Ch. 30 Neurological System

Page 1: Health Assessment Overview

Neurological System

• Introduction to the health assessment of the neurological system.

Page 2: Health History

• Key health history elements include:

  • Headache: Document frequency, duration, and intensity.

  • Dizziness or Vertigo: Distinguish between subjective (patient's perception) and objective (clinician's observation) symptoms.

  • Seizure History: Record frequency, type, and duration of seizures.

  • LOC Changes: Document any loss of consciousness events.

  • Altered Mobility: Note any difficulties in physical movement.

  • Altered Sensation: Include changes in touch, pain, temperature perception.

  • Dysphagia and Aphasia: Assess and document any swallowing difficulties or language impairments.

Page 3: Physical Examination

Assessment Components

• Cerebrum Function: Evaluate reasoning and judgment.

• Cerebellar Function and Proprioception: Assess balance and coordination.

• Cranial Nerves: Examine function through specific tests.

• Sensory Function: Measure sensation across different modalities.

• Motor Function: Evaluate strength and coordination of muscle movements.

• Deep Tendon Reflexes: Test reflex responses for neurological health.

Page 4: FROMAJE (Cerebrum Function)

• Functional Assessments:

  • ADLs: Activities of daily living performance.

  • Reasoning: Ability to interpret idioms or analogies.

  • Orientation: Assess temporal and spatial awareness (time, place, person).

  • Memory: Short-term (e.g., remember 3 words) vs. long-term recall.

  • Arithmetic: Ability to perform simple calculations (e.g., subtracting 7 from 100).

  • Judgment: Situational judgment responses.

  • Emotion: Inquiry about suicidal or homicidal thoughts.

Page 5: Mini-Mental State Exam (MMSE)

Exam Components

• Orientation: Ask about year, season, date, and location.

• Registration: Test recall of 3 objects after prompting.

• Attention and Calculation: Serial sevens or spelling words backward.

• Recall: Request the repeated objects again.

• Language: Various tasks to assess language use and comprehension.

• Total Score: Aggregate score from the MMSE.

Page 6: Cerebellar Function

Balance and Coordination Tests

• Balance:

  • Perform Romberg test, heel-toe walk (duck walk).

  • Conduct hip-hop jump as a coordination exercise.

• Coordination:

  • Use finger-nose test and rapid alternating motion.

  • Perform heel down shin test for lower extremity coordination.

Page 7: Finger-Nose Test

• Specifically designed test for assessing coordination and cerebellar function.

Page 8: Cranial Nerves

Overview of the 12 Cranial Nerves

• Cranial Nerves List:

  1. Olfactory

  2. Optic

  3. Oculomotor

  4. Trochlear

  5. Trigeminal

  6. Abducens

  7. Facial

  8. Acoustic

  9. Glossopharyngeal

10. Vagus

11. Spinal Accessory

12. Hypoglossal

• Mnemonic: Some say marry money but my brother says big benefits matter. (S=sensory, M=motor, B=both)

Page 9: Cranial Nerve Anatomy

• Detailed anatomical pathways:

  • Olfactory nerve

  • Optic nerve

  • Oculomotor nerve

  • Trochlear nerve

  • Trigeminal nerve

  • Abducens nerve

  • Others listed sequentially.

Page 10: Cranial Nerve Summary

• Numbering and functional arrangements of cranial nerves presented in a table format.

Page 11: Cranial Nerve Functions

• Detailed roles of key cranial nerves with sensory and motor fibers:

  • Olfactory: Sensory to the nose.

  • Optic: Sensory to the eye.

  • Facial: Motor to facial muscles, sensory for taste anterior tongue.

  • Vestibulocochlear: Sensory for hearing and balance.

• Continue categorizing others based on motor and sensory functions.

Page 12: Sensory Function Assessment

Evaluation Techniques

• Sensory Assessment Types:

  • Tactile perception.

  • Pain perception.

  • Vibratory sense.

  • Position sense testing (proprioception).

Page 13: ASIA (American Spinal Injury Association)

Assessment of Neurological Function

• Exam Components: Document sensory and motor responses.

• Scoring based on key sensory points and muscle function for upper/lower limbs.

Page 14: Sensory Impairment and Spinal Cord Injury Levels

• Dermal Segmentation and Key Indicators:

  • C5 - Anterolateral shoulder.

  • T4 - Nipple line.

  • T10 - Navel region.

Page 15: Stereognosis Test

• Identification of small objects by touch to assess for parietal lobe dysfunction.

Page 16: Graphesthesia Test

• Ability to recognize drawn letters/numbers to assess potential parietal damage.

Page 17: Two-Point Discrimination Test

• Measure tactile sensitivity by identifying points on the skin when touched.

Page 18: Motor Function Evaluation

Key Assessments

• Evaluate:

  • Muscle strength and tone.

  • Posture and body alignment.

  • Balance and coordination.

  • Fine motor control.

Page 19: Deep Tendon Reflexes

Testing List

• Key reflexes include:

  • Triceps, biceps, brachioradialis, patellar, Achilles.

  • Babinski’s reflex noted as abnormal in adults (indicates motor tract issues).

  • Findings will be recorded on a 0-4+ scale.

Page 20: (Unspecified Content)

Placeholder Content

• Additional data not readily identifiable from transcript.

Page 21: Achilles Reflex Testing

• Methodology for performing Achilles reflex tests and expected responses.

Page 22: Babinski Sign Assessment

• Interpretation of fanning toes in response to stimuli; normal in infants but abnormal in adults.

Page 23: The Glasgow Coma Scale

Scoring Criteria

• Eye Opening: Various responses recorded on a scale.

• Verbal Response: Levels from oriented to absent response.

• Best Motor Response: Command obedience to localization of pain.

• Total Coma Score: Aggregated score indicating consciousness level.

Page 24: Overview of Neurological Assessment

Components

• Comprehensive evaluation aspects:

  • Assess mental status and cognitive function.

  • Motor capabilities with emphasis on coordination.

  • Cranial nerve testing for functionality.

  • Assess sensory capabilities.

  • Test reflex activities for neurological integrity.

Page 25: Additional Skills Resources

Skills Video

• ATI Skills Module 3.0 for comprehensive physical assessments.

• Review of head to toe assessment techniques available.