Neurology

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• Neurology
• The nervous system divided into 2 parts central
  and peripheral
  
• Central Nervous System (CNS) included
  brain and spinal cord
  
• Peripheral system 12 pairs of cranial
• nerves,31 pairs of spinal nerves all their
• branches
• CNS-composed of cerebral cortex, basal ganglia,
  thalamus, hypothalamus, cerebellum, brain stem,
  spinal cord
  
• Cerebral Cortex- cerebrums outer layer
• 2 hemispheres
• 4 lobes in each hemisphere

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• Basal Ganglia-controls movements of the body
• Thalmus-main relay station for nervous system
• Hypothalamus-controls vital functions as
  temperature, heart rate, B/P, sleep center,
  anterior posterior pituitary gland regulator,
  coordinator of autonomic nervous system
  emotional status.
• Cerebellum-motor coordination of voluntary
  movement, equilibrium and muscle tone
  
• Brain Stem-central core of brain 3 areas
  Midbrain, Pons, Medulla
  

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• Spinal Cord-main highway for ascending
  descending fiber tracts which connect brain to
  spinal nerves mediates reflexes
  
• Pathways of CNS
• Sensory pathway- sensory receptors 2 tracts
• Spinothalamic tract Posterior (dorsal) columns
• Motor pathways-includes the corticospinal or
  pyramidal tract, extrapyramidal tract, and
  cerebellar system
  
• Peripheral Nervous System composed of
• Reflex arc
• Cranial nerves (12 pair)

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• Spinal nerves (31 pairs) 8 cervical, 12
  thoracic, 5 lumbar, 5 sacra and 1 coccygeal
  
• Test Cranial Nerves
• Cranial Nerve I- Olfactory nerve- do not test
• routine. Sense of smell
• 2. Cranial Nerve II- Optic nerve- test visual
  acuity
  
• and visual fields
• 3. Cranial Nerves III- Oculomotor, raises
  eyelids,
  
• constriction pupil, lens shape
• 4. Cranial Nerve IV- Trochlear- eye movement up
• down

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5. Cranial Nerve V- Trigeminal- muscles of
mastication, sensation of face scalp, mucous
membranes of mouth nose 6. Cranial Nerve VI-Ab
ducens- lateral movement of eye
7. Cranial Nerve VII-Facial-facial muscles, close
eye, labia speech, Taste (sweet, sour, salty,
bitter), saliva tear secretion
8. Cranial Nerve VIII- Acoustic- Hearing
equilibrium 9. Cranial Nerve IX- Glossopharyngeal
- Motor- phonation swallowing Sensory-taste
on tongue, pharynx( gag reflex)
parasympathetic-carotid reflex
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• 10. Cranial Nerve X- Vagus-talking swallowing
• general sensation from carotid body,
  carotid
  
• sinus, pharynx, viscera carotid reflex
• 11. Cranial Nerve XI- Spinal- movement of
• trapezuis sternomastoid muscle
• 12. Cranial Nerve XII-Hypoglossal-movement of
• tongue
• Subjective Data
• Questions to ask your clients
• Headache- how started, how often, associated
• with anything
• 2. Head injury-if had one describe, where it,
  loss of
  
• loss of consciousness, how long

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• Dizziness, vertigo- (rotational spinning
  sensation), how often, does it occur with any
  activity Syncope (sudden loss of strength,
  temporary loss of consciousness due to lack of
  cerebral blood flow, a faint)
• Seizures-how often, when started, what happens,
  does it go through whole body, associated with
  (color, loss of consciousness LOC,
  precipitating factors, medications taken), do you
  an AURA ( subjective sensation precedes seizure)
• Tremors-(involuntary shaking, vibrating, or
  trembling), affect hands or face, how started,
  

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• how relieved
• 6. Weakness-what in any part of the body
  (Paresis)partial or incomplete paralysis
  (Paralysis) loss of motor function due to lesion
  in the neurological or muscular system or loss of
  sensory innervation.
• Incoordination- any problem with balance
  (Dysmetria) inability to control ROM of muscles
  
• Numbness or tingling- what part of body, pins
  needles (Paresthesia)-abnormal sensation as
  burning, tingling
  
• Difficulty swallowing-solid or liquids,drooling

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• 11. Difficulty speaking- forming words, how long,
  when did you notice this
  
• Significant past history- stoke, spinal cord
  injury, etc
  
• 13. Environmental/occupational hazards

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• Vocabulary
• Astereognosis- inability to identify object
  correctly.
  
