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Neurological Assessment

Neurological Assessment. Health Assessment. Objectives. Describe the anatomy and physiology of the nervous system. Develop questions to be used when completing the focused interview. Describe the techniques required for assessment of the nervous system.

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Neurological Assessment

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  1. Neurological Assessment Health Assessment

  2. Objectives • Describe the anatomy and physiology of the nervous system. • Develop questions to be used when completing the focused interview. • Describe the techniques required for assessment of the nervous system. • Differentiate normal from abnormal findings in physical assessment of the neurologic system.

  3. Neurologic System Complex Integration, Coordination, and Regulation of Body Systems

  4. Nervous System • Central • Peripheral

  5. Central Nervous System • Brain • Spinal cord

  6. Brain • Cerebral cortex • Frontal • Parietal • Occipital • Temporal • Diencephalon • Thalamus • Hypothalamus • Epithalamus

  7. Brain • Cerebellum • Brain stem • Midbrain • Pons • Medulla oblongata

  8. Regions of the brain

  9. Spinal Cord • Meninges • Cerebrospinal fluid • Vertebrae

  10. Peripheral Nervous System • Cranial nerves • Spinal nerves

  11. 12 Pairs of Cranial Nerves • Originate in the brain • Control many activities in the body • Take impulses to and from the brain

  12. Cranial nerves and their target regions. (Sensory nerves are shown in blue; motor nerves, in red.)

  13. Cranial Nerves

  14. Spinal Cord • 31 pairs of spinal nerves • 8 pairs of cervical nerves • 12 pairs of thoracic nerves • 5 pairs of lumbar nerves • 5 pairs of sacral nerves • 1 pair of coccygeal nerves • Dermatome

  15. Spinal nerves

  16. Focused Interview • Specific questions • Illness, infection, or injury • Symptoms • Pain • Behaviors

  17. Physical Assessment of the Neurologic System • Techniques • Inspection • Palpation • Auscultation of the carotid arteries • Sensory and motor function • Reflexes

  18. Areas of the Neurologic System Assessment • Observing mental status, speech, and language • Observing sensorium, memory, calculation ability, abstract thinking ability, mood, emotional state, perceptions, thought processes, ability to make judgments

  19. Tools for Assessment of Mental Status EBP

  20. Cranial Nerves l. Olfactory: smell ll. Optic: vision lll. Oculomotor: moves eye constricts pupil, opens eyelid lV. Trochlear: moves eye in and down

  21. Cranial Nerves V. Trigeminal: sensation to face, scalp cornea Vl. Abducens: moves eye laterally Vll. Facial: moves face Vlll. Acoustic: hearing and balance

  22. Cranial Nerves lX. Glossopharyngeal: swallow & speech X. Vagus: voice quality Xl. Spinal Accessory: moves head & shoulders Xll. Hypoglossal: moves tongue

  23. Cranial Nerves Assess together: lll, lV & Vl (EOMs) Assess together: lX, X & Xll (swallow, gag & dysarthria)

  24. Areas of the Neurologic System Assessment • Motor function • Observation of gait and balance • Administration of the Romberg test • Administration of the finger-to-nose test • Observation of rapid alternating action movements • Administration of the heel-to-shin test

  25. Evaluation of gait.

  26. Heel-to-toe walk

  27. Romberg’s test for balance

  28. Finger-to-nose test

  29. Alternative for pass point test

  30. Testing rapid alternating movement, palms down.

  31. Testing rapid alternating movement, palms up

  32. Testing coordination using the finger-to-finger test.

  33. Heel-to-shin test.

  34. Areas of the Neurologic System Assessment • Sensory function • Observation of light touch identification • Sharp, dull, temperature, and vibration determination • Stereognosis • Graphesthesia • Two-point discrimination • Topognosis • Position sense

  35. Evaluation of light touch

  36. Testing the client’s ability to identify sharp sensations

  37. Testing the client’s ability to identify dull sensations

  38. Testing the client’s ability to feel vibrations, the toe

  39. Testing the client’s ability to feel vibrations, the knee

  40. Position sense of joint movement

  41. Areas of the Neurologic System Assessment • Reflexes • Biceps • Triceps • Brachioradialsis • Patellar • Achilles • Plantar • Abdominal

  42. Testing the biceps reflex

  43. testing the triceps reflex

  44. Testing the brachioradialis reflex.

  45. Testing patellar reflex, client in a sitting position

  46. Testing patellar reflex using a relaxation technique.

  47. Testing the Achilles tendon reflex with client in a sitting position

  48. Testing the Achilles tendon reflex with client in a supine position.

  49. Testing the plantar reflex

  50. Babinski response

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