Term
| How do you check the ROM of motion for the neck? |
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Definition
Flexion: chin to chest, 45 degrees extension: chin towards ceiling, 45 degrees lateral bending: ear to shoulder, 40 bilaterally rotation: turn head side to side, 70 bilaterally |
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Term
| How should you check ROM for the back flexion? |
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Definition
bend forward at waist and try to touch toes should be 75-90 degrees |
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Term
| How do you check ROM for back hyperextension? |
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Definition
bend back at waist as far as possible should be about 30 degrees |
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Term
| how do you check ROM for back lateral bending? |
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Definition
bend to each side as far as possible should be 35 degrees bilaterally |
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Term
| how do you check ROM for back rotation? |
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Definition
swing the upper trunk from the waist in a circular motion, front to side to back to side, while you stabilize the pelvis. should be 30 degrees forward and backward |
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Term
| how do you position the patient to best check for a spinal abnormality? |
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Definition
| have the pt bend forward and try to touch their toes |
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Term
| ________________: exaggerated lumbar curve |
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Definition
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Term
| who is lordosis common in? |
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Definition
| pts who are markedly obese or pregnant. Also in black women bc of their more prominent gluteal muscles. |
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Term
| _______________: curvature of the upper thoracic spine |
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Definition
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Term
| who is kyphosis common in? |
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Definition
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Term
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Definition
a sharp angular deformity assc with a collapsed vertebra from osteoporosis common in kyphosis |
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Term
| _________________: lateral and rotatry curvature of the spine |
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Definition
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Term
| who is scoliosis most commonly found in? |
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Definition
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Term
| what areas should you palpate in the back? |
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Definition
the spinous process of each vertebra the paravertebral mm for firm knotted mm and tenderness |
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Term
| what are the components of a neurologic exam? |
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Definition
mental status/speech cranial nn sensory reflexes coordination/gait motor |
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Term
| what equipment might you need to do a neurologic exam? |
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Definition
penlight tongue blades safety pins cotton balls monofilament 5.07 tuning forks 512 and 128 Hz reflex hammer familar objects |
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Term
| what are the components of the primary functions sensory exam? |
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Definition
superifical touch superifical pain temperature deep pressure vibration joint position |
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Term
| how do you do a superficial touch test? |
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Definition
| use a cotton ball or finger and ask the pt to close their eyes and tell you where you touched them |
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Term
| how do you do a superficial pain test? |
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Definition
have sharp and dull objects. With the pts eyes closed, alternate touching them with the sharp and dull objects and have them tell you if it was sharp or dull and where you touched them |
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Term
| how do you do a sensory temperature test? |
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Definition
you can use tubes of hot and cold water, so you can use your reflex hammer for cold and run it under hot water for hot. this is usually okay if superficial touch is intact have them tell you if you are touching them with a hot or cold object |
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Term
| why would you do a deep pressure sensory test? |
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Definition
if the pt doesn't respond to superficial touch used quite a bit when coming out of anesthetic |
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Term
| where do you want to do vibration tests? |
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Definition
out at the periphery. thumbs and big toes |
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Term
| how do you do a joint position sensory test? |
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Definition
| hold the joint of the thumbs or big toes btwn your fingers and with the pts eyes closed have them tell you if you are raising their digit up or down. |
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Term
| The C4 dermatome is located where? |
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Definition
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Term
| The nipple line is a landmark for what dermatome? |
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Definition
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Term
| the umbilicus is the landmark for what dermatome? |
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Definition
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Term
| where is the L2 dermatome located? |
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Definition
| the area of the thighh where your hands would go into your pockets |
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Term
| where are the L3-5 dermatomes located? |
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Definition
L3 is below L2 at the upper part of the anterior leg L4 is btwn the knee and L3 L5 runs down the anterior lateral sides of the legs below the knee |
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Term
| Where are the L3-5 dermatomes located? |
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Definition
the radiate out from the anus L5 is the most interior out to L3 |
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Term
| Where is the S2 dermatome located? |
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Definition
| down the posterior aspects of the legs |
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Term
| What dermatomes are on the posterior arm? |
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Definition
from medial to lateral C8, C7, C6 |
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Term
| what dermatomes are on the anterior side of the arm? |
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Definition
from lateral to medial C6, C5, T1, C8 |
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Term
| What are the components of the cortical functioning part of the sensory exam? |
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Definition
stereognosis two-point discrimination extinction phenomenon graphesthesia point location |
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Term
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Definition
| the ability of the pt to identify common objects just by touch |
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Term
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Definition
| using an opened paperclip, find the distance where the pt can no longer feel two points |
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Term
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Definition
| simultaneous touch two areas and see if the pt can identify both |
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Term
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Definition
| with the pt's eyes closed you draw a letter or number on their open palm and have them identify it |
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Term
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Definition
