Assessments Ch 23 – Neurologic System

loss of ability to recognize importance of sensory impressions

loss of ability to express thoughts in writing

loss of memory

loss of pain sensation

loss of power of expression by speech, writing, or signs, or loss of comprehension of spoken or written language.

loss of ability to perform purposeful movements in the absence of sensory or motor damage such as the inability to use objects correctly.

inability to perform coordinated movements.

bizarre, slow, twisting, writhing movement, resembling a snake or worm

sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face.

rapidly alternating involuntary contraction and relaxation of a muscle in response to sudden stretch

state of profound unconsciousness from which person cannot be aroused.

arms stiffly extended, adducted, internally rotated; legs stiffly extended, plantar-flexed.

arms adducted and flexed, wrists and fingers flexed; legs extended, internally rotated, plantar-flexed.

imperfect articulation of speech due to problems of muscular control resulting from central or peripheral nervous system damage.

impairment in speech consisting of lack of coordination and inability to arrange words in their proper order.

disappearance of conditioned response

rapid continuous twitching of resting muscle without movement of limbs

loss of muscle tone, limp

ability to "read" a number by having it traced on the skin

loss of motor power, paralysis, on one side of the body, usually caused by a stroke; paralysis occurs on side opposite the lesion.

motor neuron in the peripheral nervous system with its nerve fiber extending out to the muscle and only its cell body in the central nervous system

rapid sudden jerk of a muscle

stiffness in cervical neck area

back and forth oscillation of the eyes

prolonged arching of back, with head and heels bent backward, and meningeal irritation

decreased or loss of motor function due to problem with motor nerve or muscle fibers

impairment or loss of motor and/or sensory function in the lower half of the body

abnormal sensation, burning, numbness, tingling, prickling, crawling, skin sensation

ability of the person to discriminate exactly where on the body the skin has been touched

sensory information concerning body movements and position of the body in space

continuous resistance to stretching by a muscle due to abnormally increased tension, with increased deep tendon reflexes

ability to recognize objects by feeling their form, size and weight while the eyes are closed

Is the center for humans highest functions governing thought, memory, reasoning, sensation and voluntary movement.

Area Concerned with personality, behavior, emotions, and intellectual function.

Postcentral gyrus: Primary center for sensation

Primary auditory receptor center with functions in hearing, taste, and smell

Associated with language comprehension. When damaged, receptive aphasia results meaning the person hears sound, but it has no meaning. Ex. Like hearing a foreign language

In frontal lobe, mediates motor speech. When injured, expressive aphasia results meaning the person cannot talk. Ex. Can understand language and know what he wants to say but can't produce the language.

large bands of gray matter buried deep within the 2 cerebral hemispheres that form the subcortical associated motor system. They help to initiate and coordinate movement and control automatic associated movements of the body. Ex. Arm swing alternating with legs while walking.

Main relay station where sensory pathways of the spinal cord, cerebellum, and brainstem form synapses on their way to the cerebral cortex.

sites of contact between two neurons

Major respiratory center with basic vital functions: temp, appetite, sex drive, heart rate, and blood pressure control, sleep center, anterior and posterior pituitary gland regulator, and coordinator of autonomic nervous system activity and stress response.

Coiled structure under occipital lobe that is concerned with motor coordination of voluntary movements, equilibrium and muscle tone. Does NOT initiate movement but coordinates and smoothes. Ex. the complex and quick coordination of many different muscles needed in playing piano, swimming, juggling

postural balance of body

most anterior part of brainstem that still has the basic tubular structure of the spinal cord; merges into the thalamus and hypothalamus; contains motor neurons and tracts.

Enlarged area of brainstem, containing ascending sensory and descending motor tracts. Includes the pneuotaxic and apneustic respiratory centers that coordinate with the main respiratory center in the medulla.

Continuation of spinal cord in the brain that contains all ascending and descending fiber tracts; has vital autonomic centers of respiration, heart GI function, as well as nuclei for cranial nerves VIII - XII. Pyramidal decussation happens here: crossing of motor fibers.

Long, cylindric structure of nervous tissue; occupies upper two-thirds of the vertebral canal from the medulla to lumbar vertebrae L1-L2. Its white matter is bundles of myelinated axons that form main highway for ascending and descending fiber tracts that connect brain to spinal nerves; it mediates reflexes of posture control, urination, pain response; its nerve cell bodies, or gray matter, are arranged in a butterfly shape with anterior and posterior "horns".

The spinothalamic tract transmits sensations of pain, temperature, and crude or light touch. The posterior (dorsal) column allows position (proprioception) without looking resulting in knowledge of where your body parts are in space and in relation to each other. Vibration is the feeling of vibrating objects. Stereognosis is finely localized touch where you can identify familiar objects by touch (travel to thalamus).

Corticospinal or pyramidal tract: permits humans to have very skilled and purposeful movements. Extrapyramidal tract: originates in the motor cortex, basal ganglia brainstem, and spinal cord; these subcortical motor fibers maintain muscle tone and control body movements, especially gross automatic movements such as walking. Cerebellar system: coordinates movement, maintains equilibrium, and helps maintain posture; receives information about the position of muscles and joints, the body's equilibrium, and what kind of motor messages are being sent from the cortex to the muscles on feedback pathways.

