What are some topics to ask PT during neuro exam?
~seizures, triggers them
~hx of head injury or loss of consciousness
~change in vision, speech, ability to think clearly,memory loss, changein memory, or behavior
~ weakness, numbing,tremors,tingling (where?)
PT is responsive and able to open eyes and answer questions spontaneously and appropriately.
PT responds to light shaking but can be confused and slow
PT is able to open their eyes and respond but is drowsy and falls asleep easily
PT requires painful stimuli to achieve a brief response. PT might not be able to respond verbally
There is no response to painful stimuli
Flexion and internal rotation of upper extremity joints and legs
Abnormal posturing: decorticate rigidity
Neck and elbow extension with the wrists and fingers flexed
Abnormal posturing: decerebrated posturing
Cranial nerve 1
Cranial nerve 2
Visual acuity, visual fields
Cranial nerve 3, 4, 6
~ 3 Oculomotor
PERRLA, six cardinal positions of gaze
Cranial nerve 5
~sensory: light touch sensation to face [forehead, neck,jaw]
~motor:jaw opening,clenching, chewing
Cranial nerve 7
~sensory: taste (salt/sweet) on anterior 2/3 of tongue
Cranial nerve 8
Hearing and balance
Cranial nerve 9
~ Sensory: taste (sour/bitter) on posterior third of tongue
~ motor: swallowing, speech sounds, gag reflex
Cranial nerve 10
~sensory: gag reflex
~motor: swallowing-speech quality
Cranial nerve 11
Motor.: turning head, shrugging shoulders
Cranial nerve 12
Use the mini-mental state examination to:
Assess cognitive status objectively
Mini Mental State Examination evaluates:
~ orientation to time and place
~ attention and calculation to counting backward by sevens
~ registration and recalling of objects
~language (naming objects) following commands,ability to write
What would you use to establish a baseline of the PT's level of consciousness and ongoing assessment?
Glasgow coma scale
What is the highest GCS value that indicates full consciousness?
Expected findings of PTs coordination
Smooth, coordinated movements
Expected findings of PTs gait
Steady, smooth, and coordinated
2 tests that assess balance
Romberg, and heel-to-toe walk
How do you do a Romberg test? Expected results?
Ask PT to stand with feet together, arms at both sides and eyes closed
PT stands with minimal swaying for at least 5 seconds
Heel-to-toe walk? Expected results?
Ask PT to place heel of one foot in front of toesot other foot as they walk in straight line.
PT walks in straight line without losing balance
Assessing muscle strength?
ask patient to press against resistance
~ strength is equal or slightly stronger on dominant side
Place a familiar object in clients hand and ask them to identify it.
DTR response 4+
Very brisk with clonus
DTR response 3+
More brisk than average
DTR response 2+
DTR response 1+
DTR response 0