NEUROLOGICAL SHEET physiotherapy 21.pdf

Sheet

1. NEUROLOGICAL SHEET
EXAMINATION
PRESENTED BY : ASS.PROF. RASHA ELREWAINY
ASSISTANT PROFESSOR AT DEPARTMENT OF PHYSICAL THERAPY
FOR NEUROLOGY

2. NEUROLOGICAL SHEET :
I- HISTORY
II- EXAMINATION

3. I- HISTORY
▪ Personal history
▪Chief complaint
▪Diagnosis
▪Past history
▪Present history
▪Family history

4. II- Examination
▪General
✓Heart rate
✓Respiratory rate
✓Blood pressure
✓temperature
▪

5. ▪Neurological
❑Non Essential
✓Mental function assessment
✓Speech assessment
✓Cranial nerve assessment
❑ Essential
✓Motor system examination
✓Sensory system examination
✓Gait assessment
✓Coordination assessment
✓Functional assessment

6. I- HISTORY
▪Personal history :
✓Name : to be familiar with patient
✓Age :certain diseases are related to certain age as
myopathy , stroke
✓Sex : certain diseases are related to certain sexes as
myasthenia gravis (females) and myopathy (males)

7. ✓Occupation : certain diseases are related to certain
sexes as drivers and typewriters (disk prolapse) and
painter (lead neuropathy)
✓Address or residence : certain diseases are related to
certain places as Helwan is common by neuropathy
✓Special habit: smoking , alcohol addiction
✓Marital status : married or not for care giving

8. ▪Chief complaint :
Written in patients own words and arranged
according to the priority as heaviness at arm or
at legs
▪Diagnosis
Written in medical terms as stroke , ataxia ,
parkinsonism , ….

9. ▪Present history
➢Onset : may be
❖Acute :
-Dramatic : Take seconds as trauma or embolism or take
minutes as hemorrhage
-Sudden : take hours as thrombotic
-Rapid : take days as inflammation
❖Gradual : take weeks – months or years as neoplastic
(tumor) or degenerative diseases as parkinsonism

10. ➢Course
❖Progressive : as tumors
❖Stationary: as hemiplegia after 1
st
3 months
❖Regressive : as hemiplegia at 1
st
3 months
❖Remittent and relapse : as in MS
Usually Acute onset + regressive course
Gradual onset with progressive course
➢Duration : by either weeks – months – years

11. ▪You should ask about the following symptoms if the patient did not mention :
1- Symptoms of increased intracranial tension :
➢Headache
➢Vomiting
➢Blurring of vision
2- symptoms of cranial nerve affection :

12. 3- Symptoms of motor system affection (UMNL-LMNL-
Extrapyramidal system , Cerebellum ):
➢Destructive lesion : Weakness or paralysis , if present ask about tone
or weakness
➢Irritative lesion : convulsions , fasciculations ,and or abnormal
movement .
4-Symptoms of sensory system affection :
➢Destructive lesion : Hypoesthesia or anesthesia
➢Irritative lesion : pain , hyperesthesia and or paresthesia (abnormal
skin sensation )
5-Symptoms of autonomic disturbances :
➢Control of micturition and defecation
➢Impotence (in cases of conus lesions , DS , Diabetic PN)

13. ▪Past history : any previous condition :
➢Diabetes mellitus
➢Hypertension
➢Trauma
➢Fever
➢Otitis media
➢ Operations
➢Similar attacks
➢Drug intake
➢History of similar attacks as TIA

14. ▪Past history : any previous condition :
➢Trauma : in cases of paraplegia , quadriplegia , cauda equina and coma , mild trauma to head miy cause
subdural hematoma in old alcoholics
➢Fever : that occurs near the onset of disease as in cases of Meningitis , encephalitis and Myelitis
➢Diabetes mellitus : Polyuria , Polydipsia and weight loss , in cases of peripheral neuropathy , cranial nerve
palsy and impotence
➢Hypertension : Headache , Tinnitus , Epistaxis , in caese of hemiplegia , cereberal hemorrhage and
encephalopathy
➢T.B : Haempptysis , symptoms of toxaemia as night fever , night sweats , lossof weight , appetite and anti
TB drug intake ) . In cases of paraplegia (potts) , cerebellar ataxia (Tabes) , mental deterioration ,
encephalopathy .
➢Syphilis : in cases of sensory ataxia (Tabes) , Mental deterioration with convulsions
➢Rheumatic fever and rheumatic heart disease : in cases of hemiplegia and chorea
➢Otitis media : ear discharge in cases of facial palsy , brain abscess and lateral sinus thrombosis
➢Previous drug intake : in cases of : cerebellar ataxia- polyneuropathy –parkinsonism – convulsions –
myopathy

15. ▪Family history :
As similar cases at family appears as a result of +ve
consanguinity and at conditions of lumbar disc prolapse ,
certain types of weak collagen are present in these families

16. II- EXAMINATION
▪General
✓Heart rate
✓Respiratory rate
✓Blood pressure
✓Temperature
-All these vital signs should be checked before working with the patient
and the patient should be medically stable

