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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
Rapid Alternating Movements
•Client pats his knees with palms of the hands followed by backs of the hands at an ever increasing rate.
•Client touches each finger of one hand to the thumb of the same hand as rapidly as possible.
Coordination and skilled Movements
Finger to Nose
Finger to Finger
Heel to Shin
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
Deep Tendon Reflexes
- Achilles Reflex
- Bicep Reflex
- Tricep Reflex
- Brachioradialis Reflex
- Quadricep Reflex
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
(tests spinal cord levels T8 - T12)
(stroke skin of inner upper thigh which results in testicular movement on the same side)
- 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.
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
ability to recognize objects by touching and manipulating them.
by asking the client to identify letters or numbers written on each palm with a blunt point.
- Interpretation by the cerebral cortex. Three types are tested
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
awake, alert, and oriented to person place and time
Acute Nerve damage
fists at the chest
happens when you get hit and fall to the ground
more long standing
fists to the sides
how many mm indicates pathology
- Inequality of pupils >1mm indicates
assessed in unconscious patients to evaluate cranial nerves 3,4,6 (can’t do this with a cord injury)
personality, behavior, emotions, & intellectual functions
- Broca’s Area: motor speech
- → expressive aphasia
cant feel hot and cold
visual receptor center
auditory reception center
Wernicke’s Area: language comprehension → receptive aphasia.
Mimicks a stroke usually precipitated after viral illness however do not have long standing …., can come and go
Symptom of lymes disease
Deminished sensation to the periphery hands and feet
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