N210 Week 3 Lab Cognition Sensory Perception Mobility

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N210 Week 3 Lab Cognition Sensory Perception Mobility
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N210 Week Lab Cognition Sensory Perception Mobility
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  1. 1. Review the structure and function of the neurological system
    • Central nervous system (CNS) includes the brain and spinal cord.
    • • Cerebral cortex is the outer layer of nerve cell bodies, also called gray matter.
    • • The Cerebral cortex is the center for humans’ highest functioning’s-governing, thought, memory, reasoning, sensation and voluntary movement.
    • • Each half of the cerebrum is a hemisphere. Each hemisphere is divided into four lobes: frontal, parietal, temporal, and occipital.
    • • Damage to these specific cortical areas produces a corresponding loss of function: motor deficit, paralysis, loss of sensation, or impaired ability to understand or process language
    • • Thalamus main relay station for incoming sensory pathways
    • • Hypothalamus controls temperature, sleep, emotions, autonomic activity and the pituitary gland
    • • Cerebellum concerned with motor coordination, equilibrium, and muscle tone
    • • Midbrain and Pons contain motor neurons and motor and sensory tracts
    • • Medulla contains fiber tracts and vital autonomic centers for respiration, heart and gastrointestinal function
    • • Spinal cord is the main highway for ascending and descending fiber tracts that connects the brain to the spinal nerves, and it medicates reflexes.
    • Peripheral nervous system includes 12 pairs of cranial nerves, the 31 pairs of spinal nerves, and all their branches.
    • • The Peripheral Nervous System carries sensory messages to the CNS from sensory receptors, motor messages from the CNS out to muscle and glands, and autonomic messages that govern the internal organs and blood vessels.
    • • Cranial nerves: enter and exit the brain rather than the spinal cord.
    • > They supply the head and neck; with the exception of the Vagus nerve, which travels to the heart, respiratory muscles, stomach and gallbladder
    • • Spinal Nerves: 31 pairs of spinal nerves arise from the length of the spinal cord and supply the rest of the body
    • > 12 thoracic
    • > 5 lumbar
    • > 5 sacral
    • > 1 coccygeal
    • > They are “mixed” nerves because they contain both sensory and motor fibers
    • • Dermatome is a circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve
    • Reflex Arc
    • • Simplest reflex the sensory afferent fibers carry the message from the receptor and travel through the dorsal root into the spinal cord
    • • They synapse in the cord with the motor neuron in the anterior horn
    • • Motor efferent fibers leave via the ventral root and travel to the muscle
    • • The deep tendon or stretch reflex has 5 components
    • 1. An intact sensory nerve (afferent)
    • 2. A functional synapse in the cord
    • 3. An intact motor nerve gibers (efferent)
    • 4. The neuromuscular junction
    • 5. A competent muscle
  2. i. Ask person to do straight leg raises
    • ii. Ask person to life one leg at a time straight up off the bed
    • • Full strength is 90 degrees
    • iii. If multiple trauma, pain, or equipment precludes this motion, ask the person to push one foot at time at your hand's resistance
    • • Like putting your foot on the gas pedal
    • 3. Pupillary response
    • a. Note size, shape, and symmetry of both pupils
    • b. Shine light into each pupil and note the direct and consensual light reflex
    • c. Both pupils should contract briskly
    • d. Record pupil size in millimeters
    • 4. Vital signs
    • a. Measure temperature, pulse, respiration, and BP as often as the person's condition persists
    • i. This is because BP and P are notoriously unreliable parameters of CNS deficit
    • ii. Any changes are late consequences of rising intercranial pressure
    • • Cushing reflex
    • • BP pressure suddenly elevates widening pulse pressure
    • • Pulse - decreased rate, slow and bounding
    • b. Glasgow Coma Scale. (REFER IN QUESTION #3)
  3. 3. Describe the specific assessments included in the Glasgow Coma Scale
    • > The objective assessment that defines the level of consciousness by giving it a numeric value
    • > The scale is divided into three areas: eye opening, motor response, and verbal response
    • >Each area is rated separately, and a number is given for the person’s best response
    • >The three numbers are added; the total score reflects the brain’s functional level
    • > A fully alert, normal person has a score of 15
    • > Serial assessments can be plotted on a graph to illustrate visually whether the person is stable, improving, or deteriorating
    • > The score of 7 or less reflects coma
