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What is neurological examinations testing?
- - conduction
- - power
- - reflex
- - sensations
What are your dermatomes?
- C3,4 and 5 supply the diaphragm (the large muscle between the chest and the belly that we use to breath).
- C5 also supplies the shoulder muscles and the muscle that we use to bend our elbow .
- C6 is for bending the wrist back.
- C7 is for straightening the elbow.
- C8 bends the fingers.
- T1 spreads the fingers.
- T1 –T12 supplies the chest wall & abdominal muscles.
- L2 bends the hip.
- L3 straightens the knee.
- L4 pulls the foot up.
- L5 wiggles the toes.
- S1 pulls the foot down.
- S3,4 and 5 supply the bladder. bowel and sex organs and the anal and other pelvic muscles.
What is the order of neurological examinations?
- - screening test
- - sensation- light touch, pin prick
- - power- isometric strength test (mm @ mid range & try break the contraction), considr pain and wasting
- - reflexes- test reflex arc
- - babunski
- - clonus
What are the levels of reflex grading?
- - 1,2,3
- - absent, fading, normal, exaggerated, clonus (spasticity)
- - ensure you compare to the other side
What are neurodynamic test?
- Mobility of nerve tissue
- is placing a nerve on tension and seein if it reproduces thepts pain
- - SLR- eg torn hammie- fibrosis, mm spasm- piriformis
- - PKB
- - PNF
- +ve test diff pian, compare ROM to other side and see where P comes on
- - buldge disc, narrowing of spinal cannal
Where do disc buldges usually occur?
L4, L5, S1
How do you do a sensations test?
- using a cotton ball- moving around in circles up and down the limb
- Also foot and hand run down the fingers/ toes
- Usually 2 or 3 levels are affected
- If loss sensation pin prick only that area and map out area of loss sensation
How do you test the power of the lumbar spine?
- Pain can affect myotome strength
- Pt does the movement and then you try to move it
- L2- hip flexors- hold @ 90 degrees against ur resistance
- L3- quads- pt knee on towel- hold straight leg
- L4- DF/ IN- do separate and both feet together- compare side
- L5- EHL- big toe
- S1- evertors, PF in standing- walk on toes for quick screen- otherwise in supine
- S2- toe flex- bend toes over fingers
What are the clearing tests?
What are the relfexes of the lower limb and what nerve root do they test?
- - knee jerk- L4
- - ankle jerk- S1
Perform a knee jerk
- - over patella tendon
- - in gap
- - if pt resisting preoccupy them
perform an ankle jerk
- - achilles tendon
- - small DF
With testing of sensation etc if pt presents with numbness is foot do entire limb