pe_neuroexam
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pe_neuroexam

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\u2022 Open paper clip Æ ends ~ 5mm apart
\u2022 Patient closes eyes
\u2022 Alternately touch w/1 point or 2 \u2013 normal nerve

function enables them to make distinction

Special Sensory Testing
(cont)

MONOFILAMENT
TESTING

\u2022 Screening test for
diabetic neuropathy

\u2022 Touch monofilament to 5-
7 areas on bottom of
foot.

\u2022 Normal =s Patient can
detect filament when tip
lightly applied to skin (i.e.
before it bends).

\u2026Trying To Prevent This!

Sensory Testing\u2026

Reflex Testing
Anatomy and Physiology

\u2022 Reflex arc made has afferent (sensory) & efferent
(motor) limb

\u2022 Synapse in spinal cord, @ which point also input from
upper motor neuron

\u2022 Disruption of any part of path alters reflexes: e.g.
\u2013 UMN lesion Æ reflexes more brisk (hyper-reflexia)

\u2013 LMN or peripheral sensory lesionsÆopposite effect (hypo-
reflexia)

\u2022 Reflexes graded 0-4+ scale: 0 = no reflex, 1+ =
hyporeflexia, 2+ = normal, 3+ = hyper-reflexia, 4+ =
clonus (multiple movements after a single stimulus)

Reflex Basics

\u2022 Reflexes generally assessed in 5 places - 3 in
the arm (biceps, triceps, brachioradialis); 2 in the
leg (patellar & achilles)

\u2022 Basic Technique for assessing a reflex:
\u2013 Clearly identify tendon of muscle to be tested

\u2013 Position limb so muscle @ rest
\u2013 Strike tendon briskly
\u2013 Observe for muscle contraction & limb

movement

Reflex Basics (cont)
\u2022 Array of hammers \u2013 all effective

\u2022 Reflex Trouble Shooting:
\u2013 Make sure patient relaxed & that

you\u2019re striking tendon directly
\u2013 Hammer swings freely
\u2013 Reinforcement (distraction) helps

if you\u2019re having problems
\u2022 When testing legs, ask patient to pull

their hands apart as you strike
tendon

\u2022 When testing the upper extremities,
ask them to clench teeth

Patellar Hyper-Reflexia

Biceps (C 5, 6)

\u2022 Identify biceps
tendonÆhave patient flex

elbow against resistance
while you palpate
antecubital fossa

\u2022 Place arm so it\u2019s bent ~
90 degrees

\u2022 Place one of your fingers
on tendon and strike it
birskly

\u2022 Muslce should contract &
forearm flex

Triceps (C 7, 8)
\u2022 Identify triceps

tendonÆhave patient
extend elbow against
resistance while you
palpate above it

\u2022 Arm can hang down @
ninety degrees or have
hands on hips

\u2022 Strike tendon directly or
place finger on the
tendon & strike it

\u2022 Triceps muscle contracts
& arm extends.

Brachioradialis (C5, 6)

\u2022 Tendon for
brachioradialis is ~ 10 cm
proximal to wrist \u2013 you
cant see or feel it

\u2022 Place arm so resting on
patient\u2019s thigh, bent @
elbow

\u2022 Strike firmly
\u2022 Muscle will contract &

arm will flex @ elbow &
supinate

Patellar (L3, 4)

\u2022 Patellar tendon
extends below knee
cap \u2013 it\u2019s thick &
usually visible &
palpable \u2013 if not,
palpate while patient
extends lower leg

\u2022 Strike firmly on
tendon

\u2022 Muscle will contract &
leg extend @ knee

Achilles (S1, S2)
\u2022 Achilles tendonÆthick

structure connecting
calf musclesÆheel \u2013 if
having trouble finding,
palpate as patient
pushes their foot into
your other hand

\u2022 Hold foot @ 90 degrees
\u2022 Strike tendon firmly
\u2022 Muscle will contract &

foot plantar-flex (move
downward)

Babinski

\u2022 Firmly stroke bottom of
foot, starting laterally &
near heel \u2013 moving up &
across balls of feet
(metatarsal heads)

\u2022 Normal =s great toe
moving downward

\u2022 If UMN lesion (or in
newborns), great toe will
extend & other toes fan
out

Babinski Response \u2013 UMN lesion
Example

Babinski Reflex

Gait and Romberg Testing
\u2022 Romberg: Test of balanceÆ input from multiple

systems: proprioception, vestibular, cerebellum
\u2013 Ask patient to stand still w/eyes closed
\u2013 If @ risk for falling, be in position to catch \u2018em (i.e. behind

them) & get help

\u2022 Gait \u2013 pay attention to:
\u2013 initiation of activity
\u2013 arm, leg movement & position
\u2013 speed & balance

Gait S/P Stroke

Summary of Skills
\u25a1Wash Hands
\u25a1 Cranial Nerves (review from eye, head & neck)

Motor testing:
\u25a1 muscle bulk
\u25a1 tone
\u25a1 strength of major groups

Sensory testing - in distal lower & upper extremities:
\u25a1 pain
\u25a1 light touch
\u25a1 proprioception
\u25a1 vibration

Reflexes
\u25a1 achilles
\u25a1 patellar
\u25a1 brachioradialis
\u25a1 biceps
\u25a1 triceps

\u25a1 Cerebellar function (fingerÆnose, heelÆshin, etc.)
\u25a1 Gait, Romberg

Time Target: < 15 minutes

Hang In There!

	Neuro Exam
	Elements of The Neuro Exam
	Motor/Strength\ufffdAnatomy and Physiology
	Muscles \u2013 Observation/Bulk \ufffdand Palpation
	Muscle Tone; Observe For Tremor
	Anatomic Position\ufffdFlexion/Extension & Abduction/Adduction
	Extension/Flexion, Abduction/Adduction @ Major Joints
	Strength \u2013 Scoring System
	Specific Muscle Group \ufffdTesting
	Muscle Group Testing (cont)
	Cerebellar Testing:\ufffdCoordination & Fine Motor Movement
	Cerebellar Testing (cont)
	Sensory Testing\ufffdAnatomy & Physiology
	Nerves and Their Distributions
	Spinothalamics \u2013 Pain, Temperature & Crude Touch
	Spinothalamics \u2013 Pain, Temperature and Crude Touch (cont)
	Spinothalamics \u2013 Pain, Temperature & Crude Touch (cont)
	Dorsal Columns - Proprioception
	Dorsal Columns \u2013 Proprioception (cont)
	Dorsal Columns \u2013 Vibratory Sensation
	Dorsal Columns \u2013 Vibratory Sensation (cont)
	Special Sensory Testing
	Special Sensory Testing (cont)
	Reflex Testing\ufffdAnatomy and Physiology
	Reflex Basics
	Reflex Basics (cont)
	Biceps (C 5, 6)\ufffd
	Triceps (C 7, 8)\ufffd
	 Brachioradialis (C5, 6)
	Patellar (L3, 4)\ufffd
	Achilles (S1, S2) \ufffd
	Babinski\ufffd
	Gait and Romberg Testing
	Summary of Skills
	Hang In There!