17. ▪Neurological
❑Non Essential : It is applied for patients when
lesion is involving the head or with patients with
upper motor neuron lesion

18. First : Mental function assessment :
➢Level of consciousness
➢Memory
➢Orientation
➢Mood
➢Intelligence
➢Behavior

19. ➢Assessment of Level of consciousness
Grades :
•Lethargy : Impaired level of consciousness , as there can be
verbal response as a result of mild verbal stimulation but
after a period of time (calling him)
•Stuper : Impaired level of consciousness , as there can be
verbal response as a result of vigorous and continuous
stimulation (calling and shaking him)
•Semi coma :Lost level of consciousness ,there is no response
to verbal stimuli but there can be response to reflex stimuli as
painful stimulation
•Coma : Lost level of consciousness , there is no response to
either verbal or reflex stimuli

20. Definition of coma :It is a profound state of unconsciousness
❖The patient’s eyes do not respond to either spontaneous or external stimuli
❖Does not follow commands
❖Does not speak recognizable words
❖Does not demonstrate intentional movement (may show reflexive movement
such as posturing , withdrawal from pain or involuntary smiling
❖Patient cannot sustain visual pursuits through 45 degree arc in any direction
when the eyes are held open manually

21. DIAGNOSI OF COMA
Is through Glasgow Coma Scale to detect the level of
consciousness:
-It Ranks quality of response in 3 areas:
▪Eye Opening,
▪Best Motor Response
▪Best Verbal Response

22. Eye-Opening
4 - Responds Spontaneously
3 - Responds to voice
2 - Responds to pain
1 - No response

23. •Best Motor Response
•6 - Follows commands
•5 - Localizes to pain
•4 - Withdraws from pain
•3 - Decorticate (produces an exaggerated posture of upper
extremity flexion and lower extremity extension in response to pain
•2 - Decerebrate (produces an exaggerated posture of extension in
response to pain)
•1 - No response

24. Best Verbal Response
5 - Oriented and conversational
4 - Disoriented and conversational
3 - Inappropriate words
2 - Incomprehensible sounds
1 - No response

25. Scoring of GLASGOCOMA SCALE :
-Scores of 8 or below indicate severe injury
-9-12 suggest moderate brain injury
-13 and above indicate mild brain injury

27. Memory examination :
- it is the ability to retain , recall information and experiences
- It is The processes that are used to acquire, store, retain, and
later retrieve information.
•It is mainly the function of limbic system of the temporal lobe
•Memoryassessment : there are three types of memory :
❑Recent memory : memory of recent events like what did you
eat in the breakfast ? And you have to get sure from relatives ,
affection of this memory is called Anterograde amnesia
❑Intermediate memory : as repetition of what was said ,
affection of this memory is called Anterograde amnesia
❑Remote memory : retention and recall of the old or remote
events , affection of this memory is called Retrograde grade
amnesia

29. AREAS OF MEMORY

30. •Commonest causes of amnesia :
•1-Cerebral atherosclerosis
•2-Temporal lobe lesion
•3-Koraskow’s syndrome due to chronic alcoholism
•4-Dementias , e.g. Alzheimer's
•5-Post concussion
•6-Hysterical

31. ➢Orientation assessment : measuring of orientation to :
✓Time
✓Persons
✓Place
You have to ask in an unobservable manner not in a direct
way

32. ➢Mood assessment :
-The mood is the inner feelings while the affect is the outward
expressions
-Some types of mood disorders as
▪Euphoria : laughing without any cause or pathological laughing
▪Emotional lability : attacks of crying intermitted by attacks of laughing
as in MS patients
▪Depression : as in parkinsonian patients
➢Intelligence : that is measured via IQ scales
➢Behavior : changes are occurring due to lesion at prefrontal cortex that
is responsible for thinking – behavior and emotions

33. Second : Speech assessment
There are two types of speech affection which are :
A- Aphasia : inability to formulate speech properly
Types of aphasia :
1- Sensory aphasia : it is the inability to understand spoken,
written, or tactile speech symbols that results from damage (as
by a brain lesion) to an area of the brain (as Wernicke's area)
concerned with languagecalled alsoreceptive aphasia,Wernicke's
aphasia
✓Visual agnosia : inability to understand comprehend written
words previously understood
✓Alexia (word blindness) : inability to recognize or read written
words or letters, typically as a result of brain damage.
✓Auditory agnosia : inability to understand spoken words

34. 2-Motor aphasia : the inability to speak or to organize the
muscular movements of speechcalled alsoaphemia,Broca's
aphasia
✓Verbal aphasia : the patient is understanding what is said
but can not express in form of speech
✓Writing aphasia (agraphia) (inability to write) : inability to
write letters, symbols, words, or sentences, resulting from
damage to various parts of the brain.

35. B- Dysarthria : inability to articulate speech properly
✓Staccato speech :Explosive interrupted speech , occurring
due to lesion at cerebellum , so seen in ataxic patients
✓Slurred speech : there are some letters that are missed
and occur due to pyramidal tract lesion and LMNL of
speech muscles
✓Monotonous speech : low tone type of speech , occurs as a
result of extrapyramidal tract lesion , so seen at
Parkinsonian patients .