• Clonus- set of short jerking contractions of
  same
  
• muscle
• Vertigo- rotational spinning
• Anosmia- decrease or loss of smell
• Ptosis-drooping
• Strabismus-deviated gaze or limited movement
• Syncope- sudden loss of strength, temporary
• LOC, (Faint)
• Nystagmus-back forth oscillation of the eyes
• Atrophy- abnormally small muscles with a wasted
• appearance

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• Hypertrophy- increased size and strength
• Flaccidity-decreased resistance
• Ataxia- uncoordination or unsteady gait
• Hypoesthesia- decreased touch sensation
• Anesthesia- absent touch sensation
• Hyperesthesia- increased touch sensation
• Hypalgesia-decreased pain sensation
• Analgesia- absent pain sensation
• Hyperalgesia- increased pain sensation

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TESTS Romberg Test- ask client to stand
with feet to- together and arms at side, cl
ose eyes and hold position. Positive Romber
g sign is loss of balance that occurs when
closing the eyes. Rapid Alternating Movement
(RAM)-while sit- ting pat their knees w
ith both hands, lift up, turn
hands over, and pat the knees with the backs
of their hands Finger to Finger Test-
eyes open, have client use index finger to
touch your finger, then his/ her
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• own nose, try different spots.
• Finger to nose test-close eyes and stretch
  out
  
• arm. Touch tip of own nose with each
  index
  
• finger, alternating hands increasing
  speed
  
• Heel to Shin Test- on spine position, place
  heel
  
• on opposite knee, run it down shin from
  knee to
  
• ankle
• Test for pain- break a tongue blade
  lengthwise,
  
• has a fractured end and dull end. Have
  client
  
• close eyes. Randomly ask client if sharp
  or dull
  
• always allow a few seconds between each
• stimulation

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• Finger- to Finger Test- eyes open, ask
• person to use his index finger touch your
• finger, then touch their nose, then move
• your finger to different spots.
• Finger to nose test- close their eyes
• stretch out the arm touch their nose,
• then alternate with other hand, continue
• to do so with increase speed
• Heel to Shin Test-In supine position,
• place heel on opposite knee and run it
• down shin from knee to ankle, normally
• heel is in a straight line.

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• Temperature-only test if pain sensation is
• abnormal.
• Light Touch-apply a wisp of cotton to the
  skin at
  
• different area of the body, ask what area
  being
  
• touch.
• Vibration-using a low pitch tuning fork,
  vibration
  
• has slower decay, ask client when the
  vibrations
  
• start and stop.
• Position( Kinesthesia)- demonstrate to
  client
  
• how you will move finger or toe up and
  down.
  
• Have client closed eye and do same
• Stereognosis- test clients ability to
  recognize
  
• objects by feeling their forms, sizes
  weights.
  

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• use familiar object as paper clip, coin,
  key,
  
• pencil
• Graphesthesia- ability to read number be-
• ing traces on skin with eyes closed
• Biceps Reflex- pg 687
• Triceps Reflex- pg 687
• Brachioradialis Reflex- pg 688
• Quadriceps Reflex- pg 688
• Achilles Reflex- pg 689
• Clonus- Pg 690
• Abdominal Reflex pg 690

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• Neurological Check
• Level of Consciousness (LOC)- most import-ant
  factor in this exam. Easily aroused, orient-
  
• ation, person, place, and time
• 2. Motor Function- ask client to lift eyebrow,
• frown, bare teeth note symmetric facial move
• ment check upper strength by grasping your
• hand squeeze. See pg 702
• 3. Pupillary Response- note size, shape and
  symmetry of both pupils and record
  
• 4. Vital signs-T,P,R,B/P- any changes may in-
• dicate consequences of rising intracranial
  pressure
  

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• Glasgow Coma Scale (GCS)-scale divided
• into 3 area eye opening, verbal response,
• and motor response. Scored of 15 person
• alert and normal, score of 7 or less coma.

