Clinical_Placement_II

Cranial Nerves and Their Functions

• Facial Nerve (VII)

  • Supplies motor muscles of the face.

  • Sensory function: two-thirds of the anterior tongue.

  • Functions include:

    • Making a crease in the forehead.

    • Closing eyes tightly.

    • Puffing out the cheeks.

    • Smiling with teeth.

• Vestibulocochlear Nerve (VIII)

  • Sensory functions include hearing and balance.

  • Types of hearing loss:

    • Conductive Hearing Loss: Damage from outside the ear going inside (e.g., hair cell damage).

    • Sensorineural Hearing Loss: Cochlear nerve damage affecting the inner ear.

  • Bone conduction vs air conduction: Can help differentiate types of hearing loss.

Hearing Tests

• Cochlear Hearing Tests:

  • Crude Test: Place a finger on the earhole, then say a number quietly and ask the patient to repeat it.

  • Weber Test: Strike a tuning fork and place it on the midline of the skull; if sound is louder in one ear, it suggests conductive problems in that ear.

  • Rinne Test: Place the tuning fork on the mastoid bone; if air conduction is heard more than bone conduction, indicates sensory hearing loss.

• Vestibular Tests:

  • Dix-Hallpike Test: Patient sits upright with head turned 45 degrees, then lies down quickly to assess dizziness.

Glossopharyngeal Nerve (IX)

• Supplies sensory function to the posterior one-third of the tongue.

• Associated with gag reflex and elevation functions.

Vagus Nerve (X)

• Responsible for motor functions.

• Accessory Spinal Nerve (XI): Involved in muscle power and elevation of the shoulder, particularly the trapezius and sternocleidomastoid muscles.

• Hypoglossal Nerve (XII): Supplies motor functions to the tongue; issues may correlate with speech problems.

Sensory Assessment

• Superficial Sensation Tests:

  • Ensure eyes are closed for patient.

  • Pain assessment with pin or sharp object.

  • Light touch assessment.

  • Temperature testing (hot water: 40-45°C, cold: 5-10°C).

• Deep Sensation Tests:

  • Pressure detection using thumb or fingertip.

  • Vibration perception tested with tuning fork.

  • Joint position sense (static and dynamic ROM).

• Combined Cortical Sensation Tests:

  • Tactile localization and recognition of objects (stereognosis).

  • Two-point discrimination and double stimulation.

Motor Assessment

• General Muscle Tone Assessment:

  • Assess for spasticity, velocity, and resistance.

  • Evaluate for signs of Parkinson's disease, including rigidity.

• Specific Tests:

  • Floppy Baby Test: To assess muscle tone in infants.

  • Impairments in Motor Control: Identify akinetic states and potential cataplexy issues.

Bowel and Bladder Assessment

• Upper Motor Neuron (UMN) Issues:

  • Neurogenic bladder reflecting incomplete emptying and affected reflexes above the S2-S3 Conus medullaris.

  • Involves detractors and sphincter muscle reflex actions.

• Lower Motor Neuron (LMN) Issues:

  • Neurogenic bladder below S2-S3 with loss of reflex for detrusor and external sphincter muscle.

Balance and Coordination

• Balance involves maintaining center of gravity without falling.

• Romberg Test:

  • Standing with feet together, eyes open then closed, assessing for swaying.

• Single Leg Stand Test:

  • Standing on one leg; positive result indicates sway.

• Dynamic Tests:

  • Alternate single-leg standing and wobble board test for coordination.

• Coordination Tests:

  • Finger to nose test, examining motor control while assessing balancing ability.

  • Heel-Shin Test:

  • Drawing a circle with upper and lower limbs.

• Additional tests include tandem walking and various drawing tests.

Special Tests

• Lumber Test:

  • Positioning and observation tests for pain during leg raise in sitting/posture tests.

  • Assess for signs of nerve injury, meningitis, tightness, disk herniation, or fractures.

• Modification Tests:

  • Straight Leg Raise (SLR) to assess lower back and hip pain responses.

Cranial Nerves and Their Functions Q&A

Q1: What is the Facial Nerve (VII) responsible for?

A1: The Facial Nerve (VII) supplies motor muscles of the face and sensory function to two-thirds of the anterior tongue. Key functions include making a crease in the forehead, closing eyes tightly, puffing out the cheeks, and smiling with teeth.n

Q2: What are the sensory functions of the Vestibulocochlear Nerve (VIII)?

A2: The Vestibulocochlear Nerve (VIII) is responsible for hearing and balance.

Q3: What are the two types of hearing loss?

A3: 1. Conductive Hearing Loss: Damage occurs from outside the ear inward (e.g., hair cell damage). 2. Sensorineural Hearing Loss: Involves cochlear nerve damage that affects the inner ear.