part of the cortical function, sensory exam with the pt's eyes closed you touch their skin and have them point to where you touched |
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Term
| what should you observe all sensory function tests for? |
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Definition
side to side differences interpretation of sensation discrimination location |
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Term
| what are your superificial reflexes? |
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Definition
abdominal cremasteric anal wink plantar |
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Term
| what nerves are being tested when you do the abdominal reflex? |
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Definition
above the umbilicus T7-9 below the umbilicus T10-11 |
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Term
| what nerves are you testing when you do the cremasteric reflex? |
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Definition
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Term
| what nerves are you testing when you do the anal wink reflex? |
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Definition
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Term
| what are you looking for when you do an abdominal reflex? |
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Definition
| equal movement of the umbilicus |
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Term
| what are you looking for when you do the cremasteric reflex? |
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Definition
| rising of the testes and scrotum when you stroke the inner thigh of a male patient |
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Term
| what are you looking for when you do the plantar reflex? |
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Definition
| fanning of the toes or dorsiflexion of the great toe when you stroke the lateral side of the foot from the heel to the ball |
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Term
| what nerves are you testing when you do the plantar reflex? |
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Definition
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Term
| what is the babinski sign? |
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Definition
| when you test plantar reflex and there is dorsiflexion of the great toe with or without fanning of the toes |
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Term
| what does the babinski sign indicate? |
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Definition
its normal in anyone < 2 but in others it indicates pyramidal tract disease |
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Term
| what are the different deep reflexes? |
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Definition
biceps brachioradial triceps patellar achilles |
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Term
| how do you do the biceps reflex? |
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Definition
| flex the pt's arm to 45 degrees at the elbow. Find the tendon and put your thumb on it. Strike your thumb rather than directly on the tendon. |
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Term
| what nerves are you testing when you do the biceps reflex? |
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Definition
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Term
| how do you do the brachioradial reflex? |
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Definition
| flex the pt's arm up to 45 degrees and rest their forearm on your arm with the hand slightly pronated. strike the tendon directly |
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Term
| what nerves are you testing when you do a brachioradial reflex? |
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Definition
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Term
| what should happen when you do a biceps reflex? |
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Definition
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Term
| what should happen when you do a brachioradial reflex? |
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Definition
| forearm pronation/elbow flexion |
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Term
| what nerves are being tested when you do a triceps reflex? |
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Definition
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Term
| how do you do a triceps reflex? |
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Definition
flex the pt's arm at the elbow up to 90 degrees, supporting the arm proximal to the antecubital fossa. strike the tendon directly with the hammer just above the elbow |
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Term
| what should you see when you do a triceps reflex? |
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Definition
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Term
| what nerves are you testing when you do a patellar reflex? |
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Definition
|
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Term
| how do you do a patellar reflex? |
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Definition
| flex the pt's knee to 90 degrees, allowing the leg to hang loosely. Support the upper leg with your hand, not allowing it to rest against the edge of the examining table. Strike the patellar tendon right below the patella. |
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Term
| what do you expect to see when you do a patellar reflex? |
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Definition
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Term
| how do you do an Achilles reflex? |
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Definition
| with the pt sitting, flex the knee to 90 degrees and keep the ankle in a neutral position, holding the foot in your hand. Strike the achilles tendon at the level of the ankle malleoli |
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Term
| what nerves are you testing when you do an achilles reflex? |
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Definition
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Term
| what do you expect to see when you do an achilles reflex? |
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Definition
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Term
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Definition
| repetitive contraction of the muscle |
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Term
| absence of reflexes may indicate... |
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Definition
| neuropathy or lower motor neuron disorders |
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Term
| hyperactive reflexes may indicate... |
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Definition
| an upper motor neuron disorder |
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Term
| A deep tendon reflex rating of 4+ means what? |
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Definition
| reflexes are very brisk, hyperactive with clonus |
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Term
| Which deep tendon reflex grade means that the reflex is brisker than average, possibly but not necessarily indicative of disease? |
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Definition
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Term
| Which deep tendon reflex grade means the reflexes are normal? |
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Definition
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Term
| A deep tendon reflex of 1+ means... |
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Definition
| reflexes are somewhat diminished; low normal |
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Term
| a deep tendon reflex grading of 0 means... |
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Definition
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Term
| what are the 3 things you want to test for coordination? |
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Definition
rapid rhythmic alternating movements accuracy of movements balance/gait |
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Term
| how do you test rapid rhythmic alternating movements? |
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Definition
pronation/supination touch thumb to each finger toe tapping |
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Term
| what are you trying to evaluate when you are testing rapid rhythmic alternating movements? |
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Definition
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Term
| what are you trying to evaluate when you test accuracy of movement? |
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Definition
