neurological assessment. objective one assess the components of the basic neurological assessment
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The brain is highly dependent on blood flow and a consistent supply of oxygen and glucose to maintain neuronal function. Any decrease can cause neuronal malfunction. Older adults tend to be vulnerable to cognitive dysfunction secondary to many causes, ranging from decreased blood pressure to infections. Thus, any acute change in cognitive functioning needs to be assessed for an underlying cause.
Neurological SystemFunctions through transmission of chemical and
electrical signals between the body and the brain
Receives, processes, and sends out informationControls and coordinates the functioning of all
other systems in response to environment/surroundings
Involves cognition, emotion, memory, sensation and perception, and regulation of homeostasis
Comprised of the central nervous system (CNS) and the peripheral nervous system (PNS)CNS = Brain and spinal cordPNS = Cranial and spinal nerves
The PNS• includes nerves emerging from the brain (cranial
nerves) and nerves emerging from the spinal cord (spinal nerves).
• These nerves are divided into sensory nerves that conduct messages from various parts of the body to the CNS, whilst motor nerves conduct impulses from the CNS to muscles and glands.
• is further divided into the Somatic System (SNS) and Autonomic System (ANS), depending on the area of the body these messages are transmitted to and from.
The SNS• consists of sensory neurons from the head, body wall,
extremities, and motor neurons to skeletal muscle.• The motor responses are under conscious control and
therefore the SNS is voluntary.• Certain peripheral nerves perform specialized functions and
form the autonomic nervous system; they control various activities that occur automatically or involuntarily such as the contraction of smooth muscle in the walls of the digestive system.– The autonomic system is further divided into the
sympathetic and parasympathetic systems. These two systems provide nerve stimuli to the same organs throughout the body, but bring about different effects.• The balance between these two systems is
controlled to create a state of homeostasis that is where the internal stability of the bodily systems are maintained in response to the external environment
Parasympathetic Nervous System
• slows down the body• helps prepare for a more relaxed state, ready
for digestion and sleep. • It will therefore increase peristalsis of the
alimentary canal, slow down the heart rate, and constrict the bronchioles in the lungs.
.
The Sympathetic Nervous System
• helps prepare the body for "fight or flight" and create conditions in the tissues for physical activity.
• is stimulated by strong emotions such as anger and excitement and will therefore speed up heart rate, increase the activity of sweat glands, adrenal glands, and decrease those of the digestive system.
• also produces rapid redistribution of blood between the skin and skeletal muscles.
Age-Related ConsiderationsBirth reflexes include rooting, sucking,
palmar grasp, tonic neck reflex, and MoroDisappear during infancyMay return w/stroke or trauma
Denver Developmental Screening Test II (DDST) used to screen young children
Neurons decrease over lifetime, resulting in slowed reaction time, problem-solving skills, and voluntary movementDecreases in intelligence and memory not normal
in the elderly, and indicate a neurological deficit Medication effects, dehydration, Alzheimer’s dementia,
etc
Cerebral FunctionLevel of consciousness (LOC)
Arousal (alert, lethargic, stuporous, comatose) Verbal stimuli Tactile stimuli Painful stimuli
Orientation (person, place, time)Mental status and cognitive function
Behavior, appearance, response to external stimuli, speech, recent and remote memory, communication, judgment
Posture, gait, motor movements, dress, hygiene/grooming, mood, affect, facial expression
Consider language/education/culture during neuro exam
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Reflex FunctionDeep tendon reflex is tested with a rubber
percussion hammer to tap a slightly stretched muscleNormal response = muscle contractionResponse grading scale:
0 = No response detected +1 = Diminished response +2 = Response normal +3 = Response somewhat stronger than normal +4 = Response hyperactive with clonus
Clonus refers to involuntary continuous contractions of a muscle or group of muscles
Superficial reflexes are tested by lightly touching the body with the base of a reflex hammer or tongue blade, beginning with the most peripheral part of the limbGraded as positive or negativeDetermine sensory loss area by testing every 1-2
inches
Testing ReflexesBicepsReflex
Rest client’s elbow in nondominant hand with thumb over biceps tendon; strike percussion hammer to own thumb
TricepsReflex
Abduct client’s arm at the shoulder, flexing at the elbow; support upper arm with nondominant hand, letting forearm hang loosely; strike the triceps tendon 2 inches above the olecranon process
BrachioradialisReflex
Rest client’s arm on his leg; strike with percussion hammer 1-2 inches above bony prominence of the wrist on the thumb side
PatellarReflex
Position client in seated position with legs dangling; strike the tendon directly below the patella with a percussion hammer
AchillesReflex
Position client in the supine or seated position with legs dangling; hold client’s foot slightly dorsiflexed; strike the Achilles tendon about 2 inches above the heel with the percussion hammer
PlantarSuperficialReflex
Stroke the sole of the client’s foot in an arc from the lateral heel to medially across the ball of the foothttp://www.youtube.com/watch?v=kOq5Np0eZ6A&feature=related
Deep Tendon Reflexes:http://www.youtube.com/watch?v=fymDY2q0FtE&feature=related
Checking Cranial NervesCN I Identify the smell of common substances
CN II Test visual acuity and visual fields
CN III, IV, & VI
Test extraocular movement by having client move eyes through the 6 cardinal fields of gaze with head held steady; test papillary reaction to light and accommodationhttp://www.youtube.com/watch?v=YntJiBCz3pA&feature=related
CN V - Motor function
Move jaw from side to side, clenching jaw, and biting down on a tongue blade
CN V - Sensory function
Have client close eyes and identify when he is being touched on the forehead, cheeks, and chin; test corneal reflex by puffing air over the cornea
CN VII - Motor function
Have client make faces (smile, frown, whistle)
CN VII - Taste
Test taste on anterior portion of tongue by placing something sweet, salty, or sour on the tip of the client’s tongue
CN VIII Test client’s hearing using wristwatch; test air/bone conduction using Weber & Rinne test; test for balance using Romberg testhttp://video.google.com/videoplay?docid=1911735836954444981#http://www.youtube.com/watch?v=4hOSkmDYAR4&NR=1
Checking Cranial NervesCN IX & X - Motor function
Observe client’s ability to talk, swallow, and cough; have client say “ahhh” while depressing tongue with tongue blade and observing rise of soft palate and uvula
CN IX & X - Sensory function
Induce client’s gag reflex (do NOT perform in lab practice)
CN IX & X - Taste
Test taste on posterior portion of tongue by placing something sweet, salty, or sour at the back of the client’s tongue
CN XI Place hands on client’s shoulders, and have him shrug shoulders against resistance; have client turn head from side to side against resistance
CN XII Have client say “d”, “l”, “n”, “t”; have client protrude tongue and move it from side to side
Neuro examPart 1 http://www.youtube.com/watch?
v=nABAdENIbXY&feature=related Part 2 http://www.youtube.com/watch?
v=_1Rd1wVeqU4&feature=related