neurological examination mgm

7/28/2019 Neurological Examination Mgm

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Dr Chandan Kumar, Asso. Professor1

Ward name:- .......... IPD/OPD No. : - ..............

Mahatma Gandhi Missions

INSTITUTE OF PHYSIOTHERAPY

Neurological Assessment

Demographic data:-

Name

Age

Sex

Occupation

Address

Dominance

Registration no.

Date of assessment

Chief Complaint(s) (with duration/date)

1.

2.

3.

4.

History

Present history

Past medical history:-

Surgical history:-

Family history:-

Socio-economic history:-

Personal history

Drug history

Environmental history

Associated Problems

Provisional Diagnosis


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ON OBSERVATION

Built -Endomorph/ Ectomorph/ Mesomorph

Skin colour

Attitude of limbs

Alignment

Involuntary movements

Sign of trauma

Scar

Bruises

Deformity:-

Swelling:-

Presence of any extra equipment/ assistive device (if yes then reason): -

Gait

Posture: - Front view

Side view

Back view

Skull (e.g. skull contours, tenderness, cranial or orbital bruit)

Spine (e.g. deformity,)

General Examination

Vitals: HR, PR, BP, temperature, ICP, SPO2

Higher Function Examination

Level of Consciousness (alert, drowsy, sleepy, confused, coma)


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1. Mental State Examination

Attention

Judgment

Cognitive function - Calculation, Object Recognition, Information And

Vocabulary

Orientation (Time, Place, Person)

Memory( Long, Short, Immediate)

Speech

Mini Mental Scale Examination

Cranial Nerve Examination

Sr. N Cranial nerve Findings

I Olfactory

II Optic

III Oculomotor

IV Trochlear

V Trigeminal

VI Abducens

VII Facial

VIII Vestibulocochlear (Acoustic)

IX Glossopharyngeal

X Vagus

XI Accessory

XII Hypoglossal

Cranial Nerve Reflexes Findings

Sensory examination

Superficial Touch

Pain

Temperature

Deep

Proprioception

Pressure

Kinesthesia

Vibration

Sensory Grading System (ASIA)

0 Absent

1 Impaired

2 Normal

NT Not Testable


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Cortical Level

Barognosis,

Steriognosis

Graphesthesia,

Tectile localization,

2 point discrimination

Dermatome

Left/ Right

Left Right Left Right

C1/2 L1C3 L2

C4 L3

C5 L4

C6 L5

C7 S1

C8 S2

T1 S3

T4 S4

T7 S5

T10Motor Examination

Muscle Tone (CCRS):

o no response (flaccidity)

o + decreased response (hypotonia)

o + normal response

o + exaggerated response (mild to moderate hypertonia)

o + sustained response (severe hypertonia


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Spastic hypertonia: graded using modified ashworth scale (MAS)

Modified Ashworth Scale for grading Spasticity Grade

Description

0 No increase in muscle tone

1 Slight increase in muscle tone, manifested by a catch and

release, or by minimal resistance at the end of the range ofmotion when the affected part(s) is moved in flexion or

extension

1+ Slight increase in muscle tone, manifested by a catch,

followed by minimal resistance throughout the remainder

(less than half) of the range of movement (ROM)

2 More marked increase in muscle tone through most of

ROM, but affected part(s) easily moved

3 Considerable increase in muscle tone, passive movement

difficult

4 Affected part(s) rigid in flexion and extension

Range Of Motion

Active ROM

Passive ROM

Myotome:

C1/C2-neck flexion/extension

C3-neck lateral flexion

C4-shoulder elevation

C5-shoulder abduction

C6-elbow flexion/wrist extension

C7-elbow extension/wrist flexion

C8-ulnar deviation, thumb extension

T1-finger abduction

L2-hip flexion

L3-knee extension

L4-ankle dorsi-flexion

L5-great toe extension

S1-ankle plantar-flexion

S2-knee flexion


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Girth measurement:-

Landmark Measurement Muscles

U.L. olecranon process 5 above

7above

3 below

Bicep

Tricep

Brachioradialis

L.L Base of patella 5 above

7 above9 above

Vastus mediallis

Vastus lateralis, vastus intermdialisRectus femoris, hamstring, adductors

L.L. Apex of patella 5 below Gastronemius

Limb length measurement:-

o True :

o Apparent :

Contracture/Tightness/Deformity

Involuntary movements

Muscle strength

MMT / Voluntary Control Grading

MRC grading Brunnstroms Voluntary Control Grading

0 Zero No Contraction Stage 1 The patient is completely flaccid, no voluntary movement, and

patient is confined to bed

1 Trace Flicker Contraction. Stage 2 Basic limb synergy develops, no voluntary movement, can be

done as Spasticity appears but is not marked.

2 Poor Complete ROM in Gravity

eliminated position.

Stage 3 Basic limb synergy develops voluntarily and is marked, stage

of maximal Spasticity.

3 Fair Complete ROM Against gravity Stage 4 Spasticity begins to decrease; movement combinations deviate

from basic limb synergies and become available.

4 Good Complete ROM against

moderately strong resistance.

Stage 5 Spasticity continues to decline, more than half range out of

synergy movement possible. Isolated joint movements, and

more complex movement combinations possible.

5 Normal Complete available ROM

against strong resistance.

Stage 6 There are isolated joint movements

Reflexes

Superficial Reflexes: -Right Left

Abd. Upper

Abd. Lower

Cremastric

Planters

Deep Tendon Reflex: -Right Left

Biceps

Triceps

Supinator

Knee

Ankle


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Co-ordination examination

Non-equilibrium

Arm:-

Finger to nose test

Finger to finger test

Repeated movements

Leg:-

Heel-shine test

Trunk

Sit up from lying without using his hands

Equilibrium (Static)

Sitting

Standing

Romberg Test

Balance Reactions (dynamic)

Righting Reactions :

Equilibrium Reactions:

Protective Reactions :

Gait

Tendom walking

Sideways

Walking on straight line

Walking on heel

Walking on toes

Functional Examination

Functional Activities

Activities of daily living (ADL)

Institutional Activities of daily living (IADL)

Scale Used

(Barthal Index, FIM)/ Disease Specific Scales

Special Test: --

Investigation (e.g. Blood test, X- Rays, CT Scan, MRI, EMG, EEG,NCV or any other Lab Test

report):- )

Diagnosis: -


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Functional Diagnosis: ICIDH-2

I. Impairments

i) Structural

Primary

Secondary

ii. Functional

II. Activity limitation

III. Participation restriction Socially

Economically

Functionally

:

Problem List:-

1. _____________________________________________________

2. _____________________________________________________

3. _____________________________________________________

4. _____________________________________________________

Aim and objectives

Goal setting

Long Term Goals

Short Term Goals

Physiotherapy Management

Any Home Program __________________________________________________________________________________________________________________________

__________________________________________________________________________________

Follow Up: - (Date, Evaluate and reassess and changes in PT Treatment Plan)

neurological examination mgm

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