neurological health assessment

8/13/2019 Neurological Health Assessment

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3Neurological examination

Health Assessment


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The neurologic examination is a systematic

process that includes a variety of clinical

tests , observations, and assessments

designed to detect abnormities in

neurologic functioning .


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The brain and spinal cord cannot be

examined as directly as other systemsof the body. Thus, much of the neurologic

examination is an indirect evaluationthat assesses the function of thespecific body part or parts controlledor innervated by the nervous system.


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A neurologic assessment is

divided into five components:o cerebral functiono

cranial nerveso motor systemo sensory systemo and reflexes .o In addition to Vital signs


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Vital signs:-

- pt who have cervical spinal cordinjuries may have hypotension,bradycardia .- change V/S can also accompanythe late stages of increased ICP.


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Assessing Cerebral Function;

-Cerebral abnormalities may cause

disturbances in mental status


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Mental Status

Examine LOC, memory, mood, and languageand communication ..ect. consciousness (awareness of self and

environment)Level of consciousness (LOC), is mostsensitive indicator of changes in neurologicstatus.


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The GCS assesses threeparameters of consciousness:

Eye opening.

Verbal response. Motor response .


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Best Verbal Response Oriented : 5 Confused : 4

Inappropriate words :3 Incomprehensible sounds : 2

No Response: 1


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Best Motor Response:

Obeys commands : 6Localizes pain : 5Withdraws to pain: 4Abnormal Flexion (Decorticate): 3Abnormal Extensor (decerebrate): 2No Response: 1


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decortication


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decerebration


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Speech and Language

Aphonia ; abnormal production ofsound from larynx

assess ; is patient`s voice hoarse,soft, whispered dysarthria ; defects in articulation

and rhythm in speech . Assess

by askthe pt to repeat a diffcult phrase.


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Thought Processes and Perception

Perceptions Illusions/delusions Hallucinations

Ability to make a decision/judgment Insight


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Cognitive Abilities and Mentation

Immediate (sec-min) Ask to repeat 3-4unrelated words

Recent memboy (min-hrs) Ask who I am,last meal, last visitor, repeat 3-4 unrelated word (wait)

Remote memory (days-yrs) Ask BD,anniversary, last President, favorite President

Abstract reasoning skills Meaning of aproverb, simple math Interpretation of stimuli Visual, auditory, tactile


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Cranial Nerves examination

I(S) Olfactory smell

II(S) Optic vision

III(M) Oculomotor pupil constriction,lid elevation, light reflex

IV(M) Trochlear uvula movement


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V(B) Trigeminal sensation of face,scalp & (corneal reflex), mastication

VI(M) Abducens lateral eye movement

VII(B) Facial lid closure, smile, raiseeyebrows, taste

VIII(S) Acoustic hearing, equilibrium


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Motor System

includes an assessment ofmuscle:

size tone and strength

coordination , and balanceThe pt is instructed to walk across the

room while the examiner observes

posture and gait.


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Gait Abnormalities

Spastic hemiparesis stroke, immobile arm againstbody, stiff/extended leg, toe drag

Cerebellar ataxia loss of position sense, staggering,

MS, alcohol (barbiturate) Parkinsonian basal ganglia defects, stooped posture,

trunk forward, short/shuffling steps, rigid body

Scissors knees cross/in contact, CP Steppage/footdrop lower motor neuron defect Waddling MD, dislocation of hips, lordosis & protruding

abdomen Short leg >1inch


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Motor System

Muscle size, strength, tone bilaterally Grip, palpate muscle size bil, push/pull arms and legs

(0-5 scale), note tics, tremors or fasciculation

Tremor differentiation When does it occur? Table 23-4 (p. 703-704)


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Tremors continued

Chorea Sudden, rapid, jerky, purposelessmovement, disappears with sleep, Huntingtons

Athetosis Slow, twisting, writhing, continuousmovement (snake/worm like), disappears withsleep, CP


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Sensory Assessment

Exteroceptive sensation Light touch, superficial pain (sharp/dull),

summation effect , temperature(hot, cold)

Proprioceptive sensation Motion , position , vibration

Cortical sensation

Sterognosis, graphesthesia, extinction , two-point discrimination (2-3 mm is normal), pointlocation


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Exteroceptive sensation

1.Light Touch Client sitting Eyes closed Say where you are

touched. Compare bilaterally,

and distally toproximally.


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Exteroceptive sensation cont..

2. Superficial pain 3.temperature(hot,

cold)


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Cortical sensation

1.Stereognosis Close eyes Place object in hand

Identify object. Test bilaterally with

different objects.

Note speed andaccuracy

Astereognosis unable to identify object


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Reflexes

Rapid involuntary predictable motorresponse to a stimulus. Reflex arc, is notdependent on the brain.

Somatic Skeletal muscle contraction

Autonomic Cardiac, smooth muscle and glands


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Reflexes

Deep tendon Grading scale 0-4+

Compare bilaterally Biceps, brachioradialis, triceps, patellar,

achilles

Superficial Abdominal Plantar (Negative Babinski) Cremasteric


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DTR Testing

Sometimes need a distraction to help withreflex production. Ask client to lock fingers and pull Isometric

contraction away from muscle group beingtested

Try further encouragement of relaxation.

Not brain dependent often present whenunconscious, asleep


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Biceps Reflex

Support the clientsforearm

Clients arm flexed at

45-90 degree angle Hold arm loosely Strike tendon with a

brisk wrist motion ontop of your thumb


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Brachioradialis Reflex


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Triceps Reflex

Relaxed armrequired.

extension of the

forearm.


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Achilles Reflex

Loosely support footin hand.

Briskly strike Achilles

tendon. Plantar flexion of the

foot.


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Plantar Reflex

Stroke up the lateralside of the sole &across the ball of thefoot to just below thegreat toe.

Plantar flexion of thetoes, normalresponse.

Negative Babinski sign.


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Meningeal Irritation

Nuchal rigidity Severe pain, spasms and resistance with

gentle neck flexion

Kernigs sign Thigh on abdomen, knee flexed to 90

degrees, resistance with pain Brudzinskis sign

Chin to chest involuntary hip flexion andpain


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Gerontological Variations

Inc. risk for ischemic brain injuries Dec rate of nerve conduction Dec number of neurons (dec. total brain

weight) Dec neurotransmitter amt. & production

Sensory alterations (dec. vision/hearing) Cognitive changes (dec. memory, esp.short-term memory)


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