Clinical examination of higher function test By Pandian M, Tutor, Dept of Physiology, DYPMCKOP,MH.

Introduction
Examination of Higher Functions
Higher functions,
Examination of cranial nerves,
Sensory system,
Motor system,
Reflexes and
spine.

1.Level of consciousness:
2. Ask any history of suffering from hallucination or delusion or illusions.
3. Look for the appearance :

1. Clinical examination of Higher Function Test Pandian M Dept of Physiology DYPMCKOP

2. SLO Introduction Examination of Higher Functions Higher functions, Examination of cranial nerves, Sensory system, Motor system, Reflexes and spine. 1.Level of consciousness: 2. Ask any history of suffering from hallucination or delusion or illusions. 3 . Look for the appearance :

3. Introduction Examination of central nervous system is a complex procedure in which attention is to be given to all components of CNS. For e.g. Higher functions, Examination of cranial nerves, S ensory system, Motor system, Reflexes and spine.

4. Examination of Higher Functions Its mainly based upon the proper history taking and systemic questionnaire Mental state is examined under the following headings: 1.Level of consciousness: 2. Ask any history of suffering from hallucination or delusion or illusions. 3 . Look for the appearance :

5. Level of consciousness: - Level of consciousness is judged by responsiveness of patient to the painful stimulus

6. The various levels of consciousness are: Somnolence : Pt’s are drowsy, but we can be aroused them by various stimuli and will then make appropriate motor and verbal responses. Stupor: Pt’s aroused by repeated and painful stimulus and may be the response last for short period & simple commands. Semicoma : Painful & repeated stimulus cause withdrawal or other adaptive movements. If stimulus is removed Pt’s reverts to original state. Coma: Pt’s deeply unconscious, there is either no response or only slight response to very painful stimulus.

7. II. Ask any history of suffering from hallucination or delusions or illusions. III. Look for the appearance : posture, gait, bearing , cloths, hair, nails, grooming, signs of anxiety like moist hands, perspiring forehead.

8. IV. Ask for history of sleep - duration, disturbed sleep or undisturbed, nature of sleep. V. Memory : for recent events- simple qtn’s , phone number, admission date, etc. for past events- place, DOB, about school, habits, etc.

9. Intelligence : several objective tests are used here Mood state : depressed or euphoria

10. Abnormalities of behavior Most difficult to note. Here, help of any near relatives of the subject.

11. Orientation : Time , Place, Person Examination of speech and articulation:

12. Two basic types of disorders: Sensory aphasia Dysarthria Aphasia:- disorder of speech results due to injury to higher centers. There are two types of aphasia: 1. sensory aphasia: inability to understand the spoken words or written words and neologism damaged to Wernicke’s (Area 22)

13. Cont… Word blindness:- inability to understand written word (lesion in visual association area )

14. b) Word deafness:- inability to understand heard words (lesion in auditory association area)

15. A Specialized integration of Area and location

16. 2.Motor association area: T he person is able to understand the meaning of written or spoken words but he can’t able to express ones own thoughts to others through talking or writing – lesion to Broca’s area ( 44, 45 ). 3. Agraphia : selective loss of writing ability either spontaneous or dictation.

17. Applied aspects

18. Dysarthria Dysarthria is a motor speech disorder. Dysarthria affects the movement of the individual speech muscles and in coordination in the muscles of vocalization. It can vary from mild slurring to completely unintelligible speech

19. Global Aphasia This condition is produced as a result of loss of both Wernicke’s (area 22) & Broca’s area(44). As a result all the functions of speech are involved.

20. References Text book of Medical Physiology Guyton & Hall Hutchinson Clinical Methods Practical Physiology Manual A.K. Jain, C.L. Ghai , G.K. Pal Net source for pictures

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