Neuro Lab Practical 2 all information

Perform C5 nerve root evaluation
-dermatome examination
- muscle strength examination
- reflex (MSR)
-state all the muscles, nerves, grades

Perform ciliospinal reflex
-when would you perform this?
-state normal and abnormal

demonstrate the diplegic gait
-name an associated condition
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Terms in this set (16)
-dermatome: lateral arm
-myotome: Deltoid: shoulder abduction: nerve: axillary; Biceps: elbow flexion: nerve: musculocutaneous
-reflex: Biceps: response: elbow flexion: nerve: musculocutaneous

Ciliospinal reflex: pinch trap and watch for dilation
-when you perform: noticing a patient with blow pupil
Normal: dilation of both eyes equally
abnormal: lack of dilation or uneven dilation

Diplegic gait:
-Bilateral, worse in lower extremity
-narrow gait
-dragging legs and scraping toes
-very tight adductors
Associated condition: cerebral palsy
-dermatome: lateral forearm to thumb
-myotome: extensor carpi radialis longus, extensor carpi ulnaris: wrist extension: nerve: radial
-reflex: brachioradialis: elbow flexion: nerve: radial

CN 8-cochlear exam:
Finger rub test
-patient closes eyes and covers opposite ear
-Rub fingers together: ask "can you hear this? Tell me when the sound stops
-move fingers away from patient
Rinne test
Weber test
-dermatome: midline of palm through 3rd digit
-myotome: triceps: elbow extension: nerve: radial; flexor carpi radialis: wrist flexion: nerve: median; flexor carpi ulnaris: wrist flexion: nerve: ulnar; extensor digitorum, extensor digiti minimi, extensor indicis profundus: finger extension: nerve: radial
-reflex: triceps: elbow extension: radial nerve

CN 12 examination:
-inspect tongue for atrophy, fasciculation, deviation
-tongue to cheek
-dermatome: medial forearm through 5th digit
-myotome: flexor digitorum superficialis, flexor digitorum profundus, lumbricals: finger flexion: nerve: median/ulnar nerve
-reflex: finger flexors: finger flexion: median/ulnar

CN 7 evaluation:
-ask about any changes in taste sensations sweet, salt, and sour on anterior 2/3rds of the tongue
-ask about hearing changes
- inspect face for asymmetry
- perform: raising eyebrows, close eyes tightly, puff out cheeks, smile, frown

Hemiplegic gait:
-arm flexed, adduct, internal rotation
-leg extension
-foot and toe drop
-circumduction of the leg
associated symptom: cortical stroke
-dermatome: medial arm
-myotome: dorsal interossei: finger abduction: nerve: ulnar; palmar interossei: finger adduction: nerve: ulnar

Dorsal column testing:
-Vibration: use 128 Hz tuning fork on bony structures
-Joint position sense: close eyes, move PIP up and down ask to identify if it is up and down
-Romberg test: stand with feet together and have them close eyes (swaying/falling=dorsal column Involvement)
dermatome: lateral to medial distal 2/3rd of thigh
myotome: Hip flexors: Iliacus and psoas: nerve: femoral

CN 9 and 10:
-ask patient "have you had any hoarseness of the voice? have you had any change in bitter tase sensation on the posterior 1/3rd of the tongue."
-have the patient swallow
-have patient say ah and watch uvula (normal: bilateral rising of soft palate; abnormal: unilateral rising- deviates AWAY from lesion)
-gag reflex
-carotid sinus reflex

Hemiplegic gait:
-arm flexed, adduct, internal rotation
-leg extension
-foot and toe drop
-circumduction of the leg
associated symptom: cortical stroke
-dermatome: medial leg along side to side of big toe
-myotome: tibialis anterior: ankle inversion/slight dorsiflexion: nerve: Deep peroneal; quads: knee extension: femoral
reflex: patellar: knee extension: femoral nerve

Ataxic/cerebellar gait:
-wide-base gait
-may sway
associated condition: cerebellar disease

Inverted supinator sign:
-clinical relevance: UMNL
-normal: elbow flexion
abnormal: finger flexion
-dermatome: lateral leg to dorsum of foot to web of toe 1 and 2
-myotome: extensor hallicus longus: nerve: deep peroneal; Tibialis anterior: ankle dorsiflexion: nerve: deep peroneal; glute med/min: hip abduction: nerve: superior gluteal
reflex: Medial hamstring: contraction: tibial nerve

CN 11:
-Trap: inspect, palpate, muscle test
-SCM: inspect, palpate, muscle test
-dermatome: lateral foot to tip of pinkie toe
-myotome: glute max: hip extensors: inferior gluteal; peroneals: ankle plantar flexion/eversion: superficial peroneal; gastrocnemius/soleus: ankle plantar flexion: tibial
reflex: achilles: plantar flexion: tibial nerve

