Révision Neuro

• I Olfactif
• II Optique
• III Occulomoteur
• IV Trochléaire
• V Trijumeau
• VIAbducens
• VII Facial
• VIII Vestibulocochléaire
• IX Glossopharyngien
• X Vague
• XI Accessoire
• XII Hypoglosse

• I Olfactif: odorat
• II Optique: vision
• V Trijumeau: sensibilité du visage, de la bouche et de la cornée
• VII Facial: Sensibilité gustative de la partie antérieure de la langue; glandes salivaires et lacrymales 
• VIII Vestibulocochléaire: Audition; sens de l'équilibre 
• IX Glossopharyngien: Sensibilité du pharynx;  sensibilité gustative de la partie postérieure de la langue 
• X Vague: Fonction végétative du tube digestif; sensibilité du pharynx

• III Occulomoteur: Mvt des yeux; Constriction de la pupille et accommodation; Muscles des paupières
• IV Trochléaire: Mvt des yeux 
• V Trijumeau: Mastication
• VI Abducens: Mvt des yeux 
• VII Facial: Contrôle des myo de l'expression facile
• IX Glossopharyngien: barorécepteurs carotidiens
• X Vague: myo des cordes vocales; déglutition
• XI Accessoire: myo de la nuque et des épaules (SCM, trapèzes)
• XII Hypoglosse: met de la langue

Ask the pt to identify familiar odours 

Positive: inability to identify familiar odours

Ask the pt to identify objects or read selected items on a chart or diagram (Mesure de l'acuité visuelle et de l'intégrité du champ visuel)

Positive: inability to identify objects at a reasonable distance

Follow an object as it moves vertically, horizontally and diagonally (impossible de diriger le regard vers le haut, le bas ou vers le plan médian après atteinte du nerf; recherche d'un ptôsis ou d'une dilatation pupillaire)

Positive: identified tracking deficit, asymmetry or ptosis

Follow an object as it moves in an inferior direction 

Positive: inability to depress the eyes and/or complaint of diplopia (Impossible de regarder vers le bas quand les yeux sont en ABD)

Sensory: with eyes closed. Touch the pt's face with cotton ball or safety pin and ask the pt to identify if the contact is "dull" or "sharp"

Positive: impaired or absent  sensation or inability to differentiate sharp and dull sensation 

Motor: ask pt to perform mandibular protraction, retrusion and lateral deviation 

Positive: impaired ability to move the mandibule in the specified motions

pt is asked to abduct the eyes without moving the head

Positive: inability to abduct the eyes

Sensory: pt asked to distinguish between sweet and salty substances placed on the anterior portion of the tongue 

Positive: inability to accurately identify sweet and salty substances 

Motor: MMT of selected myo involved in facial expression

Positive: Inability to mimic selected facial expression due to myo impairment

PT brings a ticking watch or tuning fork (512Hz) towards the pt's ear and measure distance from the ear when the pt can hear the sound. Ipsi then contra

Positive:inability to hear the ticking sound at 18-24" or a significant difference between both ears

Sensory: assessing pt's ability to distinguish objects by taste when placed on posterior portion of the tongue

Positive: inability to accurately identify tasted substances (especially sour and bitter)

Motor: PT touches the pharynx with tongue depressor 

Positive: lack of gag reflex or inability to feel the tongue depressor

Sensory: No test

Positive: N/A

Motor: PT touches the pharynx with tongue depressor 

Positive: lack of gag reflex or inability to feel the tongue depressor

pt shrugs the shoulders and maintain the position while PT applies resistance in a downward direction

Positive: Inability to maintain position against resistance

Ask pt to protrude the tongue 

Positive: inability to fully protrude the tongue or tongue deviating to one side during protrusion

• C1: Top of skull
• C2: Temple, forehead, occiput
• C3: Entire neck, posterior cheek, temporal area, prolongation forward under mandibule
• C4: Shoulder, clavicular and upper scapular area
• C5: Deltoid area, anterior aspect of entire arm to bas of thumb
• C6: Anterior arm, radial side of hand to thumb and index finger 
• C7: Lateral arm and forearm to index, long and ring fingers
• C8: Medial arm and forearm to long, ring and little fingers

• C1: None
• C2: Longus colli, SCM, rectus capitis
• C3: Trapezius, splenius capitis
• C4: Trapezius, levator scapulae
• C5: Supraspinatus, infraspinatus, deltoid, biceps
• C6: Biceps, supinator, wrist extensors
• C7: Triceps, wrist flexors
• C8: Ulnar deviators, thumb extensors and ADD

