2. AN IMPORTANT ASPECT OF THE NEUROLOGIC ASSESSMENT IS THE HISTORY OF THE PRESENT ILLNESS
3. HEALTH HISTORY Should include: Onset Character Severity Location Duration Frequency of s/sx Associated complaints Precipitating and aggravating factors Progression, remission, and exacerbation Presence and absence of similar symptoms among family members Review of medical history History of falls or trauma Use of alcohol, medications and illicit drugs
4. Common Clinical Manifestations Pain (chronic or acute) Seizures Dizziness and vertigo Visual disturbances Weakness Abnormal sensation
5. Physical Examination A neurological assessment is divided into five components: Cerebral function Cranial nerves Motor system Sensory system Reflexes Follows a logical sequence and progresses from higher levels of cortical function (ex: abstract thinking) to lower levels of function (ex: determination of the integrity of the peripheral nerves)
6. I. Assessing cerebral function Interpretation and documentation of neurologic abnormalities, particularly mental status abnormalities, should be SPECIFICandNONJUDGMENTAL.
7. Mental Status Assessment begins by observing client’s appearance and behavior Posture Gestures Movements Facial expressions Motor activity Manner of speech LOC Orientation
23. Language Ability Aphasia- deficiency in language function Broca’s Aphasia (non-fluent aphasia)- speech output is severely reduced and is limited mainly to short utterances of less than four words. Wernicke’s Aphasia (fluent aphasia) -ability to grasp the meaning of spoken words is chiefly impaired, while the ease of producing connected speech is not much affected. Global aphasia- most severe form of aphasia, and is applied to patients who can produce few recognizable words and understand little or no spoken language. Global aphasics can neither read nor write.
25. Wernicke’s Aphasia Ex: I called my mother on the television and did not understand the door. It was too breakfast, but they came from far to near. My mother is not too old for me to be young.
28. III. Examining the Motor System Assess muscle size, tone, and strength, coordination, and balance Note for rigidity, spasticity and flaccidity
29. Muscle Strength Grading 0 – No contraction1 – Slight contraction, no movement2 – Full range of motion without gravity3 – Full range of motion with gravity4 – Full range of motion , some resistance5 – Full range of motion, full resistance
30. Balance and Coordination Rapid, alternating movements Point-to-point testing Ataxia- incoordination of voluntary muscle action Romberg test
31. IV. Examining the Reflexes Stretch or Deep Tendon Reflexes A brisk tap to the muscle tendon using a reflex hammer produces a stretch to the muscle that results in a reflex contraction of the muscle. The muscles tested, segmental level, and grading of DTR's is listed below. Grading DTR's 0 – Absent1 – Decreased but present2 – Normal3 – Brisk and excessive4 – With clonus
39. Myelography An x-ray of the spinal subarachnoid space after injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture
40. Post myelography care Head elevated to 30-45 degrees for 3H or as prescribed by the AP Encouraged to increase OFI Assess VS and ability to void Untoward signs------headache, fever, stiff neck, photophobia, and seizures