| accuracy, speed and rhythm |
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Term
| when testing balance you want to evaluate ________ and observe _________. |
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Definition
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Term
| what is the Romberg sign? |
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Definition
it is when you ask the pt (with eyes open and then closed) to stand, feet together and have their arms at their sides it checks for loss of balance |
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Term
| what does a positive romberg test indicate? |
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Definition
| cerebellar ataxia, vestibular dysfunction or sensory loss |
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Term
| how long should balance be maintained for when the pt stands on one foot? |
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Definition
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Term
| how should you check gait? |
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Definition
have the pt walk in the hallway, heel to toe observe upright posture and simultaneous arm swinging, pivot regular rhythm |
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Term
| what gait abnormalities do you want to look for? |
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Definition
shuffling wide stance foot drop spasticity staggering leg lag dragging of the lower extremity toe walking scissoring reeling |
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Term
| what will heel toe walking do? |
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Definition
| exaggerate any unexpected findings in gait evaluation |
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Term
| what are the components of the motor exam? |
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Definition
muscle strength muscle tone examine individual muscle groups observe patterns of weakness symmetry |
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Term
| A muscle strength grading of 0 means: |
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Definition
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Term
| A muscle strength grading of 1 means: |
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Definition
| barely detectable contraction |
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Term
| A muscular strength grading of 2 means: |
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Definition
| movement of body part with gravity eliminated |
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Term
| A muscle strength grading of 3 means: |
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Definition
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Term
| A muscle strength grading of 4 means: |
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Definition
| movement against gravity and some resistance |
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Term
| A muscle strength grading of 5 means: |
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Definition
| movement against full resistance |
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Term
what movements do you test for the motor exam of the upper extremity? what nerves are being tested too? |
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Definition
flexion at elbow (biceps): C5-6 extension at elbow (triceps): C6-8 extension at wrist: C6-8, radial nerve grip: C7, C8, T1 finger abduction: C8, T1, ulnar nerve opposition of thumb: C8, T1, median nerve |
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Term
| which nerves need to be activated to test thumb opposition? |
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Definition
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Term
| which nerves are being used to test finger abduction? |
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Definition
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Term
| which nerves are being used when testing grip? |
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Definition
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Term
| which nerves are being used when testing extension at the wrist and elbow? |
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Definition
C6-8 Also radial nerve for wrist |
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Term
| which nerves are being used when testing elbow flexion? |
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Definition
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Term
| which muscle movements do you need to test when testing motor function of the lower extremity? |
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Definition
flexion, adduction, abduction and extension at hips flexion and extension at knees dorsiflexion and plantar flexion |
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Term
| which nerves are involved when testing for flexion (iliopsoas) and adduction (adductors) at hips? |
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Definition
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Term
| which nerves and muscles are being used when testing for hip abduction? |
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Definition
L4, L5, S1 gluteus medius and minimus |
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Term
| which nerves and muscles are being used when testing for hip extension? |
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Definition
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Term
| Which nerves and muscles are being used when testing motor function for extension of knee? |
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Definition
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Term
| which nerves and muscles are being used when testing motor function of flexion of the knee? |
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Definition
L4, L5, S1, S2 hamstrings |
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Term
| which nerves are involved in plantar flexion and dorsiflexion? |
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Definition
plantar flexion: S1 dorsiflexion: L4-5 |
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Term
| when testing for muscle tone what do you look for? |
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Definition
muscle tension (resistance) and either decreased or increased tone |
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Term
| what causes decreased muscle tone? |
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Definition
disease of peripheral nervous system, cerebellar disease, acute spinal cord injury |
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Term
| what causes increased muscle tone? |
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Definition
spasticity rigidity upper motor neuron disease |
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Term
| what are the signs of UMN lesions? |
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Definition
weakness increased reflexes and tone |
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Term
| what are signs are LMN lesions? |
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Definition
weakness fasciculations decreased reflexes and tone |
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Term
| what would you used a monofilament to test for? |
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Definition
| protective sensation on several sites of the foot on all pts with DM and peripheral neuropathy |
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Term
| what size monofilament do you use? |
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Definition
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|
Term
|
Definition
a stiff neck assc with meningitis and intracranial hemorrhage with pt supine, slip you hand under the pt's head and raise it, flexing the neck, trying to make the chin touch the chest |
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Term
|
Definition
may also be present when neck stiffness is assessed involuntary flexion of hips and kness when flexing the neck |
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Term
| if the brudzinski sign or kernig sign are positive what does that indicate? |
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Definition
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Term
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Definition
evaluated by flexing the leg at the knee and hip when the pt is supine, then attempting to straighten the leg. pain in the lower back and resistance to straightening the knee constitute a positive sign |
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Term
| for the male exam, what equipment do you need? |
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Definition
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