neuro eval lecture 2

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shmvii
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neuro eval lecture 2
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2012-09-30 13:25:15
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neuro eval lecture 2
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  1. transduction def
    conversion of mechanical energy to electrical energy
  2. basic path of transduction in sensory system
    • stim to
    • peripheral nerves to
    • higher centers (cortical centers) to
    • those centers receivingthe impulses to
    • them interpreting the perceptions to
    • motor output
  3. some place you can have sensory problems (the basic pathway)
    receptor --> sensory nerve-->dorsal root-->spinal cord-->cortical centers
  4. how will it present if you hurt the sensory receptor (like by burning it)?
    • focal issue
    • dermatone otherwise intact
  5. localization pattern if you hurt a peripheral nerve
    the dermatome of the nerve (median, ulnar, musculocutaneous, etc) will go numb
  6. localization pattern for dermatomal dammage
    • (I'm not clear on this)
    • "dermatomal - nerve root, cord -- a pattern of sensory loss that's central or peripheral"
  7. localization pattern for cortical dammage
    diffuse, large area, non-dermatomal -- can be an injury in the cortex, subcortex, brainstem
  8. localization pattern for association cortex
    difficulty with sensory interpretation
  9. "primary sensations" are processed where?
    primary somatosensory cortex
  10. "primary sensation" feelings
    superficial-light touch, sharp, dull, deep-proprioception, vibration
  11. "primary sensations" ar mediated by what paths?
    • anterolateral system aka lateral spinothalmic tract
    • dorsal column medial lemniscus, esp vasiculus cuneats and vasciculus gracilis
  12. "cortical (discrimintory) sensations" are processed where?
    association cortex
  13. "cortical (discrimintory) sensations" involve what 4 types of sensation
    • 2-point discrimination
    • graphesthesia (id-ing writing on yr palm)
    • stereognosis (id-ing stuff in yr hand)
    • double simultaneous extinction (feeling something only on one side when touched on both)
  14. sensory exam rules
    • expose the part (remove clothing)
    • compare bilat
    • be systematic
    • be "random" (no patterns the pt can predict)
    • pt's eyes are closed
    • pt responses: y or n (unambiguous)
  15. 5 words for documenting sensory findings
    • intact (good)
    • absent
    • diminished
    • inconsistent
    • delayed
  16. paraesthesia
    tingling, like ants crawling
  17. dysesthesia
    painful
  18. analgesia
    unable to distinguish pain (seen in DM - feels something, don't know it's pain)
  19. hyperaesthesia
    excessive sensation (aka complex regional pain syndrome)
  20. hypoaesthesia
    diminished sensation
  21. anaethesia
    absent sensation
  22. allodynia
    non-noxious stim elicits pain
  23. dorsal column aka medial lemniscus - ways to test it
    • light touch (cotton wisp or fingertip)
    • vibration (tuning fork)
    • position sense (proprioception and kinesthesia)
  24. proprioceptive sensation def
    an awarness of body position and of movements of parts of body. Proprioception tells us location and rate of movement of one body part in rel to others.
  25. proprioceptive sense informs us of 4:
    • degree our muscles are being contracted
    • amount of tensing created in tendon
    • change of position in joint
    • orientation of head rel to ground and in response to movements
  26. proprioception vs kinesthesia
    • prop - where did I move?
    • kinĀ - did I move?

    kin loss can precede prop loss
  27. some proprioceptive tests
    • move pt's toe up and down
    • move pt's limb and have her mimic w other limb
  28. anterolateral system - what to test to see if it's good
    • pin prick for sharp vs dull
    • thermal sense
    • deep pain (noxious stim)
  29. cortical/discriminatory tests
    • double simultaneous stim
    • point localization
    • 2 point discrim
    • stereognosis
    • graphesthesia
  30. stereognosia is a lesion of...?
    contralateral parietal association cortex
  31. graphagnosia is a lesion of...?
    contralateral parietal association cortex

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