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Neuro Exam/Tests

NPTE Neuromuscular

Myotatic reflex stimulus muscle stretch
Myotatic reflex arc Afferent Ia from muscle spindle to alpha MN and back to muscle
Myotatic reflex function maintenance of muscle tone, support agonsist muscle contraction, provide feedback about muscle length
Myotatic reflex testing DTR
Via an inhibitory IN the myotatic reflex inhibits the antagonist Reciprocal inhibition
Myotatic reflex effect on synergistic muscles facilitation
Inverse myotatic reflex stimulus muscle contraction
Inverse myotatic reflex arc Afferent Ib from GTO via inhibitory IN to muscle
Function of inverse myotatic reflex arc provides agonist inhibition, decreases force of agonist, stretch protection reflex
Allows muscle tension to come under control of descending pathways Gamma reflex loop
Gamma reflex loop path excite gamma MN causing muscle spindle contraction then increased stretch sensitivity and increased firing from spindle afferents then conveyed to alpha MNs
Flexor withdrawal reflex stimulus cutaneous sensory stimuli
Flexor withdrawal reflex arc cutaneous receptors via Ins to flexor muscles
Flexor withdrawal reflex arc function protective withdrawal mechanism
Crossed extension reflex stimulus and response noxious stimuli – Flexors excited with extensor inhibition, opposite on CL side
Crossed extension reflex function coordinates reciprocal limb activities such as gait
3 elements of Glasgow Coma Scale eye opening, motor response, verbal response
Scoring of GCS 3-8 severe, 9-12 moderate, 13-15 minor
State defined by no eye opening even to pain, failure to obey commands, inability to speak Coma
Return of sleep/wake cycles, normalization of basic functions, lack of cognitive responsiveness Vegetative state
Central language DO with speech is awkward, restricted, interrupted, produced with effort Expressive aphasia (Broca’s, nonfluent, motor)
Expressive aphasia result of L hemisphere – Broca’s area
Impairment of volitional articulatory control 2/2 cortical dominant hemisphere lesion Verbal apraxia
Impairment of speech production Dysarthria
Central language DO where spontaneous speech preserved/smooth while auditory comprehension impaired Receptive or Wernicke’s aphasa
Receptive aphasia is result of damage to Posterior frist temporal gyrus of L hemisphere (Wernicke’s area)
Severe aphasia with impairments in comprehension & production of language Global aphasia
Periods of apnea followed by gradually increasing depth/frequency of respirations Cheyne Stokes respiration
Cheyne Stokes caused by depression of frontal lobe and diencephalic dysfunction
Increased rate and depth of respirations Hyperventilation
Hyperventilation can be caused by dysfunction of lowere midbrain and pons
Abnormal respiration with prolonged inspiration Apneustic breathing
Apneustic breathing is result of damage to upper pons
Elevation of temperature may be damage to hypothalamus or brainstem
Signs of meningeal irritation Kernig’s sign, Brudinski’s sign, guarding in neck flexion, photophobia, disorientation, restlessness, persistent HA that increases with head down, altered vitals, weakness
Kernig’s sign meningeal irritation. Supine with flexed hip/knee to chest then extend knee.
Brudzinski’s sign meningeal irritation. Supine, flex neck. Causes flexion of hips/knees
Increased ICP leads to restless, confused, decr LOC, incr BP, widening pulse P & slowed pulse, Cheyne-Stokes, elevated temp, HA, vomiting, unequal pupils, slowed PLRs, dilated pupils*, papilledema, weakness, hemiplegia, Babinski, decorticate or decerebrate rigidity, seizures
Joint position sense test for ability to perceive joint position at rest in response to passive positioning
Kinesthesia movement sense
Pallesthesia vibration sense with tuning fork
Combined cortical sensation testing discriminative sensory tests including Steriognosis, Tactile Localization, Two Point Discrimination, Bilateral Simultaneous Discrimination, Barognosis, Graphesthesia, Texture recognition
Stereognosis ID familiar objects by touch
Two point discrimination ability to recognize one or two blunt points applied to skin simultaneously
Barognosis ability to differentiate weights
Graphesthesia ability to ID numbers, letters or symbols traced on skin
Homonymous hemianopsia loss of half of visual field in each eye contralateral to side of cerebral hemisphere lesion
Somatognosia body scheme disorder – unable to ID body parts or relations to each other
Unilateral neglect patient ignores one side of body and stimuli from that side
Anosognosia severe neglect or denial of severity of condition
Figure ground discrimination spatial relations syndrome with lack of ability to pick out object
Form constancy pick out object from array of similar shapes but different sizes
Spatial relations pt duplicates a pattern of 2-3 blocks
Topographical disorientation navigation of a familiar route
Vertical disorientation inability to accurately determine what is upright
Agnosia inability to recognize familiar objects with one sensory modality
Apraxia inability to perform voluntary learned movements in the absence of loss of sensation , strength, coordination, attention, or comprehension. Breakdown in conceptual or motor production system or both
Ideomotor apraxia cannot perform task on command, but can do independently
Ideational apraxia cannot perform the task at all, either on command or independently
Clasp-knife response marked resistance to PROM suddenly gives way
Clonus maintained stretch stimulus produces cyclical spasmodic contraction, usu plantar flexors or wrist flexors
Babinski DF of great toe with fanning of other toes with stroke to lateral bottom of foot
Babinski indicates corticospinal (pyramidal) tract disruption
Hyperreflexia increased DTRs
Lead pipe Rigidity uniform throughout range
Cogwheel rigidity interrupted by series of jerks
Decerebrate posturing increased tone in extension, seen in brainstem lesions between superior colliculus and vestibular nucleus
Decorticate posturing UEs in flexion, LEs in extension, seen in brainstem lesions above superior colliculus
Opisthotonos arching back of head back and heels with UEs rigidly flexed. Seen in severe meningitis, tetanus, epilepsy, strychnine poisoning
Plantar reflex Normal is PF of toes in response to stroking lateral sole of foot from calcaneus to 5th met, S1-2, tibial nerve
Abdominal reflex T6-L1, lateral to medial scratching of skin to umbilicus in each of 4 quadrants should cause deviation of umbilicus to stimulus
Cremasteric reflex L1-L2, stroking of skin on inner thigh elevates testicle, lost in SCI and Corticospinal lesions
Sources of fatigue CNS/central fatigue, neural/myoneural fatigue, muscle contractile failure
CNS/Central fatigue in MS, ALS, CFS
Neural/myoneural junction fatigue MS, Post Polio syndrome, GBS, myasthenia gravis
Muscle contractile failure fatigue metabolic changes at muscle, muscular dystrophies
Extrapyramidal disorders (basal ganglia dysfunction) Tics, Chorea, athetosis, tremors, myoclonus
Tics spasmodic contractions of specific muscles
Chorea relatively quick twitches or dancing movments
Athetosis slow, irregular, twisting movements, esp in UEs
Tremor continuous quivering mvmt, rhythmic, oscillatory observed at rest
Myoclonus single, quick jerk
Cerebellar disorders cause intention tremors
Cortical disorders cause seizures, tonic/clonic convulsive mvmts
Dyssynergia impaired ability to associate muscles together for complex mvmt
Dysmetria impaired ability to judge distance or range of movement
Dysdiadochokinesia impaired ability to perform rapid alternating movements
Created by: Jenwithonen