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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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assessing motor system
Assessing Motor System

Muscle Strength

  • Tone
    • Tension pressure when the muscle is at rest
  • Spasticity
    • Increase muscle tone
  • Rigidity
    • Resistance to passive stretch
slide3
Flaccidity
    • Decreased muscle tone
  • Atrophy
    • Wasting away of muscle
  • Hypotonia
    • Lose of tone or strength
  • Atonia
    • No tone or strength
slide4
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
balance coordination cerebellum assessment
RAM

Rapid Alternating Movement

Pronate / supinate

Balance & Coordination Cerebellum assessment
slide8
Heel to toe walking
  • Hopping in place
slide9
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.
slide10
Romberg
    • Stand feet together arms at side
    • Eyes open
    • Eyes closed 20-30 seconds
    • Slight sway is normal
assessing reflexes
Assessing Reflexes

Grading Scale

0 = No response

+ = hypoactive

++ = Normal

+++ = More active

++++ = Hyperactive

deep tendon reflexes14
Deep Tendon Reflexes

Biceps

  • Thumb on the biceps tendon
  • Strike your thumb with hammer
  • Compare with other arm
deep tendon reflexes15
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.
superficial reflexes protective reflexes
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
superficial reflexes protective reflexes19
Superficial Reflexes (protective reflexes)
  • Gag reflex
    • Test: gently touch posterior pharynx with cotton applicator
    • Normal: (+) elevation of the uvula (gag)
    • Abnormal: (-) No gag
      • NPO
superficial reflexes protective reflexes20
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
vital signs
Vital Signs
  • Temperature
    • With head trauma  increased
vital signs23
Vital Signs
  • Pulse
    • Strength, rate rhythm
    • Bradycardia  indicative of Increased ICP
vital signs24
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
vital signs25
Vital Signs
  • Blood Pressure
    • Right verses left
    • Lying verses standing
    • Difference in systolic by > 20mmHg  potential cerebral ischemia
vital signs26
Pulse Pressure formula:

Systolic – diastolic

120

------ = ?

80

Vital Signs
vital signs27
Vital Signs
  • Pulse Pressure
    • Systolic – diastolic

120

------ = 40

80

    • Normal Pulse pressure = 40
    • Widening pulse pressure = Increased ICP
neuro checks
Neuro Checks
  • LOC
  • Pupils
    • PERRLA
      • Pupils
      • Equal
      • Round
      • Reactive to
      • Light
      • Accommodation
neuro check
Neuro Check
  • Pupils
    • Anisocoria
      • Inequality in the size of the pupils
    • Nystagmus
    • Progressive dilation
      •  Increase ICP
    • Fixed & dilated
      • Injury at level of midbrain
brudzinski s
Brudzinski’s
  • Flexion of the neck  pain and flexion of the knees
  • Indicates
    • Meningitis
  • No not perform if…
    • Neck or back injury
kernig s
Kernig’s
  • Pain with flexion of the hip and knee
  • Indicates
    • meningitis
cushing sign
Cushing Sign
  • Vital sign changes assoc. with Increased ICP
    • Increase in Systolic pressure
    • Widening pulse pressure
    • Bradycardia
    • Bradypnea (slight)
day 2

Day 2

Diagnostic tests