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Neurological Assessment- Health Assessment test 4

Terms in this set (93)

-size: compare the right with the left; muscle groups should be within the normal size limits for age and symmetric bilaterally. When muscles in the extremities look asymmetric, measure each in centimeters and record the difference. A difference of 1 cm or less is not significant
-strength: test the power of homologous muscles simultaneously and test muscle groups of the extremities, neck, and trunk
-tone: tone is the moral degree of tension (contraction) in voluntarily relaxed muscles; it shows as a mild resistance to passive stretch; to test muscle tone move the extremities through a passive ROM but firs tell the pt to relax completely and then move each extremity smoothly through a full ROM. Support the arm at the elbow and the leg at the knee; normally you will note a mild, even resistance to movement
-involuntary movements: normally no involuntary movements occur. If they are present, note their location, frequency, rate, and amplitude. Note if the movements can be controlled at will
-Abnormal findings: atrophy: abnormally small muscle with a wasted appearance this occurs with disuse, injury, LMN disease such as polio and diabetic neuropathy; hypertrophy: increased size and strength this occurs with isometric exercise. Paresis or weakness is diminished strength and paralysis or plegia is absence of strength; flaccidity: decreased resistance, hypotonia occur with peripheral weakness; spasticity and rigidity are types of increased resistance that occur with central weakness; tic, tremor, fasciculation, myoclonus, chorea, and athetosis
-use the same examination as use with the younger adult, but be aware that some aging adults show a slower response to your requests, esp. to those calling for coordination of movement
-any decrease in muscle bulk is most apparent in the hand as seen by guttering between the metacarpals
-these dorsal hand grip strength remains relatively good
-senile tremors occasionally occurs, these benign tremors include an intention tremor of the hands, head nodding, and tongue protrusion
-dyskinesias are the repetitive stereotyped movements in the jaw, lips, or the lounge that may accompany senile tremors
-no associated rigidity is present
-the gait may be slower and more deliberate than that in the younger person, and it may deviate slightly from a midline path
-they may have more difficulty performing rapid alternating movement
-after 65 yoa, loss of the sensation of vibration at the ankle malleolus is common and is usually accompanies by loss of ankle jerk
-position sense in the big toe may be lost
-tactile sensation may be impaired
-they may need stronger stimuli for light touch and esp for pain
-the DTRs are less brisk-> those in the upper extremities are usually present, but the ankle jerks commonly are lost
-knee jerks may be lost, but this occurs less often
-Abnormal findings: hand muscle atrophy is worsened with disuse and degenerative arthopathy; distinguish senile tremors from tremors of parkinsonism, the latter includes rigidity of slowness and weakness of voluntary movement; absence of a rhythmic reciprocal gait pattern is seen in parkinsonism and hemiparesis; note any difference in sensation between right and left sides, which may indicate a neurologic deficit; still consider a definite extensor response to be abnormal
-check the voluntary movement of each extremity by giving the person specific commands
-this procedure also tests LOC by noting the person's ability to follow commands
-ask the person to lift eyebrows, frown, bare teeth and note any symmetric facial movements and bilateral nasolabial folds (CN VII)
-you can check upper arm strength by checking hand grasps; ask the person to squeeze your fingers; offer your two fingers, one on top of the other, so a strong hand grasp doesn't hurt your knuckles
-be judicious about asking the person to squeeze your hands. some people with diffuse brain damage, esp. frontal lobe injury have grasp that is a reflex only
-ask the person to lift each hand or to hold up one finger; you can also check upper-extremity strength by palmar drift
-ask the person to extend both arms forward or halfway up, palms up, eyes closed, and hold for 10-20 seconds and normally the arm stays steady with no downward drift
-check lower extremities by asking gate person to do straight leg raises; ask the person to lift one leg at a time straight up off of the bed; full strength allows the leg to be lifted 90 degrees, if multiple trauma, pain, or equipment precludes this motion, ask the person to push one foot at a time against the resistance in your hand "like putting your foot on the gas pedal of your car"
-for the person wit decreased LOC, note if movement occurs spontaneously and as a result of noxious stimuli such as pain or suctioning
-an attempt to push away your hand after such stimuli is called localizing and is characterized as purposeful movement
-Abnormal findings: a weak grip occurs with upper and lower motor neuron disease and with local hand problems (arthritis, carpal tunnel syndrome); profanatory drift is a downward unilateral drift and turing in one of the forearm that occurs with mild hemiparesis; any abnormal posturing, decorticate, rigidity, or decerebrate rigidity indicates diffuse brain injury