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Range Of Movement (ROM) 1.Flexion- bending a
limb at a joint 2.Extension- straightening a limb
at a joint 3.Abduction- moving a limb away from
the midline of the body 4.Abduction- moving
a limb toward the midline of the body 5.Prona
tion- turning the forearm so that the palm
is down 6.Supination- turning the forearm so t
hat the palm is up 7.Circumduction- moving th
e arm in a circle around the shoulder
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8. Inversion- moving the sole of the foot inward
at the ankle 9. Eversion- moving the sole of
the foot outward at the ankle 10.Rotation-
moving the hear around a central axis
11.Protraction- moving a body part forward
and parallel to the ground
12.Retraction- moving a body part backward
and parallel to the ground
13.Elevation- raising a body part
14.Depression- lowering a body part
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• INFANTS
• Neurological system not completely developed
• at birth shows dramatic growth
  development
  
• at 1st year.
• At birth newborn very alert, eyes open and
• demonstrates strong urgent sucking. Cry loud
• lusty and even angry
• Next 2-3days mostly sleeps
• 2 months smiles responsively recognizes
• parents face.
• 4 months babbling after 9 months uses mama
• dada

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• Testing cranial Nerve Function for Infants-
• pg 691
• Motor System observe for smoothness
• symmetry newborn favors flexed position
• extremities symmetrical folded inward,
• hips slightly abducted, fists tightly flexed
• After 2 months flexion fives away to
• to extension
• Fits tight flexion for first 3 months
• Purposeful reach for objects with both
• hands around 4 month

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• transfers things from hand to hand 7 months
• purposeful release of things at 10 months
• ambidextrous at 18 months
• supine position newborn holds head in same
• plan as body but flops forward
• 4mo. Head stays in line with body and doesnt
• flop.
• Lifts baby in prone position with 1 hand
• supporting the chest head 450 or less from
• horizontal back straight or slightly arches
• elbows knees partly flexed
• 3 mo. Raises head arches back as in swan
• dive (Landau Reflex)

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• Infantile automatisms-check to rooting, gasp,
• tonic neck Moro reflexes
• Rooting-brush side of check, infant turns
• head toward that side opens mouth
• appears birth disappears 3-4 mo.
• Sucking- touch lips offers gloved finger
  to suck appears birth disappears 10-12 mo.
  
• Palmar Grasp- Palmar grasp- head
  midline ensure symmetric response your fingers
  babys, away from thumb, baby grasp fingers and
  can you can pull baby to sit up appears at
  birth strong 1- 2 mo disappears 3-4 mo

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• Plantar- your thumb touch ball of infants foot,
  note toes curls downward, appears at birth
  disappears at 8-10 mo
  
• Babinskis reflex-stroke finger ip lateral edge
  across ball of babys foot note fanning of toes
  positive Babinski present at birth disappears at
  24 mo
• Tonic Neck reflex-infant supine, relaxed or
  sleeping, head turned to 1 side chin down over
  shoulder, ipsilateral extension of arm leg and
  flexion of opposite arm leg when turn head to
  opposite side position reverse appears 2-3

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• mo and decrease 3-4 mo. disappears at 4-6 mo
• Moro reflex- startle infant by jarring crib, loud
  noise infants looks like hugging tree present
  at birth disappears at 1-4 mo.
  
• Placing reflex- hold infant upright under arms
  close to table top of feet touch table note flex
  of hip knees reflex appears at birth
  disappears 4 days
• Steeping reflex- hold infant under arms with feet
  on surface, note alternating steps disappears
  before regular walking
  

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• Older Adults
• Aging process causes general atrophy
• Causes decrease in weight
• Reaction time slower
• Muscle strength and agility decrease
• Decrease in muscle bulk
• Tremors may occur in hands, head jaw
• Possible repetitive facial grimacing
  (Dyskinesias)
  
• Decrease in cerebral blood flow O2 consumption
• May cause dizziness loss of balance ( Need to
  teach people to get up slowly otherwise risk of
  falling