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Neurology 2

Neurology 2. Part 3. Assessing Motor System. Muscle Strength Tone Tension pressure when the muscle is at rest Spasticity Increase muscle tone Rigidity Resistance to passive stretch . Flaccidity Decreased muscle tone Atrophy Wasting away of muscle Hypotonia Lose of tone or strength

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Neurology 2

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  1. Neurology 2 Part 3

  2. Assessing Motor System Muscle Strength • Tone • Tension pressure when the muscle is at rest • Spasticity • Increase muscle tone • Rigidity • Resistance to passive stretch

  3. Flaccidity • Decreased muscle tone • Atrophy • Wasting away of muscle • Hypotonia • Lose of tone or strength • Atonia • No tone or strength

  4. Hypertonia • Increased tone or strength • Gait • Manner / style of walking • Ataxia • Failure of muscle coordination, irregular voluntary muscle action • Akinesia • Abnormal absence of movement • Bradykinesia • Slow movement

  5. RAM Rapid Alternating Movement Pronate / supinate Balance & Coordination Cerebellum assessment

  6. Point to Point

  7. Heel to Shin

  8. Heel to toe walking • Hopping in place

  9. Have the patient walk across the room under observation. • Next ask the patient to walk heel to toe across the room, • Then on their toes only, • finally on their heels only.

  10. Romberg • Stand feet together arms at side • Eyes open • Eyes closed 20-30 seconds • Slight sway is normal

  11. Assessing Reflexes Grading Scale 0 = No response + = hypoactive ++ = Normal +++ = More active ++++ = Hyperactive

  12. Deep Tendon Reflexes

  13. Deep Tendon Reflexes Biceps • Thumb on the biceps tendon • Strike your thumb with hammer • Compare with other arm

  14. Deep Tendon Reflexes Triceps • Strike the triceps tendon directly with the hammer while holding the patient's arm with your other hand. • Repeat and compare to the other arm.

  15. Deep Tendon Reflexes Patellar

  16. Deep Tendon Reflexes Achilles

  17. Superficial Reflexes (protective reflexes) • Corneal Reflex • Test using a clean cotton wisp, lightly touch the outer corner of each eye on the sclera • Normal: (+) elicits a blink • Abnormal: (-) no blink • Eye protection • Lubrication

  18. Superficial Reflexes (protective reflexes) • Gag reflex • Test: gently touch posterior pharynx with cotton applicator • Normal: (+) elevation of the uvula (gag) • Abnormal: (-) No gag • NPO

  19. Superficial Reflexes (protective reflexes) • Plantar Reflex • Test: stroke the lateral side of the foot with tongue blade • Normal: (- Babinski) toe flexion (curl) • Abnormal: (+ Babinski) toe tanning

  20. - Babinski = Normal + Babinski = Abnormal Superficial Reflexes (protective reflexes)

  21. Vital Signs • Temperature • With head trauma  increased

  22. Vital Signs • Pulse • Strength, rate rhythm • Bradycardia  indicative of Increased ICP

  23. Vital Signs • Respirations • Depth, rate, rhythm, effort • Ataxic • Damage to medulla • Cheyne-stokes • Lesion deep in both hemispheres, basal ganglia and upper brainstem • Hyperventilation • Metabolic problems or brainstem

  24. Vital Signs • Blood Pressure • Right verses left • Lying verses standing • Difference in systolic by > 20mmHg  potential cerebral ischemia

  25. Pulse Pressure formula: Systolic – diastolic 120 ------ = ? 80 Vital Signs

  26. Vital Signs • Pulse Pressure • Systolic – diastolic 120 ------ = 40 80 • Normal Pulse pressure = 40 • Widening pulse pressure = Increased ICP

  27. Neuro Checks • LOC • Pupils • PERRLA • Pupils • Equal • Round • Reactive to • Light • Accommodation

  28. Neuro Check • Pupils • Anisocoria • Inequality in the size of the pupils • Nystagmus • Progressive dilation •  Increase ICP • Fixed & dilated • Injury at level of midbrain

  29. Brudzinski’s • Flexion of the neck  pain and flexion of the knees • Indicates • Meningitis • No not perform if… • Neck or back injury

  30. Kernig’s • Pain with flexion of the hip and knee • Indicates • meningitis

  31. Cushing Sign • Vital sign changes assoc. with Increased ICP • Increase in Systolic pressure • Widening pulse pressure • Bradycardia • Bradypnea (slight)

  32. Day 2 Diagnostic tests

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