Q4: How can bone conduction and air conduction help differentiate hearing loss types?

A4: Bone conduction tests can show if the problem is conductive in nature (e.g., issues in the outer/middle ear) vs. sensorineural (e.g., issues in the cochlea or auditory nerve).

Q5: What are the Cochlear Hearing Tests mentioned?

A5: 1. Crude Test: Place a finger on the earhole, say a number quietly, and ask the patient to repeat it. 2. Weber Test: Strike a tuning fork, place it on the midline skull; a louder sound in one ear suggests conductive problems in that ear. 3. Rinne Test: Place tuning fork on the mastoid bone; if air conduction is heard more than bone conduction, indicates sensory hearing loss.

Q6: What does the Glossopharyngeal Nerve (IX) supply?

A6: The Glossopharyngeal Nerve (IX) supplies sensory function to the posterior one-third of the tongue and is associated with the gag reflex and elevation functions.

Q7: What is the function of the Vagus Nerve (X)?

A7: The Vagus Nerve (X) is responsible for various motor functions throughout the body.

Q8: What is the role of the Accessory Spinal Nerve (XI)?

A8: It is involved in muscle power and elevation of the shoulder, particularly in the trapezius and sternocleidomastoid muscles.

Q9: What does the Hypoglossal Nerve (XII) do?

A9: The Hypoglossal Nerve (XII) supplies motor functions to the tongue, and issues may correlate with speech problems.

Q10: What assessments are included in Sensory Assessment?

A10: 1. Superficial Sensation Tests: Pain, light touch, temperature testing. 2. Deep Sensation Tests: Pressure detection, vibration perception, joint position sense. 3. Combined Cortical Sensation Tests: Tactile localization, recognition of objects, two-point discrimination.

Q11: How is Motor Assessment evaluated?

A11: Assess general muscle tone for spasticity and velocity, specific tests like the Floppy Baby Test assess muscle tone in infants, and identify impairments in motor control.

Q12: What are Upper Motor Neuron (UMN) and Lower Motor Neuron (LMN) issues in bowel and bladder assessment?

A12: UMN issues reflect neurogenic bladder with incomplete emptying above the S2-S3 Conus medullaris, while LMN issues indicate loss of reflex for the detrusor and sphincter muscle below S2-S3.

Q13: Describe the Romberg Test for balance assessment.

A13: The Romberg Test involves standing with feet together, first with eyes open and then closed, assessing for swaying to evaluate balance.

Q14: What do coordination tests evaluate?

A14: Coordination tests assess motor control through the finger to nose test, heel-shin test, and tandem walking.

Q15: What does the Lumber Test assess?

A15: The Lumber Test assesses for pain during leg raise in sitting/posture and evaluates signs of nerve injury, meningitis, tightness, disk herniation, or fractures.

Q16: What is the Straight Leg Raise test used for?

A16: The Straight Leg Raise (SLR) test is used to assess responses related to lower back and hip pain.

Cranial Nerves and Their Functions

Facial Nerve (VII)

• Controls muscles of the face.

• Sends taste sensations from the front part of the tongue.

• Key actions:

  • Wrinkle forehead.

  • Close eyes tightly.

  • Puff out cheeks.

  • Smile.

• Vestibulocochlear Nerve (VIII)

• Involved in hearing and balance.

• Hearing loss types:

  • Conductive Hearing Loss: Problems caused by external damage.

  • Sensorineural Hearing Loss: Inner ear nerve damage.

Hearing Tests

• Crude Test: Cover ear, whisper a number, and ask for repeat.

• Weber Test: Use tuning fork on head; louder sound in one ear indicates a problem.

• Rinne Test: Use tuning fork on bone behind ear; if air hearing is better, it shows inner ear issues.

Glossopharyngeal Nerve (IX)

• Supplies taste from the back of the tongue; involved in gag reflex.

Vagus Nerve (X)

• Controls various muscle functions in the body.

Accessory Spinal Nerve (XI)

• Helps raise shoulder muscles.

Hypoglossal Nerve (XII)

• Controls tongue movement; issues can affect speech.

Sensory Assessment

• Superficial Tests: Check for pain, light touch, and temperature.pll

• Deep Tests: Check pressure, vibration, and joint position.

Motor Assessment

• Check muscle tone and movement control.

Bladder Assessment

• UMN Issues: Problems above lower spine leading to incomplete bladder emptying.

• LMN Issues: Problems below lower spine affecting bladder control.

Balance Tests

• Romberg Test: Stand with feet together, eyes open, then closed to check balance.

Coordination Tests

• Check skills like touching nose and walking straight.

Lumber Test

• Check for pain when lifting legs and look for nerve issues or injuries.