• C5: Biceps, brachioradialis 
• C6: Biceps, brachioradialis 
• C7: Triceps

• L1: Back, over trochanter and groin
• L2: Back, front of thigh and knee
• L3: Back, upper buttock, anterior thigh and knee, medial lower leg
• L4: Medial buttock, lateral thigh, medial leg, back of foot, big toe
• L5: Buttock, posterior and lateral thigh, lateral aspect of leg, back of foot, medial half of sole, 1st-2nd-3rd toe
• S1: Lateral and plantar aspect of foot
• S2:  Buttock, thigh and posterior groin

• L1: None
• L2: Psoas, hip ADD
• L3: Psoas, quadriceps, thigh atrophy
• L4: Tibialis anterior, extensor hallucis
• L5: Extensor hallucis, peroneals, gluteus medius, dorsiflexors, hamstring and calf atrophy
• S1: Calf and hamstrings, wasting of gluteals, peroneals, plantar flexors
• S2: Calf and hamstrings, wasting of gluteals, plantar flexors

• L3: Knee jerk
• L4: Knee jerk
• L5: Plantar reflex
• S1: Achilles reflex

• Multiple sclerosis (MS)
• Traumatic brain injury (TBI)
• Huntington's chorea
• Cerebral palsy
• Stroke (CVA)

• Bell's palsy
• Guillain-Barré Syndrome (GBS)
• Poliomyelitis (Polio)
• Muscular dystrophy

• - Weakness/paralysis of the R side
• - Increased frustration
• - Decreased processing
• - Possible aphasia (expressive, receptive, global)
• - Possible dysphagia
• Possible motor apraxia (ideomotor and ideational)
• - Decreased discrimination between L and R
• - R hemianopsia

• - Weakness/paralysis of the L side
• - Decreased attention span
• - L hemianopsia
• - Decreased awareness and judgement 
• - Memory deficits
• L inattention
• Decreased abstract reasoning 
• - Emotional lability
• - Impulsive behaviour
• - Decreased spatial orientation

• - Unstable vital signs
• - Decreased consciousness 
• - Decreased ability to swallow
• - Weakness on both sides of the body
• - Paralysis on both sides of the body

• - Decreased balance
• - Ataxia
• - Decreased coordination
• - Nausea
• - Decreased ability for postural adjustment 
• - Nystagmus

• Function :
• - Voluntary met (primary motor cortex/precentral gyrus), intellect, orientation
• - Broca's area typically located in the L hemisphere (speech, concentration)
• - Personality, temper, judgement, reasoning, behaviour, self-awareness, executive functions

• Impairment:
• - Contralateral weakness
• - Perseveration, inattention
• - Personality changes, antisocial behaviour
• - Impaired concentration, apathy
• - Broca's aphasia (expressive deficit)
• - Delayed or poor initiation
• - Emotional lability

• Functions:
• - Associated w sensation of touch, kinaesthesia, perception of vibration and T˚
• - Receives info from other areas of the brain for hearing, vision, motor, sensory and memory
• - Provides meaning for objects
• - Interpret languages and words
• - Spatial and visual perception 

• Impairment:
• - Dominant hemisphere (typically L): agraphie, alexa, agnosia
• - Non-dominant hemisphere: dressing and constructional apraxia, anosognosia
• - Contralateral sensory deficit
• - Impaired language comprehension
• - Impaired taste

• Functions:
• - Primary auditory processing and olfaction
• - Wernicke's area (typically in L hemisphere): ability to understand and produce meaningful speech, verbal and general memory, assists w understanding of language
• - Rear of temporal lobe enables humans to interpret other people's emotions and reactions 

• Impairments:
• - Learning deficits
• - Wernicke's aphasia (receptive deficits)
• - Antisocial, aggressive behaviour
• - Difficulty w facial recognition
• - Difficulty w memory, memory loss
• - Inability to categorize objects

• Functions:
• - Main processing center for visual information
• - Processes visual information regarding colours, light and shapes
• - Judgement of distance, seeing in 3 dimensions 

• Impairments:
• - Homonymous hemianopsia 
• - Impaired extra ocular muscle movement and visual deficits 
• - Impaired colour recognition
• - Reaching and writing impairment 
• - Cortical blindness w bilateral lobe involvement

• Blood supply:
• - anterior frontal lobe
• - medial surface of frontal and parietal lobe

• Possible impairment:
• - Contralateral LE motor and sensory 
• - Loss of bowel and bladder control
• - Loss of behavioural inhibition
• - Significant mental changes
• - Neglect
• - Aphasia
• - Apraxia and agraphia
• - Perseveration
• - Akinetic mutism w significant bilateral involvement

