1. Romberg Test
    Instruct patient to stand with the feet together, first with the eyes open and then with the eyes closed. Slight swaying is normal.

    • Stand close enough to the client to
    • prevent falling.

    • Normal:client is able to do this for about 20
    • seconds with the eyes closed
  2. Rapid Alternating Movements
    •Client pats his knees with palms of the hands followed by backs of the hands at an ever increasing rate.

    •Assessing Coordination

    •Client touches each finger of one hand to the thumb of the same hand as rapidly as possible.
  3. Coordination and skilled Movements
    Finger to Nose

    Finger to Finger

    Heel to Shin
  4. Reflexes
    Use a reflex hammer to tap a tendon. Record symmetry comparing one side to the other.

    Use a stick figure representation to document the reflex findings.

    Reinforcement is done to enhance a reflex. Person performs an isometric exercise in a muscle group somewhat away from the one being tested
  5. Deep Tendon Reflexes
    • Achilles Reflex
    • Bicep Reflex
    • Tricep Reflex
    • Brachioradialis Reflex
    • Quadricep Reflex
  6. Scale for Reflexes
    4+ = Very brisk, hyperactive with clonus, indicative of disease

    3+ = Brisker than average, may indicate disease

    2+ = Average, normal

    1+ = Diminished, low normal

    0 = No response
  7. Abdominal Reflex
    (tests spinal cord levels T8 - T12)
  8. Cremasteric reflex
    (stroke skin of inner upper thigh which results in testicular movement on the same side)
  9. Plantar reflex
    • Plantar reflex (L4, L5, S1, S2) elicited by firmly stroking the lateral surface of the
    • sole of the foot

    Normal:plantar flexion of the toes

    Abnormal: Positive Babinski: extension of the great toe and fanning of the other toes

    Before a child can walk, fanning and extension of the toes are a normal finding.
  10. Spinothalamic Tract Sensory Function
    Apply stimuli to test major peripheral nerves.

    Minimal number of test sites includes areas on the forehead, cheek, hand, and foot.

    In the screening exam, assume the nerve to be intact if sensation is normal at its most distal area.

    When there is evidence of dysfunction, localize the site of the dysfunction and map the boundaries. Sketch the region involved and describe the sensory change.

    Client closes his eyes
  11. Stereogenesis
    ability to recognize objects by touching and manipulating them.
  12. Graphesthesia
    by asking the client to identify letters or numbers written on each palm with a blunt point.
  13. Tactile discrimination
    • Interpretation by the cerebral cortex. Three types are tested
    • -Stereogenesis
    • -Graphesthesia
    • -
  14. Two point discrimination
    • Ability to sense whether one or two
    • areas of the skin are being stimulated by pressure. To test this, apply disposable pins or a paperclip bent into a “u” shape to the skin simultaneously. Ask if client feels one or two pinpricks
  15. aaoX3
    awake, alert, and oriented to person place and time
  16. Decorticate
    Acute Nerve damage

    fists at the chest

    happens when you get hit and fall to the ground
  17. Decerebrate
    more long standing

    fists to the sides
  18. how many mm indicates pathology
    • Inequality of pupils >1mm indicates
    • pathology
  19. Dolls eyes
    assessed in unconscious patients to evaluate cranial nerves 3,4,6 (can’t do this with a cord injury)
  20. Frontal Lobe
    personality, behavior, emotions, & intellectual functions

    • Broca’s Area: motor speech
    • → expressive aphasia
  21. Parietal Lobe

    cant feel hot and cold
  22. Occipital Lobe
    visual receptor center
  23. Temporal
    auditory reception center

    Wernicke’s Area: language comprehension → receptive aphasia.
  24. Bells Palsy
    Mimicks a stroke usually precipitated after viral illness however do not have long standing …., can come and go

    Symptom of lymes disease
  25. Nueropathy
    Deminished sensation to the periphery hands and feet
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