PT Fundamentals Week 4 - Systems Review 2 (Transcripts)

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Questions and Answers

What is the primary objective of a neuromuscular systems review?

To analyze the patient's range of motion at joints

To assess the function of both the central and peripheral nervous systems (correct)

To measure muscle strength exclusively

To evaluate only the musculoskeletal components of the body

Which of the following regions is included in the upper quarter systems review?

Ankle

Pelvis

Shoulder (correct)

Knee

During a neuromuscular systems review, what is assessed through observation?

Bone density through imaging

General coordinated movement and balance (correct)

Joint pressure and palpation techniques

Electric muscle stimulation response

When deciding whether to use an upper or lower quarter systems review, what factor is most relevant?

The chief concern presented by the patient Signup and view all the answers

What components make up the lower quarter systems review?

Pelvis, knee, ankle, and foot Signup and view all the answers

What is the typical grading for a normal reflex response?

2+ Signup and view all the answers

Which reflex is associated with the S1 nerve root?

Achilles tendon reflex Signup and view all the answers

What indicates the presence of an upper motor neuron lesion during reflex testing?

Reflex grading between 3+ to 5+ Signup and view all the answers

In the context of reflex testing, what does a score of 0 indicate?

Absent reflex Signup and view all the answers

During the Babinski reflex test, which response would be considered a positive result?

Extension of the big toe with splaying of other toes Signup and view all the answers

What indicates a pathological reflex in adults?

Presence of primitive reflexes Signup and view all the answers

What does the briskness of deep tendon reflexes help to assess?

Upper versus lower motor neuron lesions Signup and view all the answers

How can the Jendrasikk maneuver aid in reflex testing?

By increasing central excitability Signup and view all the answers

Which of the following reflexes is tested for the C6 nerve root?

Brachioradialis reflex Signup and view all the answers

What condition is indicated if deep tendon reflexes are diminished?

Lower motor neuron lesion Signup and view all the answers

What is assessed during the patient's ability to perform specific motions?

Motor coordination and fluidity of movement Signup and view all the answers

Which test might be selected if a patient demonstrates impaired gait?

Functional gait assessment Signup and view all the answers

What should be done before conducting the sensation screening on a patient?

Properly expose the areas being assessed Signup and view all the answers

During sensation testing, what is the significance of the forehead touch?

It serves as a reference point for the patient Signup and view all the answers

What indicates that the sensation is felt the same on both sides during the assessment?

There are no differences in sensitivity Signup and view all the answers

What should be assessed if a patient reports differences in sensation during a screening?

Whether the sensation is completely absent or impaired Signup and view all the answers

Which anatomical landmarks are assessed during the lower quarter sensation screening?

Anterior medial thigh and medial malleoli Signup and view all the answers

What is the primary purpose of testing deep tendon reflexes (DTRs)?

To observe responses mediated by spinal nerves and identify lower motor neuron lesions Signup and view all the answers

How can sensory loss help differentiate between a spinal nerve root lesion and a peripheral nerve lesion?

Sensory loss that follows a dermatomal map indicates a spinal nerve root issue. Signup and view all the answers

What might brisk reflex responses indicate during reflex testing?

An upper motor neuron lesion Signup and view all the answers

What is one primary purpose of performing a musculoskeletal system screen?

To evaluate joint function, muscle performance, and connective tissue integrity. Signup and view all the answers

Which observation is NOT typically included during the musculoskeletal systems review?

Evaluating the patient's financial background. Signup and view all the answers

What does abnormal gross active range of motion indicate in a patient?

Further examination with specific tests and measures is needed. Signup and view all the answers

What type of active range of motion is specific to movements of the spine?

Axial gross active range of motion. Signup and view all the answers

What is typically assessed during heel walking as part of the neuromuscular systems review?

Gross coordinated movement and balance. Signup and view all the answers

Study Notes

Overview of Neuromuscular System Review

The neuromuscular system screen assesses both central and peripheral nervous systems.
It screens for abnormalities warranting further objective examination.

Components of the Neuromuscular System Screen

Upper Quarter Screening:
- Includes cervical/thoracic spine, shoulder, elbow, wrist, and hand.
Lower Quarter Screening:
- Consists of lumbar/thoracic spine, pelvis, knee, ankle, and foot.