• Blood supply:
• - Most of outer cerebrum
• - Basal ganglia
• - Post and ant internal capsule
• - Putamen
• - Pallidum
• - Lentiform nucleus

• Impairments:
• - MOST COMMON SITE OF CVA
• - Wernicke's aphasia in dominant hemisphere
• - Homonymous hemianopsia
• - Apraxia
• - Flat affect w R hemisphere damage
• - Contralateral weakness and sensory loss of face and UE w lesser involvement in LE
• - Impaire spatial relations
• - Anosognosia in non-dominant hemisphere
• - Impaired body schema

• Blood supply:
• - Portion of the midbrain
• - Subthalamic nucleus
• - Basal nucleus
• - Thalamus
• - Inferior temporal lobe
• - Occipital and occipito-parietal cortices 

• Impairments:
• - Contralateral pain and T˚ sensory loss
• - Contralateral hemiplegia (central area), mild hemiparesis
• - Ataxia, athetosis or choreiform movement
• - Quality of movement impaired
• - Anomia
• - Thalamic pain syndrome 
• - Prosoagnosia w occipital infarct
• - Hemiballismus
• - Visual agnosia
• - Homonymous hemianopsia
• - Memory impairment
• - Alexia, dyslexia 
• - Cortical blindness from bilateral involvement

• Blood supply:
• - Lateral aspects of pons and midbrain together w superior surface of cerebellum
• - Cerebellum (branches from basilar artery)
• - Medulla 
• - Pons
• - Midbrain and thalamus
• - Occipital cortex 

• Impairments:
• - Loss of consciousness
• - Hemi or tetraplegia
• - Comatose or vegetative state
• - Inability to speak
• - Locked-in syndrome
• - Vertigo
• - Nystagmus
• - Dysphagia
• - Dysarthria
• - Syncope
• - Ataxia

• - Logical and rational
• - Understand and express language
• - Mathematical calculations
• - Express positive emotions

• - Understand non-verbal communication- Spatial relationships
• - Artistic abilities
• - Body image awareness
• - Express negative emotions

• 1. No volitional movement initiated
• 2. The appearance of basic limb synergies. The beginning of spasticity
• 3. The synergies are performed voluntarily; spasticity increases
• 4. Spasticity begins to decrease. Movement patterns are not dictated solely by limb synergies
• 5. A further decrease in spasticity is noted w independence from limb synergy patterns
• 6. Isolated joint movements are performed w coordination
• 7. Normal motor function is restored

• Stimulus: head position turned to one side
• Response:
• - arm and leg on face side are extended
• - arm and leg on opposite side are flexed
• - spine curved w convexity toward face side

• Stimulus: head position, flexion or extension
• Response:
• - When head is in flexion, arms are flexed and legs are extended
• - When head is in extension, arms are extended and legs are flexed

Stimulus: position of labyrinthe in inner ear, reflected in head position

• Response:
• - In the supine position, body and extremities are held in extension
• - In the prone position, body and extremities are held in flexion

Stimulus: touch to skin alongside the spine from shoulder to hip

Response: lateral flexion of trunk to the side of stimulus

Stimulus: pressure in palm or ulnar side of hand 

Response: flexion of fingers causing a strong grip

Stimulus: pressure to base of toes

Response: toe flexion

Stimulus: touch on cheek 

Response: turning head to same side with mouth open

Stimulus: head dropping into extension suddenly for a few inches

Response: arms abduct with fingers open, then cross trunk into adduction, cry

Stimulus: loud, sudden noise

Response:arms abduct with elbows flexed and hands closed, then cross trunk into adduction, cry

Stimulus: weight placed on balls of feet when upright

Response: stiffening of the legs and trunk into extension

Stimulus: supported upright position with soles of feet on firm surface

Response: reciprocal flexion/extension of legs

• GMS:
• - Prone: physiological flexion, lifts head briefly, head to side
• - Supine: physiological flexion, rolls partly to the side
• - Sitting: head lag in pull to sit
• - Standing: reflex standing and walking 

• FMS:
• - Regards objects in direct line of sight
• - Follows moving objects to midline
• - Hands fisted
• - Arm movements jerky
• - Mvt may be purposeful or random

• GMS:
• - Prone: lifts head 90˚ briefly, chest up in prone positon w some weight through forearm, rolls prone to supine
• - Supine: asymmetrical tonic neck reflex, legs kick reciprocally, prefers head to side
• - Sitting: head upright but bobbing, variable head lag in pull to sitting position, needs full support to sit
• - Standing: poor weight bearing, hips in flexion and behind shoulder 

• FMS:
• - Can see farther distances
• - Hands open more
• - Visually follows through 180˚
• - Grasps is reflexive
• - Uses palmar grasp