Upper motor neuron: located in the CNS, they are a complex of descending motor fibers that can influence or modify the lower motor neurons. They convey impulses from motor areas of the cerebral cortex to the lower motor neurons in the anterior horn. Lower motor neuron: located in the PNS, the cell body of the lower motor neuron is located in the anterior gray column of the spinal cord, with nerve fiber extending from to the muscle. Many neural signals spark here providing the final direct contact with muscles.

1. an intact sensory nerve (afferent) 2. a functional synapse in the cord 3. an intact motor nerve fiber (efferent) 4. neuromuscular junction 5. a competent muscle

Assess: headache, head injury, dizziness/vertigo, seizures, tremors, weakness, incoordination, numbness or tingling, difficulty swallowing, difficulty swallowing, difficulty speaking, significant past history (stroke, spinal cord injury, meningitis), and environmental/occupational hazards

Observe as the patient walks 10 to 20 feet, turns, and returns to the starting point. Observe a heel-to-toe walk and a walk on tip-toes to assess balance. The normal gait should be smooth, rhythmic, and effortless with a coordinated opposing arm swing and smooth turns. An uncoordinated or unsteady gait are abnormal. The Romberg Test has the patient stand up with feet together and arms at the sides. Once in a stable position, ask them to close the eyes and to hold the position. Test the shallow knee bend or to hop in place, first on one leg, then the other followed by rapid alternating movements and pats on the knees with hands. The finger-to-finger test asks the client to use their index finger to touch your finger then or his own nose as the position of your finger changes. The finger-to nose test ask the patient to touch the tip of his nose with each index finger while alternating hands and increasing speed. The heel-to-shin test places the heel on the opposite knee followed by running it down the shin from the knee to the ankle.

Pain: break a tongue blade for a "sharp" and "dull" side. Lightly apply the sharp point or the dull end to the person's body in a random, unpredictable order. Ask the person to say "sharp" or "dull" depending on the sensation felt. --Abnormal findings: ---hypoalgesia- decreased pain sensation ---hyperalgesia-increased pain sensation Temperature: place the flat side of the tuning fork on the skin; its metal always feels cool. Light touch: wisp of cotton over the arms, forearms, hands, chest, thighs and legs. Ask the person to say "now" or "yes" when touch is felt. ---abnormal findings: ---hypoesthesia- decreased touch sensation ---anesthesia- absent touch sensation ---hyperesthesia- increased touch

4+ very brisk, hyperactive with clonus, indicative of disease 3+ brisker than average, may indicate disease, probably normal 2+ average, normal 1+ diminished, low normal, or occurs only with reinforcement 0 no response

Biceps reflex: C5-C6 - blow to biceps tendon triceps reflex: (C5-C6)--blow to biceps tendon quadriceps reflex: (C2-C4)--(knee jerk) strike tendon just below patella Achilles reflex: (C5-S2): ankle jerk

Level of consciousness: check orientation to the place and time; note the quality and the content of the verbal response: articulation, fluency, manner of thinking, and any deficit in language comprehension or production. Motor function: giving the person specific commands: lift the eyebrows, frown, bare teeth; check upper arm strength by checking hand grasps; ask person to lift hand up; check lower by having them lift their leg. Pupillary response: note the size, shape, and symmetry of both pupils: shine a light into each pupil and note the direct and consensual light reflex. Both pupils should constrict briskly. Vital signs: blood pressure is notoriously an unreliable parameters of CNS deficit.

Best eye: opening response: spontaneously, to speech, to pain, no response Best motor response: obeys, verbal command, localizes pain, flexion-withdrawal, flexion-abnormal, extension-abnormal, no response. Best verbal response: conversation-confused, speech, sounds, no response A fully normal person has a score of 15. 7 or less reflects a coma.

Plane of coronal section B Hypothalamus Pituitary Brainstem Spinal cord Medulla Cerebellum pona thalamus corpus callosum internal capsule basil ganglia hypothalamus

1. Olfactory 2. Optic 3. Oculomotor 4. Troclear 5. Trigeminal 6. Abducens 7. facial 8. Acoustic 9. Glossopharyngeal 10. vagus 11. Accessory 12. Hypoglossal

A. difficulty speaking

D. hypothalamus.

C. place a coin in the person's hand and ask them to identify it.

C. S2

B. reinforcement

C. coordination- hopping on one foot.

B. Stroke the lateral aspect of the sole of the foot from heel to across the ball.

A. Dorsiflexion of the big toe and fanning of all toes

B. Is positive when the ipsilateral testicle elevates on stroking of the inner aspect of the thigh.

B. Rigidity and weakness of voluntary movement.

C. Slow, monotonous.

B. Eye opening, motor response to stimuli, and verbal response.

D. The baby raises his head and arches the back, as in a swan dive.

A. The cerebral lobe responsible for these behaviors is the frontal Lobe.

F. Smell

B. Vision

G. Extraocular movement, pupil constriction, down and inward movement of the eyes

K. Down and inward movement of the eye

H. Mastication and sensation of face, scalp, cornea

C. Lateral movement of the eye

L. Tasting anterior 2/3s of tongue, closing eyes.

D. Hearing and equilibrium

I. Phonation, swallowing, tasting posterior third of tongue.

E. Talking, swallowing, and sensory information from pharynx and carotid sinus.

J. Movement of trapezius and sternomastoid muscle

A. movement of the tongue