General Coordinated Movement and Balance Assessment

Observational assessment during patient movements (walking, sitting, standing).
Movements assessed include:
- Toe walking and heel walking.
- Performance of balanced transitions (sitting to standing).
- Full squat motion.
Identifying weaknesses and deficits informs decision-making for further tests.

In-Depth Tests based on Observations

Impaired gait may lead to tests like:
- Functional Gait Assessment
- 10-Meter Walk Test
For balance issues, consider:
- Berg Balance Scale
- Modified CTSIB Tests
Weakness assessments may include:
- Manual Muscle Testing
- Dynamometry

Sensation Screening Process

Aims to determine normal, absent, or impaired sensation in upper/lower quarters.
Procedure requires areas to be properly exposed without clothing interference.
Reference sensation established using gentle touch on the patient’s forehead.
Assess specific dermatome areas bilaterally:
- Identify differences in sensation and document findings.
If differences found, determine if sensation is absent or impaired.

Dermatome Sensation Mapping

Upper Quarter focuses from C4 to T1 nerve roots.
Lower Quarter covers L2 to S2 nerve roots.
Knowledge of specific sensory points is essential for testing.

Reflex Testing

Includes assessment of Deep Tendon Reflexes (DTRs) and pathological reflexes.
DTRs signify interaction of spinal nerves and are tested via reflex hammer stimulation.
Normal DTRs indicate no lower motor neuron lesions; brisk responses suggest upper motor neuron lesions.

Procedure for Deep Tendon Reflex Testing

Conducted on the upper or lower quarter based on patient's concerns.
Involves tapping specific tendons while patient is relaxed.
Tests muscle contraction response, and comparison between sides reveals pathology.
Reinforcement techniques (Jendrasik maneuver) can enhance reflex response.

Key Reflexes in Upper Quarter Testing

Biceps Reflex (C5)
Brachioradialis Reflex (C6)
Triceps Reflex (C7)
Familiarity with associated nerve roots for effective testing.

Closing Remarks

Understanding the complete neuromuscular system review facilitates comprehensive patient assessment.
Clinical decision-making should guide the choice of further assessments based on initial screening results.### Reflex Hammer Technique
Use the thumb to palpate the tendon and strike with the reflex hammer on the thumbnail or directly on the tendon.
Ensure the patient is relaxed during the reflex test.
Hold the reflex hammer loosely; a quick and direct strike is essential for an accurate response.

Reflex Response Assessment

Observe speed, amplitude, and force of reflex response, comparing sides to establish grading.
Quadriceps (patellar) reflex correlates with the L4 nerve root.
Achilles tendon reflex correlates with the S1 nerve root.

Grading Deep Tendon Reflexes

Reflexes are graded on a scale from 0 to 5.
A normal reflex is rated as 2+.
Grades above 2+ indicate brisk (3+) or very brisk responses (4+), potentially signaling upper motor neuron lesions.
Grades below 2+ suggest diminished (1+) or absent reflexes (0), which may indicate lower motor neuron lesions.
Utilize the Jendrasikk maneuver if reflexes are weak to determine reflex response improvement.

Pathological Reflexes

Upper motor neuron lesion tests, like the Babinski reflex, assess spinal or brain integrity.
Babinski reflex is tested by dorsiflexing the ankle; positive response (extension of the big toe) is abnormal in adults.
Clonus is graded; absence is normal, while greater than 3 beats indicates an abnormal response.

Neuromuscular Systems Review

Collect data on sensory impairments, reflex impairments, and pain to guide differential diagnosis.
Peripheral neural system issues present with sensory loss and decreased reflexes; central neural system issues present with increased reflexivity and pathological reflexes.
Observations include gross coordinated movements, movement screening (heel/toe walking, squats), and reflex testing.

Musculoskeletal System Screening Purpose

Assesses joint function, muscle performance, and connective tissue integrity.
Aids in determining specific exams necessary for patients during objective examination.

Observation and Measurement in Screening

Measure patient height and weight to gather initial data.
Assess posture and symmetry in the frontal and sagittal planes for abnormalities.
Active Range of Motion (AROM) is evaluated to provide insight into muscle strength and coordination.

Axial and Appendicular Range of Motion

Evaluate cervical and thoracolumbar ranges of motion by assessing flexion, extension, side bending, and rotation.
For upper extremities, test shoulder abduction, reaching behind the head/back, and wrist movements.
For lower extremities, assess hip flexion, internal/external rotation, knee flexion/extension, and ankle movements.

