Neurologic System

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Neurologic System

• The Motor System and the Cerebellar Function

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Motor Pathways Type of Movements

• Corticospinal or Pyramidal Tract
• Voluntary, skilled, discrete, purposeful
  (writing)
• Extrapyramidal Tracts
• Maintain muscle tone and control body movements
  (walking)
• Cerebellar System
• Coordinates movement, maintains equilibrium and
  posture.Operates on subconsious level

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Question for Thought

• Describe 3 major motor pathways in the CNS
  including the type of movements mediated by each?

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Chapter 21

• Cerebral Cortex

Figure 21-1. p. 688.
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Upper and Lower Motor Neurons

• Upper motor neurons
• All descending motor neurons that impact on the
  lower motor neurons
• Located in the CNS
• Convey impulses from motor areas of cerebral
  cortex to lower motor neurons in the cord
• Diseases CVA, Cerebral palsy, Multiple sclerosis

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Upper and Lower Motor Neurons

• Lower motor neurons
• In the peripheral nervous system
• 12 cranial nerves
• 31 pairs of spinal nerves and all branches
• Final direct contact with the muscles
• Movement translated into action
• Reflex arc
• Examples cranial nerves, spinal nerves
• Diseases spinal cord lesions, poliomyelitis, ALS

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Question for Thought

• Differentiate an upper motor neuron from a lower
  motor neuron?

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Subjective Data

• In the Interview
• Any shakes or tremors in the hands or face?
• Worsen with anxiety, fatigue
• Relieved with activity, alcohol
• ADLs affected
• Weakness
• Where? When? Why?

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Subjective Data

• Incoordination
• Balance, falling,
• Legs give out
• Clumsy
• Numbness/ Tingling
• Describe ( pins and needles)
• Significant past history
• TIAs, Atrial Fib.

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Assessment of Motor System

• Body position
• Involuntary movements
• Muscle size ( bulk)
• Muscle tone
• Muscle strength

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Body Position

• Observe during movement
• Observe at rest

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Involuntary Movements

• Tremors, tics, fasciculations, myoclonus
• Note
• Location
• Quality
• Rate
• Rhythm
• Amplitude

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Involuntary Movements

• Note the involuntary movement in relation to
• Posture
• Activity
• Fatigue
• Emotion
• Other factors

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Terms to Describe Movement

• Flexion
• Extension
• Abduction
• Adduction
• Pronation
• Supination

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More Terms for Movement

• Circumduction
• Inversion
• Eversion
• Rotation
• Protraction

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Terms of Movement Continued

• Retraction
• Elevation
• Depression

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Muscle Size

• Compare size and contour
• Atrophy
• Unilateral/bilateral
• Proximal/distal

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Muscle Tone

• A relaxed muscle maintains a slight residual
  tension referred to as muscle tone.
• Hypo tonic, Flaccidity.
• Spasticity.
• Lead-pipe rigidity.

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Muscle Strength

• Test muscle strength by asking the client to move
  actively against your resistance or to resist
  your movement.
• A muscle is strongest when shortest and weakest
  when longest.

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Terms to Describe Strength

• Weakness (paresis)
• Paralysis (plegia)
• Hemiparesis
• Hemiplegia
• Paraplegia
• Quadriplegia

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Grading Muscle Strength

• Scale 0-5
• 0 - no muscular contraction
• 1 slight contraction
• 2 Full ROM, gravity eliminated

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Grading Muscle Strength

• 3 Full ROM against gravity
• 4 Full ROM against gravity, some resistance
• 5 Full ROM against gravity full resistance
  without evident fatigue Normal Muscle Strength

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Cerebellar Function

• Balance tests
• Gait
• Observe normal walk
• Tandem Walking ( heel to- toe )
• Romberg Test (stand, feet together, arms at
  side, close eyes)
• Shallow knee bend or hop on one leg
• What findings would you expect to see when
  assessing gait and balance in an older adult?

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Cerebellar Function

• Coordination and Skilled Movements
• RAM ( Rapid alternating movements)
• Pat Knees
• Thumb to each finger
• Finger to finger
• Finger to nose
• Heel to shin

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Question for Thought

• List and describe 3 tests of cerebellar function?

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Charting Sample

• For Normal Muscle Strength (objective)
• Able to maintain flexion against resistance and
  without tenderness
• For Motor ( objective)
• No atrophy, weakness or tremors. Gait smooth and
  coordinated, able to tandem walk, negative
  Romberg. RAM, finger-to-nose smoothly intact