Neurology and Muscle Function Quiz

Neuro Foundations 3 - Notes

• Course code: OCCTH 583
• Instructor: Jennifer Krysa, MSc, Reg OT (AB), OTR
• University: University of Alberta

The Neurological Examination

• Comprehensive assessment encompassing: mental status, cranial nerves, motor system, muscle strength, gait/stance/coordination, sensation, reflexes, and autonomic nervous system.

Mental Status

• Level of Consciousness:
  • Alert: aware of surroundings
  • Comatose: unresponsive to stimuli
  • Intermediate levels: use descriptive terms (stuporous, lethargic, drowsy), but lack precision. Note details like rousable, need for specific stimuli to awaken, and duration of wakefulness.
• Content of Consciousness:
  • Client needs to be awake and alert for proper assessment.
  • If inattentive, assessment of content is limited.
• Mental Status Examination (MSE):
  • Part of a complete neurological exam or can be a standalone examination.
  • Not a psychiatric interview, neuropsychological test, or OT functional cognitive assessment.
  • Purpose: diagnosis of neuropathology.
  • Strengths: short, practical, and flexible.
  • Weaknesses: not highly standardized; often lacks norms.

Content of Consciousness

• Orientation: Person, place, and time. Consider if the individual has been disoriented or unconscious before. Use cues to determine their awareness; hospital, calendar, clock, watch help gauge orientation to place. Time perception varies based on individual context and circumstance.
• Attention and Concentration: Tasks including spelling a five-letter word forward and backward, serial 7s, and digit span (forward or backward).
• Memory: Long-term memory (personal and historical information) and short-term memory (registration and recall of 3-5 objects, possibly with delay).
• Verbal and Mathematical Abilities: Reading, writing, sentence repetition, object naming, word finding, list generation, basic calculations, and recognizing numbers.
• Judgment: Considering "what if" scenarios and everyday situations. Assess reactions in response to potential emergencies and assistance to others.
• Reasoning: Examining concrete and abstract concepts including comparing similarities between objects and interpreting proverbs.

Orientation to Time - Try It

• Discuss with a partner how you track time (e.g., date vs. day of the week).
• Reflect on what moving a 3 o'clock meeting back 2 hours means.
• Identify when seasons officially change.

Attention & Concentration

• Assessing attention required for memory and perception.
• Include tasks like spelling short words and serial 7s.
• Digit span exercises (forward and backward).

Cranial Nerves

• Detailed descriptions of each nerve (e.g., olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, spinal accessory, hypoglossal).
• Includes sensory, motor, and mixed functions.
• Mechanism of injury (MOI) and associated abnormal findings are relevant for each nerve.

Olfactory

• Sensory function only evaluated typically after head trauma affecting the ethmoid bone.
• Asses for Anosmia (loss of sense of smell). Parkinson's patients frequently experience anosmia before motor symptoms.

Other Cranial Nerves (2-12)

• Detail assessment strategies and symptoms, as well as MOI.
• Examples include, visual fields and acuity, color perception in optic nerve, assessing eyelid movement, pupil constriction/accommodation oculomotor (3), eye movements trochlear (4) and abducens (6), facial expression, taste sensation, hearing, and balance/ equilibrium function in vestubulocochlear (8).

Related Terminology & Abbreviations

• Definitions provided for various neurological terms and abbreviations, such as Ptosis, Myadriasis, Diploplia, EOM, MOI, and ICP

Tips for Neurological Assessments

• Procedures and strategies for specific tests such as pupillary light reflex, assessments of motor functions associated with extra-ocular muscles (EOMs), and testing of Cranial Nerves 3, 4 and 6.

Pathologic Reflexes

• Describe assessment tasks and tests like Babinski, rooting, snout, grasp reflexes.

Reflexes

• Describe deep tendon reflexes (DTRs).
• Assess reflexes in relation to upper or lower motor neuron lesions and include specific tests like clonus, and sphincter reflexes (in SCI). Provide detailed information about specific pathological reflexes for each nerve.

Autonomic Nervous System

• Assess for postural hypotension during Valsalva maneuvers.
• Evaluate heart rate changes, sweating(decreased or absent), and Horner syndrome (unilateral ptosis, constricted pupil, and absence of sweat).
• Monitor for changes in sexual, bowel, bladder, and hypothalamic function (temperature, appetite, sleep-wake cycles).

Peripheral Nervous System: Structure & Classifications

• Details about the structure of the peripheral nervous system (endoneurium, perineurium, epineurium).
• Classified nerve types include large myelinated (fastest, proprioception, motor), small myelinated & unmyelinated nerves in regard to their function (e.g., pain, temp, touch).

Four Peripheral Nerves Major Plexi

• Provide details of the Cervical, Brachial, Lumbar, and Sacral Plexi which involve several important nerve groups for each. Note how they're important for function.

Peripheral Neuropathies: Causes Summary

• Discusses environmental factors (heavy metals, chemicals, repetitive motions), diseases (e.g., demyelinating syndromes, autoimmune disorders, and hereditary conditions such as Charcot-Marie-Tooth, diabetes), medications (cytotoxic and chemotherapy, for instance), & nutritional deficiencies which can cause peripheral neuropathies.

Peripheral Nerve Injury (Seddon & Sunderland)

• Provides details and classifications about neurapraxia, axonotmesis, and neurotmesis (including clinical assessment). Sunderland classification expands on Seddon's descriptions further in regard to injury and recovery.

Myotonia

• Describes lead pipe rigidity, uniform rigidity throughout range of motion often associated with clonus. This is a sign suggestive of basal ganglia disorder.
• Note simultaneous co-contraction of opposing muscle groups (agonists and antagonists)
• Detail clasp-knife phenomenon, a sign of increased resistance to passive range of motion initially followed by relaxation. This is a sign of possible upper motor neuron lesion.
• Note where myotonia typically most pronounced in upper and lower extremities for these assessment tests

Muscle Strength & Other Components

• Assessments involving muscle strength testing (MMT), screening for factitious weakness (e.g., middle deltoid).
• Describe assessment of Gait, stance, Coordination, and Sensation in detail.

Diabetes Neuropathy

• Describe the impact of glycemic control on nerve damage severity, and pattern (distally symmetric). Assessment of sensory and motor functions is key. Discuss length of nerves most impacted, increased risk of skin breakdown, and common effects on gait/balance and falls risk.

• Describe how the factors like glycemic control determine the degree and severity of diabetic neuropathy.

• Details how nerve fiber loss and atrophy often characterize diabetic neuropathy, and how it affects sensory, motor nerves.

• Considerations like risk factor for skin breakdown, changes in gait or balance and associated falls.

Guillain-Barré Syndrome (GBS)

• Emphasize GBS's causes, progression (sudden onset over hours to weeks), and symptoms of flaccid paralysis and areflexia. Note that the initial symptoms usually include weakness and tingling in hands and feet.
• Importance of recognizing when respiratory function is compromised (a medical emergency).
• Detail how intravenous immunoglobulins (IVIg) are often used to treat GBS and provide prognosis where full recovery is often seen in most patients.