Documenting Findings in Screening

Document findings based on mobility (hypomobile, normal, hypermobile) and pain presence.
Painful motions should be tested last to prevent symptom exacerbation.

Gross Strength Testing

Provides an overall assessment of muscle function and strength.
Weakness identified in screening may necessitate further evaluation with specific tests like manual muscle testing or dynamometry.
Factors such as pain, comprehension issues, fatigue, and fear can impact patient performance during testing.### Gross Strength Assessment Overview
Gross strength is evaluated in two primary areas: axial spine (cervical and thoracolumbar) and appendicular strength (upper and lower extremities).
Assessment varies based on whether the patient's chief complaint is in the upper or lower quarter.

Axial Spine Strength Testing

Cervical spine strength testing occurs with the patient seated; resistance is applied deliberately while stabilizing the patient.
Resistance begins light and is gradually increased, applied for three seconds.
Six motions tested include:
- Left side bending
- Right side bending
- Cervical extension
- Cervical flexion
- Left rotation
- Right rotation
Monitor for weaknesses or symptom reproduction during each movement.

Thoracolumbar Spine Testing

Thoracolumbar strength testing is conducted similarly, initiated for patients with lower extremity concerns.
Patience is seated with knees touching the table and arms crossed for stable positioning.
Movements tested include:
- Right side bending
- Left side bending
- Left rotation
- Right rotation
- Extension
- Flexion
Maintain visual and positional awareness to prevent patient safety risks.

Appendicular Strength Testing

Upper extremity strength assessment is performed during the systems review for upper quarter concerns.
Requires memorization of specific resisted movements and their associated nerve roots (key myotome tests).
Movements include:
- Shoulder abduction
- Shoulder shrug
- Shoulder external/internal rotation
- Elbow flexion/extension
- Wrist flexion/extension
- Finger flexion/abduction
- Thumb extension
For finger tests, match resistance application to the patient's movements for accurate assessment.

Lower Extremity Appendicular Testing

Conducted for patients with lower quarter chief concerns.
Key myotome strength tests include:
- Hip flexion
- Hip internal/external rotation
- Knee extension/flexion
- Ankle dorsiflexion/plantarflexion
- Ankle inversion/eversion
- Great toe extension
Emphasis on proximal stabilization during tests to enhance accuracy and safety.

Documentation and Analysis

Document findings based on strength (strong or weak) and symptom reproduction (pain-free or painful).
An example includes assessing knee extension strength with distinctions between left (weak/painful) and right (strong/pain-free) knees.
Testing results help guide more detailed examinations and interventions.

Differential Diagnosis Considerations

Assessing the nature of muscle weakness provides insights into underlying conditions.
Weakness patterns may suggest nerve root issues or peripheral nerve involvement.
Strong and pain-free testing typically rules out contractile tissue issues, while strong and painful may suggest tendonitis.
Weak and pain-free could indicate neural lesions, while weak and painful points to partial muscle tendon ruptures.

Integration of Neurological Findings

Neurological system review findings (reflexes, dermatomes) reinforce differential diagnosis.
Recognizing relationships between muscle strength deficits and specific nerve root patterns is crucial.

Integumentary System Review Objectives

The integumentary screen assesses skin condition for signs of damage, injury, or abnormalities.
Vital for identifying risk factors, especially in patients with limited mobility or neurological symptoms.
Physical therapists often detect initial wounds or abnormal reactions in the integumentary system.

Observational and Palpation Characteristics

Observation includes assessing skin coloration, moisture, and integrity (lesions, scars, rashes).
Palpation evaluates skin texture, firmness, pliability, elasticity, and temperature.
Skin elasticity tests can indicate hydration levels; utilize the back of the hand for temperature assessment.

Significance of Skin Changes

Color variations may signify underlying health conditions, with bruising and discoloration differing across skin types.
Specific conditions, such as Raynaud syndrome or cyanosis, manifest visible skin changes, providing diagnostic clues.
Careful assessment of skin characteristics aids in the holistic evaluation of patient health.

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Description

Test your knowledge on the objectives and components of neuromuscular systems reviews. This quiz covers observation techniques, the regions included in the upper and lower quarter systems reviews, and reflex response grading. Perfect for students and professionals in physical therapy and related fields.