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H&P Exam 3
Neuro-Motor
82
Medical
Graduate
11/30/2008

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Cards

Term
What are we testing in Neuro-Motor
Definition
Strength
Term
What does motor activity require the combination and coordinated activity of?
Definition
  1. Cerebellum
  2. Upper motor neurons (CNS)
  3. Lower Motor Neurons (PNS)
  4. Muscles
Term

When asseccing the Muscle tone what should you instruct the patient to do?

 

Definition
"Let me do all the work."
Term
Muscle Strength grading scale:
Definition

0= no muscular contraction detected

1=barely detectable flicker or trace of contraction

2=active movement with gravity eliminated

3=Movement against gravity

4=Movement against gravity and some resistence

5=movement against full resistenc (no fatigue)

 

5 is considered normal muscle strength

Term
Dermatomes tested in the ARM:
Definition

flexion--biceps--C6

extension--triceps--C6,7,8

Term
Dermatomes tested at wrist:
Definition

extension--Radial nerve--C6,7,8

Term

Dermatomes tested at hand:

 

Definition

Grip strength--C7,8, T1, median

Abduction--C8,T1, ulnar nerve

Thumb opposition--C8,T1, median nerve

Term
Dermatomes tested at hips:
Definition

Hip flexion--L2,3,4

Hip extension--S1--gluteus maximus

Hip abduction--L4,5, S1

Hip adduction--L2,3,4--adductor muscles

 

Term
Dermatomes tested at knee joint:
Definition

Knee extension--L2,3,4--quadraceps muscles

Knee flexion--L4,5, S1,2--hamstrings

Term
Dermatomes tested at ankle:
Definition

Dorsiflexion--L4,5--toes toward the ceiling

Plantar flexion--S1--toes toward the floor

Term
Dysdiadochokinesis
Definition
Inability to tap distal thumb against each digit forward and backward.
Term
Clumsiness and overshooting of touching one finger by the patient to the one finger of the PA suggestes what?
Definition
Cerebellar Disease
Term

Tandem walking (AKA heal to toe) is the most sensitive test for what?

 

Definition

Ataxia

It assess cerebellar function and postiion sense.

Term

Walking on heels assesses?

 

Walking on toes assesses?

Definition

H--L4.5

 

T--S1

Term
Rhomberg test
Definition

Mainly test position sense (sensory cortex and posterior column)

 

Patient stands with feet together and then closes eyes for 20-30 seconds.  There shoudl be minimal to no swaying repoted as a negative test.

Term
Pronator Drift
Definition

Testing motor strength (motor cortex, corticospinal column)

 

Patient holds palms up toward the ceiling and closes eyes for 20-30 seconds.  what for downward drift of the palms.

Finally, tap arms slightly downward and watch for rebound.

Term
Deep Tendon reflexes:
Definition
  1. Triceps--C6,7
  2. Biceps--C5,6
  3. Brachioradialis--C5,6
  4. Abdominal  above umbilicus--T8,9,10  Below--T10,11,12
  5. Knee--L2,3,4
  6. Ankle--S1
  7. Plantar--L5,S1
  8. Rectal--S2,4
Term
Deep Tendon reflex scale:
Definition

4+ very brisk, hyperactive

3+ better than average

2+ average, normal

1+ slight movement

0 No response

Term
Babinski response
Definition

Dorsiflexion of big toe with fanning of other toes.

Indicates a CNS lesion in the corticospinal tract, with ETOH and drug intoxication, or following a seizure.

Term
Three important question to remember when assessing a patient:
Definition
  1. Is the mental status intact?
  2. Are R and L sided findings the same?
  3. Does the Causitive lesion lie in the CNS or PNS?
Term
5 Catagories to organize thoughts:
Definition
  1. Mental status, Speech and language
  2. Cranial Nerves
  3. Motor system
  4. Sensory system
  5. Reflexes
Term
Regions of the Brain
Definition
[image]
Term

Cerebral Lobe Function:

 

Definition

Frontal--motor cortex

Perital--sensory cortex

Temporal--Sound taste smell and balance

Occipital--primary vision center

Lymbics--mediates patterns of behavior, viceral responses to emotion and biological rythms

Term
Cerebellum Funciton
Definition

Aids the cerebrum in voluntary movement

Processes senory information

Reflexive control of muscle tone

Term
Brainstem Function
Definition

Pathway between cerebral cortex and spinal cord

(Pons, medulla, midbrain and diencephalon)