CN 1 examination:
-ask "do you have any disorders of smell or taste?"
-check that everything is clear (have them breathe in and out)
-close eyes, occlude one nostril, then smell the coffee then cinnamon
-"do you smell anything? what do you smell?"
normal: normal smell
abnormal: uni/bilateral changes in smell
Perform the following tests:
-ankle clonus: state normal, abnormal, and clinical relevance
-Plantar response: state normal, abnormal, and clinical relevance
-Hoffman's: state normal, abnormal, and clinical relevance
-Heel walk: state normal, abnormal, and clinical relevance
-Demonstrate Sensory Gait: state normal, abnormal, and clinical relevance
-Demonstrate Choreiform gait: state normal, abnormal, and clinical relevance
ankle clonus:
-normal: nothing
-abnormal: continued involuntary contractions
-clinical relevance: UMNL

plantar response:
-normal: plantar flexion of great toe and toes 2-5
-abnormal: dorsiflexion of great toe and fanning of toes 2-5
-clinical relevance: UMNL

-normal: nothing
-abnormal: approximation of the 1st and 2nd digit
-clinical relevance: UMNL

heel walk:
-normal: can walk on heels
-abnormal: unable to walk on heels
-clinical relevance: L4/L5 disc lesion (L5 nerve root)

Sensory gait:
-slams foot on ground hard
-associated condition: uncontrolled diabetes

Choreiform gait:
-involuntary, irregular, and jerky movements
-all 4 extremities involved
-associated condition: huntington's disease
Perform CN 8- Vestibular Examination -state normal and abnormal with each testCN 8: Tandem gait: -stand behind patient, have them walk heel-to-toe with eyes open, repeat with eyes closed -normal: walk without swaying -abnormal: swaying Vestibular Ocular Reflex (VOR): -Stand in front of patient and have them fixate on a spot on your face, turn patients head into rotation, lateral flexion, flexion/extension -normal: eyes stay fixated -abnormal: cant maintain fixation Head Impulse Test (HIT): -rotate head fast -normal: remain fixated -abnormal: refixation saccade is present Dix-Hallpike: -patient seated legs extended, rotate head 45 degrees, extend patient and let head extend looking for nystagmus -normal: no nystagmus -abnormal: nystagmus Epley's Maneuver: -from dix-hallpike wait 20 seconds, rotate head to other side, patient lay on side (face is towards ground), support head and bring patient up with head still rotated normal: no nystagmus Pathological signs: BPPV, strokePerform Cerebellar examination -State normal associated with each test Demonstrate a Neuropathic GaitRapid alternating movements: -patting -supination/pronation -normal: can do it -abnormal: cannot alternate between movements rebound test: -arms extended, dr. push/pulls on arms -normal: can hold -abnormal cannot hold dysmetria: finger-nose-finger test: -patient touches your index finger and then their nose several times (test all 4 quadrants) -normal: can do it -abnormal: overshooting Dysmetria: heel-shin: patient supine, run heel of foot along shin to tip of their foot -normal: can do it -abnormal: unsteadyPerform Somatosensory Tests Demonstrate parkinsonian Gait Perform Toe walk test -state abnormal -what does this indicate?Somatosensory tests: point localization: sharp vs. dull: graphesthesia: two point discrimination: Parkinsonian gait: -entire upper body in flexion and knee flexion -stooped with head and neck forward -difficult initiating, little steps condition associated: Parkinson's disease Toe walk: -have patient walk on tippy toes -normal: can do it abnormal: cannot do it indicate: S1 nerve root- L5/S1 disc lesionPerform CN 3 evaluation-State you are checking for ptosis, anisocoria, and blepharospasm -Perform direct and indirect lighting normal direct: pupil constricts abnormal direct: pupil doesnt constrict normal indirect: opposite pupil constricts abnormal indirect: opposite pupil doesn't constrict Convergence/divergence test: -normal: both eyes abduct and adduct -abnormal: one eye fails Cardinal field of gaze: -H in space -X in space Cover-uncover test: -abnormal: eye goes any direction besides centralPerform CN 2 evaluation -Please ask for your question whenever you are readyTest Visual acuity: snellen chart Peripheral Vision Examination: -test all 4 quadrants (GO SLOW) and test bilaterally Perform direct and indirect lighting normal direct: pupil constricts abnormal direct: pupil doesnt constrict normal indirect: opposite pupil constricts abnormal indirect: opposite pupil doesn't constrict Convergence/divergence test: -normal: both eyes abduct and adduct -abnormal: one eye failsPerform CN 5 examinationOcculocardiac Reflex: take pulse, apply pressure to closed eye, pulse should decrease Corneal reflex: poke cornea with cotton ball Pain: pinwheel on 3 divisions Light touch: cotton on 3 divisions Motor exam: palpate masseter, temporalis at rest and contraction, muscle test jaw opening muscles