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What are important basic concepts in neuro exams?
- watch for symmetry
- OBSERVE without telling them first
- watch for details
- be aware of distractions
- dont be predictable or they'll guess
What are some CN damages you can see just through basic observation?
- ptosis (III)
- facial droop (VII)
- hoarseness (X)
- can't articulate words (V, VII, X, XII)
- eye position (III, IV, VI)
- asymetric pupils (II, III)
How do you test the olfactory I nerve?
- identify common smells
- not commonly tested
How do you test for optic II nerve?
- visual acuitiy (snellen chart)
- visual fields (hands to side and wiggle fingers, as pt which side)
- pupillary light reflex (watch for direct and consensual response)
How do you test the oculomotor nerve III?
follow an object with eyes, no head movement
Do you keep your glasses/contacts in when testing the optic nerve?
How do you test the trochlear nerve IV?
- same as oculomotor
- follow an object with eyes, no head movement
How do you test the trigeminal nerve V?
- temporal and masseter strength (open mouth, clench teeth)
- sensation of pain (use shar object on forehead, jaw & cheeks)
- corneal reflex (don't do if have contacts or lasic eye surgery)
How do you test the abducens nerve VI?
lateral movements of the eye
How do you test the facial nerve VII?
- observe for asymmetry/droop
- observe movemetnts (eyebrow raise, smile to frown, show teeth, puff cheeks)
- Bells's palsy (paralysis of mm inervated by VII)
- salvation and tear production can be affected
How do you test the vestibulocochlear nerve VIII?
- make noise at varying distance of the ear
- should be symmetrical
How do you test the vagus nerve X?
- have pt swallow
- say 'AHHH'
- voice abnormalities
How do you test the Accessory nerve XI?
- MMT traps and SCM
- watch for trap assymetry
How do you test the hypoglossal nerve XII?
- observe tongue movements- shouldn't deviate or protrude
- listen for disarticulations
What are basic observations of a motor exam?
- involuntary movements/spasms
- muscle symmetry
- gait analysis
How do you test muscle tone?
- pt need to relax and perform flex/ext of wrist, elbow, ankle, and knee
- watch for flaccidy, increased tone, or catching sensation
How do you test clonus?
- support knee with pt in supine and quickly DF foot
- observe for oscillation- sustained or non sustained
How do you test muscle strength?
- 3= full range against gravity
- 2- have to move into anti-gravity position
How do you test muscle coordination?
- alternate pronation/supination
- finger to nose
- alternate tapping toes
What is the Romberg test?
- use gait belt and have pt stand feet together for 15 seconds without support
- + test = instability
- indicated vestibular or proprioceptive problems
How do you test gait?
- normal walking
- heel to toe
- sit to stand
What are the relfexes?
- Biceps: C5-C6
- Triceps: C6-C7
- Brachioradialis: C5-C6
- Patellar: L2-L4
- Achilles: S1-S2
What is the Babinski Sign?
- probe on lateral part of foot
- normal= toe flexion
- + = big toe extension and fanning of toes
- indicates UMN lesion
What is some basic info to perform sensory exams?
- have pt close eyes
- don't be predictable or pt will guess
- watch for symmetry
How do you test for light touch?
- light touch both sides simultaneously with a cutip and see if pt has sensation difference
- do with a sharper object to feel "scratch"
How do you test position sense??
have pt close eyes, move big toe up and down then have pt tell you their toe position
How do you test pain?
use sharp objects to test dermatomes
How do you test temperature?
- not necessary to test if other sensory exams are nomral
- will usually say if they can't feel when the shower gets too warm
How do you test discrimination?
- graphesthesia: use blunt object to draw and # and ask patient to identify it
- stereognosis: ask pt to identify familiar objects with vision
- 2 pt discrimination: open a paper clip and see if pt can distinguish between 1 or 2 point and determine minimal distance they can distinguish