12 cranial nerves

Reticular formation--constanst muscle tone

Thalamus--pain and temp(relay center)

Basal ganglia--fine tunign effect of gross motor movement

Term

Somatic organization of the Cerebrum

(picture)

Definition
[image]
Term
Sensory pathways emerge from what nerve root?
Definition

Posterior nerve root

(contains spinothalamic tract and posterior column)

Term
motor pathways emerge from what nerve root?
Definition

Anterior nerve root

(contains corticospinal and corticobulbular tract)

Term
Dermatome
Definition
An area of the body supplied by a single spinal nerve
Term

Nerve Plexus

Definition
anterior branches of a spinal nerve combine to form this.
Term
Dermatome locations to know:
Definition
[image]
Term

Upper motor Neurons

 

&

Defect signs

Definition

--originate in the motor strip of the cerebral cortext

--Synapse with motor nuclie in the brain stem and anterior horn of the spinal cord

 

Dcreased strength but no atrophy, above brainstem will affect opposite side, hyperactive deep tendon reflex

Term

Lower Motor neurons

 

&

Defect signs

Definition

cell bodies that originate in the anterior horn of the spinal cord

 

loss of tone, muscle atrophy, weakend deep tendon reflex,

Term
3 motor patheways travel to the anterior horn cell:
Definition
  1. Corticospinal tract
  2. Basal ganglia
  3. Cerebellum

--a lesion at any site will affect movement or reflex activity

Term
corticospinal tract injury manifestations:
Definition
functions are lost or reduced below the level of injury
Term

motor neuron damage above level of crossover in the medulla:

 

motor neuron damagae below level of crossover in the medulla:

Definition

--motor impairment is seen on opposite side of lesion

 

--motor impairment is seen on same side as the lesion

Term
Cerebral cortex lesion
Definition

motor and sensory loss on contralateral side

increased DTR's

 

ie: cerebral stroke

Term
Brainstem Lesion
Definition

motor weakness

No typical sensory findings

increased DTR's

Term
Spinal Cord Lesion
Definition

--motor weakness often affecting both sides

--dermatomal sensory deficit often bilateral and seen at site of injury

--increased DTR's

Term
Basal Ganglia Lesion
Definition

Motor--Bradykinesia, rigidity, tremor

No typical Sensory deficit

DTR's normal or decreased

Term
Cerebellum Lesion
Definition

Motor: hypotonia, nystagmus, ataxia

No sensory findings

DTR's normal or dcreased

Term
Disorders of Muscles tone
Definition
  1. Spasticity (UMN)--clasp knife
  2. Rigidity (basal ganglia)--cog-wheel rigidity
  3. Flaccidity (LMN)--guillain Barre
  4. Paratonia(hemispheres of frontal lobe)--dementia
Term
Peripheral Nerve Damage locations:
Definition
  1. Anterior horn
  2. Spinal roots and nerves
  3. Peripheral Nerve-mononeuropathy
  4. Peripheral nerve--polyneropathy
  5. Neuromuscular Junciton
  6. Muscle
Term
Anterior horn lesion
Definition
 

motor -focal weakness or atrophy, fasiculations

  sensory - intact, DTR’s - ¯.

  ex: polio, ALS.

Term
Spinal nerve and root lesion
Definition
 

  motor- dermatomal weakness, fasiculations

  sensory - corresponding dermatomal deficit,DTR’s - ¯.

 ex: herniated cervical or lumbar disc.

Term

Peripheral nerve--Mononeuropathy

Definition
 

  motor- dermatomal weakness and atrophy

  sensory - corresponding dermatomal deficit, DTR’s - ¯.

ex: trauma

Term
Peripheral Neuropathy--Polyneuropathy
Definition
 

motor- weakness and atrophy distally + fasiculations

 sensory - stocking glove distribution, DTR’s - ¯.

ex: alcoholism, diabetes

Term
Neuromuscular Juncion Lesion
Definition
 

motor- fatigability rather than weakness

sensory - intact, DTR’s - normal.

ex: myasthenia gravis

 

Term
Muscle PNS Damage
Definition
 

motor- weakness proximally + fasiculations

 sensory - intact. DTR’s - normal or ¯.

