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ASSESSMENT IN
NEUROLOGY
Mohd Haidzir b Abd Manaf
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Introduction
2
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Principles of Physiotherapy
3
Assessment
History Taking
Details about the nature, severity,
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Principles of Physiotherapy
4
Assessment
History Taking
Difficulties patients may experience in
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Skull and spinal X-rays
6
These show:
fractures of the skull vault or base
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Computed tomography: CT
8
CT scanning demonstrates:
cerebral tumours
intracerebral haemorrhage and infarction
subdural and extradural haematoma
free blood in the subarachnoid space
(subarachnoid haemorrhage, see )
lateral shift of midline structures and
displacement/enlargement of the ventricular
system
cerebral atrophy
spinal trauma (with CT myelography) PHT266
Magnetic resonance
9
imaging: MRI
The hydrogen nucleus is a proton whose
electrical charge creates a local electrical field.
These protons are aligned by sudden strong
magnetic impulses.
Protons are then imaged with radiofrequency
waves at right angles to their alignment.
The protons resonate and spin, then revert to
their normal alignment. As they do so, images
are made at different phases of relaxation,
known as T1, T2, T2 'STIR', diffusion-weighted
imaging (DWI) and other sequences.
From these sequences, referred to as different
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weightings, recorded images are compared.
Magnetic resonance
10
imaging: MRI
Advantages of MRI
distinguishes between brain white and
grey matter.
Spinal cord and nerve roots are imaged
directly.
Pituitary imaging.
Brainstem death
The EEG is isoelectric (flat), but is no longer
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Electromyography and
14
conduction studies
Electromyography
A concentric needle electrode is inserted
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Mental state, attitude, insight
Orientation
Score one point for each correct answer:
What is the: time, date, day, month, year? 5 points
Maximum:
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Motor system
21
Muscle strength
2. Scale of muscle strength (MRC UK, 1878)
Grade
0 No muscular activity
1 Minimal contraction of muscle but
insufficient to move a joint
2 Contraction of muscle sufficient to move
a joint but not to oppose gravity
3 Muscle contraction sufficient to move a
joint against gravity but not against
4 physical resistance sufficient to move a
Muscle contraction
joint against gravity but against
mild/moderate physical resistance
5 Normal power, that is muscular
contraction sufficient to resist firm
resistance. PHT266
Muscle Function
23
Muscle strength
2. Grip strength and pinch strength using
hand dynamometer (Bohannon &
Andrews, 1987)
3. Equipment to measure muscle strength
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Muscle function
24
Muscle Size
2. Decrease or increase in muscle bulk
( atrophy or hypertrophy).
3. Tape measure – measuring limb
circumference
4. Ultrasound imaging – reliable
measurement
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Muscle function
25
Muscle tone
Assessed by passively moving the limbs
1. Normal
2. Increased – hypertonic due to spasticity or
rigidity
3. Decreased - hypotonic
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Muscle function
26
Muscle tone
Depend on the velocity of the movement
Grade Modified Ashworth Scale of muscle Spasticity
0 No increase in muscle tone
1 Slight increase in muscle tone , manifested by a
catch and release or by minimal resistance at the
end of the range of motion when the affected part is
moved in flexion or extension.
1+ Slight increase in muscle tone, manifested by a
catch, followed by minimal resistance through the
remainder (less than half) of the range of movement
Co-ordination
Integration of sensory feedback with
motor output of sufficient strength
Involuntary contractions, involuntary
movement reactions, control of
voluntary movement functions and
involuntary movement functions.
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Deep Tendon Reflexes
29
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Triceps (C6, C7)
31
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Brachioradialis (C5, C6)
32
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Knee (L2, L3, L4)
33
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Ankle (S1, S2)
34
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Clonus
35
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Plantar Response
(Babinski)
36
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Balance Task
1 Sitting to standing
37
2 Standing unsupported
Traditionally – 3 Sitting unsupported
good, fair , poor 4 Standing to sitting
5 Transfer
Validated
6 Standing with eyes closed
measure – Berg 7 Standing with feet together
Balance Scale 8 Reaching forward with
outstretched arm
The Functional
9 Retrieving object from floor
Reach Test 10 Turning to look behind
11 Turning 360º
12 Placing alternate foot on stool
13 Standing with one foot in front
14 Standing
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Co-ordination
38
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Co-ordination
39
Heel-shin test
Line supine
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Sensory Function
41
Proprioception
Joint position sense
Sensory function for detecting and
joints.
The patient is asked in what direction
First,
ask whether feeling in the limbs, face and
trunk is entirely normal
Posterior columns:
Vibration (using a 128 Hz tuning fork)
Joint position
Light touch
2-point discrimination (normal: 0.5 cm finger tips, 2
cm soles)
Spinothalamic tracts:
Pain:
use a split orange-stick or a sterile pin
Temperature: hot or cold tubes
Romberg’s Test
Patient is asked to stand with the feet
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Touch
44
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46 Assessing Activities
Observation of gait
Assessment of gait
Global measures of activity limitations
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Observation of gait
47
Symmetry
Duration of swing and stance phases
Muscle activation around ankle, knees,
hips and trunk, arm swing, trunk
rotation, balance and speed.
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Parkinson's disease
48
Hemiplegia
Foot drop
High step
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Observation of gait
54
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