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Neuroscreen

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PT 581 Neuro PT Management Mind Map on Neuroscreen, created by Mia Li on 26/01/2018.
Mia Li
Mind Map by Mia Li, updated more than 1 year ago
Mia Li
Created by Mia Li almost 7 years ago
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Resource summary

Neuroscreen
  1. Observation
    1. Posture
      1. Hypothesis for possible impairments?
      2. General Asymmetry
        1. Muscle Atrophy
          1. Atrophy + weakness: is LMN more likely?
            1. Long term disuse: may also cause atrophy
            2. Fasciculations
              1. LMN involvement!
              2. Involuntary movements, tremors
                1. If present, perform thorough coordination screening
                2. Brady/hypokinesia
                  1. Movement analysis
                    1. Walking, stand-to-sit, arm movement, carrying a bag...
                    2. Mental Status Screen
                      1. Alert and awareness
                        1. (1) Who are you? (2) Where are you? (3) What is the date and time? (4) Why are you here
                        2. Memory
                          1. Immediate registration and delayed recall : repeat 3 words, recall after 5 min.
                          2. Other abnormalities
                            1. Behavior, language, attention, affect
                            2. Reflexes
                              1. DTRs
                                1. Biceps (C5), brachioradialis (C6), triceps (C7), patellar (L3), Achilles (S1)
                                  1. 4+ Hyperactive, 3+ Brisk, 2+ Average, 1+ Diminished, 0 Absent.
                                    1. Abnormally diminished: LMN; Abnormally increased/ clonus: UMN
                                  2. Special reflexes
                                    1. Babinski, Hoffman
                                      1. If present: UMN lesion
                                    2. Sensory Screening
                                      1. Light touch/ pin prick/ vibration (DCML)
                                        1. Practice trial after explanation -- eyes closed -- say 'now' when feeling the touch -- face + body
                                          1. How many times for vibration?
                                            1. If absent: further testing: proprioception (DCML)

                                              Annotations:

                                              • practice with 'up' and 'down'  - hand placement on bone segments, isolate joints - at least 5 movements in random order - great toe, ankle, thumb, wrist, elbow. - test order: distal to proximal
                                              1. Possible further tests: Stereognosis (contralateral posterior parietal cortex, S2)

                                                Annotations:

                                                • Must have normal light touch and language to begin with - assess both sides - use at least 6 objects, 3 per hand
                                                1. Possible further tests: Graphesthesia (contralateral posterior parietal cortex)

                                                  Annotations:

                                                  • light touch must be intact - 'name the letter or number that is written on your palm' - numbers 1-9, letters - no lifting of the pen  - 5 trials per hand
                                              2. Extinction (contralateral posterior parietal cortex)
                                                1. 'right, left, or both?' -- randomize order -- at least 4 bilateral contacts.
                                                2. Motor Screening
                                                  1. Tone
                                                    1. Hypertonic: more likely UMN. Hypotonic: more likely LMN
                                                      1. Spasticity: SCI, CP, Stoke
                                                      2. Strength
                                                        1. Start with 3/5. If completed, add resistance. If unable, remove gravity.
                                                          1. Pronator drift (10 sec)
                                                            1. UMN: motor cortex, premotor cortex, internal capsule, pyramids
                                                          2. Coordination
                                                            1. Finger-to-nose
                                                              1. Rapid pronation/supination on thigh
                                                                1. 10 sec rapid pronation and supination.
                                                                  1. Dysdiadochokinesia: cerebellum
                                                                    1. Brady/ hypokinesia: basal ganglia
                                                                  2. Rapid finger and foot tapping
                                                                    1. 10 sec. 'as quickly as possible with large amplitude
                                                                      1. Dysmetria: cerebellum
                                                                        1. Hypo/ bradykinesia: basal ganglia
                                                                      2. Eye movement coordination
                                                                        1. CN screen
                                                                          1. CN 2
                                                                            1. Visual Fields (optic nerve, optic chiasm, optic tract, LGN, optic radiations, visual cortex) ----------- 'look at my nose at all times' -- 'say now when you see my finger' -- at least one practice trial -- cover one eye at a time -- superior temporal, inferior temporal, superior nasal, inferior nasal.

                                                                              Annotations:

                                                                              • Documentation: L eye: full vision in all quadrants. R eye: vision restriction in superior temporal quadrant. 
                                                                              1. Pupillary light reflex
                                                                                1. CN II, CN III, Brainstem nuclei, parasympathetic pathway
                                                                              2. CN 3,4,6
                                                                                1. Eye movement
                                                                                  1. 'H', vergence
                                                                                  2. Only when necessary: Smooth pursuit in 30 deg.
                                                                                    1. Flocculonodular lobe, vermis (vestibulocerebellum
                                                                                    2. OWN: Saccades
                                                                                      1. Initiation difficulty: Frontal eye fields, basal ganglia
                                                                                        1. dysmetric: cerebellar vermis
                                                                                        2. OWN: Nystagmus
                                                                                        3. CN 5
                                                                                          1. Sensory: 3 points.
                                                                                            1. Strength: temporalis, massater, buccinator, pterygoid
                                                                                              1. Jaw jerk reflex
                                                                                              2. CN 7
                                                                                                1. Muscles of facial expression
                                                                                                2. CN 8
                                                                                                  1. finger rub
                                                                                                    1. Rinne test (only when necessary)
                                                                                                      1. Fork on mastoid: cocholear nerve
                                                                                                        1. Fork suspended: middle ear conduction
                                                                                                      2. CN 9+ 10
                                                                                                        1. Palate elevation and uvula deviation
                                                                                                          1. deviation towards stronger side.
                                                                                                        2. CN 11
                                                                                                          1. SCM and Trapezius
                                                                                                            1. Head turn and shoulder shrug
                                                                                                          2. CN 12
                                                                                                            1. genioglossus function
                                                                                                              1. tongue deviates to weaker side
                                                                                                            2. Gait and balance
                                                                                                              1. Romberg
                                                                                                                1. Sharpened if necessary
                                                                                                                2. Heel- and toe-walking
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