 ex: muscular dystrophy

Term
Ascending tracts
Definition

Sensory

Lateral Spinothalamic

Anterior Spinalthalamic

Poterior Column

Anterior and dorsal spinocerebellar

Term
Descending Tracts
Definition

Motor

Lateral and anterior Corticospinal

Medial and Lateral Reticulospinal

Term
Spastic Hemiparesis
Definition

Associated with a lesion in the corticospinal tract

 

Leading to weakness on one side of the body

Term
Scissors Gait
Definition
associated with polyneuropathy
Term
Steppage Gait
Definition

Associated with foot drop

(ie herniated disc)

Term
Sensory Ataxia
Definition

associated with loss of position sense in legs as seen in polyneuropathy or posterior collumn damage

 

+Rhomberg

Term
Cerebellar Ataxia
Definition

Patient cannot stand steady with eyes open

 (DZ of cerebellum)

+Rhomberg

Term
Parkinson's Gait
Definition
Associated with damage to the basal ganglia
Term
Gait of old age
Definition
Speed balance and agility decrease with age
Term
CN VII and Facial Paralysis
Definition
  1. Lower face is controlled by UMN pathways from opposite side of cortex only
  2. Upper face is controlled by UMN pathways from both sides of the cortex

--A L sided stroke will affect the right lower face but will not affect the upper face

Term
Aphonia
Definition
loss of voice entirely
Term
Dysphonia
Definition

Impairment of volume--seen with laryngitis, unilateral vocal cord paralysis

Term
Dysarthria
Definition

defect in muscle control of lips, tongue, palate or pharynx

--Results in slurred speech

--central or peripheral motor lesions, parkensonism, cerebellar DZ

Term
Aphasia
Definition

disorder in producing or understanding language

 

Wernicke's--receptive deficient

Broca's--expressive deficient

Term
Nystagmus to the left:
Definition
a slow drift to the right, then a quick jerk to the left
Term
Nystagmus
Definition
A rapid, involuntary, oscillatory motion of the eyeball.
Term
Causes of Nystagmus
Definition

Disorder of inner ear or vestibular nerve damage

Pontine area damage--upbeat

brainstem or cerebelar stroke--downbeat

Basal artery ischemia--vertical gaze disturbance

pons--horizontal gaze disturbacne

Term
Stoke VS Seizure eye deviations
Definition

Stroke--eye deviation toward lesion side (will resolve in time)

Seizure--eye deviation away from lesion side

Term

Pupils:

 

Normal

Miotic

Mydriatic

Definition

Norm--3-4 mm

miotic--constriction

Mydriatic--dilation

 

Term
Midposition fixed pupils
Definition

midposition slightly dilated and fixed to light

--suggests structural damage in the midbrain

Term
Bilarteral large pupil
Definition
cocaine, amphetamine, LSD, or other sympothetic nervous system agonists
Term
One Large Pupil
Definition

disruption of the CN III pupillary constrictors

--Warning of herniation of the temporal lobe causing compression of the oculomotor nerver

Term
Oral Facial Dyskenisia
Definition

Rythmic, repetative, bizarre movements of the face, lips, mouth, tongue and jaw

 

Late manifestation of psychotropic drugs

Term
Chorea
Definition
brief, rapid,jerky, irregualar, and unpredictable movements
Term
Alertness--assessment
Definition

Speak to the patient in a normal tone of voice.
An alert patient opens the eyes, looks at you,
and responds fully and appropriately to stimuli (arousal intact)

Term
Lethargy
Definition

Patient appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep.

Term
Obtundation
Definition

Patient opens the eyes and looks at you, but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.

Term
Stupor
Definition

Patient arouses from sleep only after painful stimuli. Verbal responses are slow or even absent. The patient lapses into an unresponsive state when the stimulus ceases. There is minimal awareness of self or the environment.

Term
Hemiplegia
Definition
sudden unilateral brain damageinvolving the cortical spinal tract can produce this one sided paralysis
Term
Decorticate rigidity
Definition

the upper arms are held tight to the sides with elbows, wrists, and fingers flexed.  Legs are extended and itnernally rotated with feet plantar flexed

 

--implies structural corticospinal tract lesion at or near the cerebral hemisphere

Term

Descending Spinal tracts

(all)

Definition

Motor

  • Lat. and Ant. Corticospinal
  • Med. and Lat. Reticulospinal
Term

Minimal distance discrimination

(general)

Definition
  • tongue has the smallest minimal distance
  • finger tips
  • toes
  • palms
  • chest
  • back
  • thighs
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