Neuro/Musculoskeletal Assessment

 

You can combine the neuro and MSK assessment and integrate it throughout the full exam of the client.

 

Musculoskeletal Assessment

 

Inspection

 

Palpation

 

Range of motion

 

Muscle strength

 

Branching exams:  In lab

 

A Targeted Assessment:  Low Back Pain

 

 

 

 

 

Neurological Examination

Objectives of Neuro Assessment

Is there a problem involving the nervous system?

Localize the problem within the nervous system

Determine the etiology

Determine appropriate diagnosis and treatment

 

 

History:  Most important factor in neuro assessment

Chief complaint

HPI

Details about the symptoms

Acute or chronic in nature?

Precipitating factors?

Improving or worsening?

Associated symptoms

Any recent travel to foreign countries?

 

Past Medical History

Previous similar symptoms

Other medical illnesses

Previous surgeries

Pregnancy or birth illness or injury

 

General health information

Family history

Huntington’s chorea, tics, etc.

Social history

employment

drug or alcohol intake

home life

Allergies

ROS

 

General Approach

Detail of exam depends on the data collected

Neuro exam can be integrated with other systems

What have you already done re: neuro?

 

Neuro exam: 5 parts

Mental status (and speech)

Cranial nerves

Motor function

Reflexes

Sensory function

 

1.  Mental Status:  Look for any signs of change from previous behavior patterns.

 

RED FLAGS regarding mental status

 

2.  Cranial Nerves

Sensory deficits are present when afferent fibers are involved.

 

deficits are present when efferent fibers are involved.

 

Cranial Nerves

A = Afferent (sensory)

E = Efferent (motor)

 

I   Olfactory (A)

II  Optic (A)

III Oculomotor (E)

IV Trochlear (E)

V  Trigeminal (A,E)

VI Abducens (E)

VII Facial (A,E)

VIII Vestibulocochlear (Acoustic) (A)

IX   Glossopharyngeal (A,E)

X    Vagus (A,E)

XI   Spinal Accessory(E)

XII  Hypoglossal (E)

 

3.  Motor Function

 

Inspection of motor system

Observe limbs and trunk for:

atrophy

fasciculations

involuntary movements

abnormalities of position

 

Station and Gait

Walk across room and back

Walk heel to toe (tandem walking)

If has difficulty:

Romberg

Hop in place

Shallow knee bend

Walk on toes (plantar flexion)

Walk on heels (dorsiflexion)

 

Coordination: 
Cerebellar Function

Arms

Rapid rhythmic alternating movement

Point to point

Legs

Rapid rhythmic alternating movement

Point to point

 

Muscle tone

Bulk

Contour

Symmetry

 

Note:  Check for muscle tone and resistance while putting joints through ROM.

 

Muscle Strength:  Grading

5/5   Normal Strength

4/5   Full ROM against gravity, with some effort at resistance

3/5   ROM against gravity

2/5   ROM without gravity

1/5   Trace joint or muscle contraction

0/5   No movement

 

4.            Reflexes

Technique

Relaxed client

Limb supported

Muscle mildly stretched

Strike tendon briskly

If reflexes are symmetrically diminished or absent, use isometrics.

 

Grading of Reflexes

0      Absent, no muscle contraction

1+        Hyporeflexia

2+   Normal

3+        Hyperreflexia

4+ and 5+        Abnormal - strong contractions, with clonus

 

Check these reflexes:

Biceps

Triceps

Brachioradialis

Patellar (knee)

Achilles (ankle)

 

Abnormal:

Jaw reflex

Snout reflex

Glabellar reflex

Hoffman’s reflex

Babinski reflex

 

5.  Sensory function

 

Sensory dermatomes

Pinprick

Light touch

Vibratory

Thermal

 

Sensory Function

Position (kinesthesia)

Sense of where body part is in space

Check finger, toe

Vibratory sense

Vibrating tuning fork placed over a bony prominence

 

Sensory Function:  Discrimination

Stereognosis:  object identification

Graphesthesia:  number identification

Two point discrimination

Point localization

Extinction