  4. 4. Identify the specific subjective data necessary to obtain a health history of a patient’s cognition, sensory perception, and mobility status
    • > Headache (unusually frequent or severe)
    • > Head injury
    • > Dizziness (feeling light-headed or faint)/vertigo (feeling a rotational spinning)
    • > Seizures
    • > Tremors
    • > Weakness or incoordination
    • > Numbness or tingling
    • > Difficulty swallowing
    • > Difficulty speaking
    • > Significant neurologic past history (stroke, spinal cord injury, meningitis or encephalitis, congenital defect, alcoholism)
  5. 5. Identify and describe sensory function tests and motor examination
    • A. Motor Examination
    • 1. symmetry, size and presence of involuntary movements
    • 2. full ROM of joints
    • 3. check strength against resistance
    • 4. neuro patients: assess hand grips and foot pushes if bedridden
    • 1. Cerebellar Function
    • a. Gait and posture
    • i. observe as the person walks 10 to 20 feet
    • ii. gait is normally smooth, rhythmic, effortless
    • iii. arm swing is coordinated; turns are smooth
    • b. Romberg Test
    • i. stand with feet together and arms at sides
    • ii. ask person to close eyes and hold the position
    • iii. a person can maintain posture and balance is normal
    • iv. ask person to hop in place
    • a. demonstrates normal position sense, muscle strength
    • c. Heel to toe in straight line
    • d. Walk on toes and heels
    • e. Hop on one foot
    • 2. Reflexes
    • a. PERRLA
    • b. Reflex arc: deep tendon reflex (DTR)
    • A. Sensory Function
    • 1. With eyes closed
    • a. Interpret sensations
    • b. Discriminate side to side
    • 2. Examine in detail if:
    • a. Reduced sensation
    • b. Numbness or pain
    • c. Motor or reflex abnormal
    • d. Skin changes
    • 1. Touch
    • a. Light touch
    • 2. Vibration
    • 3. Proprioception
    • 4. Stereognosis
    • 5. Graphesthesia
    • 6. Two-point discrimination
  6. 6. Describe specific assessments performed during examination of patients mobility status
    • A. Subjective and Objective Data
    • 1. obtain a health history
    • 2. Assessment
    • a. inspect/palpation
    • b. ROM
    • i. passive and active
    • c. muscular strength
    • A. Inspect/Palpate
    • 1. inspect swelling, mass, deformities, stiffness, instability of joints, limbs and body regions
    • 2. palpate for temperature, tenderness surrounding joint
    • B. ROMs
    • 1. have pt. perform active ROM
    • 2. if unable to, use passive ROM
    • 3. palpate for unusual joint movement during ROM
    • A. Assessing muscles
    • 1. assess muscle tone and strength
    • 2. strength against gravity/full resistance
    • 3. note as 0/5 – 5/5
    • 4. “5/5” = normal
  7. 7. Identify the specific subjective data necessary to obtain a health history of a patients mobility status (Taylor 1054)
    • Factors to Assess
    • A. Daily Activity Level
    • Describe the normal activities you normally carry out during a routine day?
    • > Activities of daily Living
    • > Type, frequency, duration of exercise
    • > Past history of exercise; recent changes
    • B. Endurance
    • Describe what type of activity make you tired and how much?
    • > History of dizziness, dyspnea, frequent pauses of activity to rest, pounding heart, increased respiratory rate
    • C. Exercise/Fitness Goals
    • What fitness goals are you currently working on?
    • - Attitudes about exercise and fitness
    • - Knowledge of the benefits of exercise
    • - Motivation to exercise
    • - Current goals
    • D. Mobility
    • Do you experience any problems with movement or with more vigorous activity or exercise? If yes, please describe these problemes
    • > Nature of problem (including symptoms)
    • > Onset of disturbance & frequency
    • > Known causes
    • > Severity
    • > Effect on everyday functioning
    • > Interventions attempted and results
    • E. Physical or Mental Health Alterations
    • Are there any physical or mental health problems that may be affecting your mobility? Tell me about them:
    • > Decrease of strength/endurance (MI, CHF, COPD, Cancer, GI disorders, cardiomyopathy)
    • > Neuromuscular Impairment (Multiple sclerosis, Parkinson’s, spinal)
    • > Musculoskeletal impairment (arthritis, fracture, muscular dystrophy)
    • > Perceptual/Cognitive impairment (cerebrovascular accident, brain tumor or trauma, vision disorders, dementia)
    • > Pain or discomfort
    • > Depression/severe anxiety
    • F. External Factors affecting mobility
    • Is there anything else you can think of that limits your ability to get around?
    • > Environmental (stairs, lack of railings or other assistive devices, poor lighting, unsafe neighborhood)
    • > Financial resources

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