain feeling or temperature sense.

POSITION OR KINESTHETIC SENSATION

  • Normal Findings: Ability to identify finger and toe positions.

  • Deviation from Normal: Inability to recognize the position.

ASSESSMENT OF THE MUSCULOSKELETAL SYSTEM

  • Health History Consideration:
      - Pain Assessment: (Bone, Muscle)
      - Diet: High purine diets may suggest gout risks.
      - Family History and Allergy Status

  • Physical Exam Findings:
      - Look for deformities, joint function abnormalities, range of motion limits.

  • Neurovascular Function: Includes checks for circulation, motion, and sensation.

  • Assessing Joints:
      - Inspect, palpate, test each joint’s motion.

  • Muscle Strength Testing: Assess movement through full ROM against resistance with grading scale from 0 to 5.

  • Classification of Muscle Strength:
      - 5: Normal strength
      - 4: Slight weakness
      - 3: Average weakness
      - 2: Passive ROM
      - 1: Flicker of contraction
      - 0: No contraction (severe weakness or paralysis).