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Slide 23-2
Pathways of the CNS
Crossed representation
Sensory pathways
Spinothalamic tract
Posterior (dorsal) column
Motor pathways
Corticospinal or pyramidal tract
Extrapyramidal tracts
Cerebellar system
Upper motor neurons
Lower motor neurons
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Slide 23-4
[PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical
Examination and Health Assessment, 5e, ISBN: 978-1-4160-3243-4)]
Slide 23-5
© Pat Thomas, 2006.
Slide 23-6
Headache
Head injury
Dizziness/vertigo
Seizures
Tremors
Weakness
Slide 23-7
Preparation
Screening neurologic examination
Complete neurologic examination
Neurologic recheck
Equipment needed
Penlight
Tongue blade
Cotton swab
Cotton ball
Tuning fork (128 or 256 Hz)
Percussion hammer
Occasionally need: familiar aromatic substance
Slide 23-8
Test Cranial Nerves
VII—Facial
I—Olfactory
Motor function
II—Optic Sensory function
III—Oculomotor, VIII—Acoustic
IV—Trochlear, (vestibulocochlear)
VI—Abducens IX—Glossopharyngeal,
V—Trigeminal X—Vagus
Motor function
Motor function
Sensory function
Sensory function
XI—Spinal accessory
Corneal reflex
XII—Hypoglossal
Slide 23-9
Motor System—Inspect and palpate
Muscles Cerebellar function
Slide 23-11
Sensory System
Person is alert, Posterior column tract
cooperative, and Vibration
comfortable Position (kinesthesia)
Guidelines for sensory Tactile discrimination
testing (fine touch)
Stereognosis
Spinothalamic tract
Graphesthesia
Pain Two-point discrimination
Temperature Extinction
Light touch Point location
Slide 23-12
Test the stretch or deep Test the superficial
tendon reflexes reflexes
Technique Abdominal reflex
Grading Cremasteric reflex
Reinforcement Plantar reflex
Biceps reflex
Triceps reflex
Brachioradialis reflex
Quadriceps reflex
Achilles reflex (“ankle jerk”)
Clonus
Slide 23-13
Neurologic recheck
Level of consciousness
Person
Place
Time
Motor function
Pupillary response
Vital signs
Glasgow Coma Scale (GCS)
Slide 23-14
Oculomotor response (Cranial nerve III)
Size, equality, and roundness of pupils
assessed
Size measured in millimeters
Evaluated for symmetry in size and response to
light stimulus
Brisk, sluggish, non-reactive
Consensual reaction of opposite pupil at same
time
Assess accommodation by holding finger 4-6
inches from client’s nose and then pull out to
18 inches.
As finger moves away pupil will accommodate
by dilating, as finger moves closer, constricting
PEARLA- Pupils equal and reactive to light
and accommodation
Ability to follow commands
Muscle tone
Muscle strength
Coordination
Balance (Romberg test)
Posturing (Decorticate, Decerebrate)
Tactile sensation
Pain
Temperature
Vibratory sensation
Tactile discrimination
Superficial
Deep tendon
Biceps
Triceps
Patellar
Achilles
Plantar (Babinski Response)
Clear and appropriate
Confused
Inappropriate
Garbled
Aphasia (Expressive, Receptive)
Limited hearing
Use of hearing aids
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