12003324
Neuroscreen
- Observation
- Posture
- Hypothesis for possible impairments?
- Hypothesis for possible impairments?
- General
Asymmetry
- Muscle Atrophy
- Atrophy + weakness:
is LMN more likely?
- Long term disuse: may
also cause atrophy
- Atrophy + weakness:
is LMN more likely?
- Fasciculations
- LMN involvement!
- LMN involvement!
- Involuntary movements, tremors
- If present,
perform thorough
coordination
screening
- If present,
perform thorough
coordination
screening
- Brady/hypokinesia
- Movement analysis
- Walking, stand-to-sit, arm
movement, carrying a
bag...
- Walking, stand-to-sit, arm
movement, carrying a
bag...
- Mental Status Screen
- Alert and awareness
- (1) Who are you?
(2) Where are you?
(3) What is the
date and time? (4)
Why are you here
- (1) Who are you?
(2) Where are you?
(3) What is the
date and time? (4)
Why are you here
- Memory
- Immediate registration and
delayed recall : repeat 3
words, recall after 5 min.
- Immediate registration and
delayed recall : repeat 3
words, recall after 5 min.
- Other abnormalities
- Behavior,
language,
attention, affect
- Behavior,
language,
attention, affect
- Reflexes
- DTRs
- Biceps (C5), brachioradialis
(C6), triceps (C7), patellar
(L3), Achilles (S1)
- 4+
Hyperactive,
3+
Brisk,
2+
Average,
1+
Diminished,
0
Absent.
- Abnormally diminished:
LMN; Abnormally
increased/ clonus: UMN
- 4+
Hyperactive,
3+
Brisk,
2+
Average,
1+
Diminished,
0
Absent.
- Biceps (C5), brachioradialis
(C6), triceps (C7), patellar
(L3), Achilles (S1)
- Special reflexes
- Babinski, Hoffman
- If present: UMN lesion
- If present: UMN lesion
- Babinski, Hoffman
- Sensory Screening
- Light touch/ pin
prick/ vibration (DCML)
- Practice trial after
explanation -- eyes closed --
say 'now' when feeling the
touch -- face + body
- How many times for vibration?
- If absent: further
testing:
proprioception (DCML)
Annotations:
- practice with 'up' and 'down' - hand placement on bone segments, isolate joints - at least 5 movements in random order - great toe, ankle, thumb, wrist, elbow. - test order: distal to proximal
- Possible further tests:
Stereognosis (contralateral
posterior parietal cortex, S2)
Annotations:
- Must have normal light touch and language to begin with - assess both sides - use at least 6 objects, 3 per hand
- Possible further tests:
Graphesthesia (contralateral
posterior parietal cortex)
Annotations:
- light touch must be intact - 'name the letter or number that is written on your palm' - numbers 1-9, letters - no lifting of the pen - 5 trials per hand
- How many times for vibration?
- Practice trial after
explanation -- eyes closed --
say 'now' when feeling the
touch -- face + body
- Extinction (contralateral posterior parietal cortex)
- 'right, left, or both?' --
randomize order -- at
least 4 bilateral contacts.
- 'right, left, or both?' --
randomize order -- at
least 4 bilateral contacts.
- Motor Screening
- Tone
- Hypertonic: more likely
UMN. Hypotonic: more
likely LMN
- Spasticity: SCI, CP, Stoke
- Hypertonic: more likely
UMN. Hypotonic: more
likely LMN
- Strength
- Start with 3/5. If
completed, add
resistance. If unable,
remove gravity.
- Pronator drift (10 sec)
- UMN: motor cortex, premotor cortex, internal capsule, pyramids
- UMN: motor cortex, premotor cortex, internal capsule, pyramids
- Start with 3/5. If
completed, add
resistance. If unable,
remove gravity.
- Coordination
- Finger-to-nose
- Rapid pronation/supination on thigh
- 10 sec rapid pronation and supination.
- Dysdiadochokinesia: cerebellum
- Brady/ hypokinesia: basal ganglia
- Dysdiadochokinesia: cerebellum
- 10 sec rapid pronation and supination.
- Rapid finger and foot tapping
- 10 sec. 'as quickly as possible with large amplitude
- Dysmetria: cerebellum
- Hypo/ bradykinesia: basal ganglia
- Dysmetria: cerebellum
- 10 sec. 'as quickly as possible with large amplitude
- Eye movement coordination
- CN screen
- CN 2
- Visual Fields (optic nerve, optic chiasm, optic tract, LGN,
optic radiations, visual cortex) ----------- 'look at my nose at
all times' -- 'say now when you see my finger' -- at least one
practice trial -- cover one eye at a time -- superior temporal,
inferior temporal, superior nasal, inferior nasal.
Annotations:
- Documentation: L eye: full vision in all quadrants. R eye: vision restriction in superior temporal quadrant.
- Pupillary light reflex
- CN II, CN III, Brainstem nuclei,
parasympathetic pathway
- CN II, CN III, Brainstem nuclei,
parasympathetic pathway
- Visual Fields (optic nerve, optic chiasm, optic tract, LGN,
optic radiations, visual cortex) ----------- 'look at my nose at
all times' -- 'say now when you see my finger' -- at least one
practice trial -- cover one eye at a time -- superior temporal,
inferior temporal, superior nasal, inferior nasal.
- CN 3,4,6
- Eye movement
- 'H', vergence
- 'H', vergence
- Only when necessary: Smooth pursuit in 30 deg.
- Flocculonodular lobe, vermis (vestibulocerebellum
- Flocculonodular lobe, vermis (vestibulocerebellum
- OWN: Saccades
- Initiation difficulty: Frontal eye fields, basal ganglia
- dysmetric: cerebellar vermis
- Initiation difficulty: Frontal eye fields, basal ganglia
- OWN: Nystagmus
- Eye movement
- CN 5
- Sensory: 3 points.
- Strength: temporalis, massater, buccinator, pterygoid
- Jaw jerk reflex
- Sensory: 3 points.
- CN 7
- Muscles of facial expression
- Muscles of facial expression
- CN 8
- finger rub
- Rinne test (only when necessary)
- Fork on mastoid: cocholear nerve
- Fork suspended: middle ear conduction
- Fork on mastoid: cocholear nerve
- finger rub
- CN 9+ 10
- Palate elevation and uvula deviation
- deviation towards stronger side.
- deviation towards stronger side.
- Palate elevation and uvula deviation
- CN 11
- SCM and Trapezius
- Head turn and shoulder shrug
- Head turn and shoulder shrug
- SCM and Trapezius
- CN 12
- genioglossus function
- tongue deviates to weaker side
- tongue deviates to weaker side
- genioglossus function
- Gait and balance
- Romberg
- Sharpened if necessary
- Sharpened if necessary
- Heel- and toe-walking
- Romberg
- CN 2
- Finger-to-nose
- Tone
- Light touch/ pin
prick/ vibration (DCML)
- DTRs
- Alert and awareness
- Posture
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