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36 Cards in this Set

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How do you evaluate upper extremity motor testing
pt. sitting down, ask to flex the arm
- push forearm down against my resistance
- try to pull forearm up against my resistance
Lower extremity motor testing
pt. sitting down
- holding anterior bw ankle and calf ask pt to push against resistance
- holding posterior bw ankle and calf ask pt to pull against my resistance
triceps tendon reflex
flex pt arm to the side
tap the tendon of the triceps musc. with the pointy end of reflex hammer
- repeat on opposite elbow
Cranial nerve I examination
sense of smell
- cover one nostril identify a scent
- repeat w other nostril
Cranial nerve II
- visual fields by confrontation
- Visual fields by confrontation
inspect upper, middle, lower visual fields.
- stand in front of pt
-make eye contact, ask pt to keep looking at you
-place fingers at side of pt head (outside of peripheral vision)
-bring moving fingers anteriorly and ask pt to tell you when he can see your fingers.
Cranial nerve II
- test for visual acuity
Rosenbaum card 14in from pt.
Snellen 20in form pt
- ask pt to cover one eye
- ask pt to read the lines
- determine the smallest print the pt can read more than half of the letters
- ask pt to cover the other eye and repeat the exam
cranial nerve II and III
- direct and consensual reaction
- ask pt to look into distance
- shine light obliquely into each pupil
- DO IT TWICE
- once for direct reaction
- second time for consensual rx
- test at room light one eye at a time
Cranial nerves II and III
- Near reaction and Near response
-hold a pen 10cm in front of pt
-ask pt to look alternately to pen and to the wall
- note pupillary CONStricion w NEAR focus
Cranial nerve III
- assessing convergence
- ask pt to follow finger as i move it towards the bridge of the nose to about 5 cm
- normal will follow eye to about 5-8cm of the nose
Cranial n. III, IV, and VI
- assessing extraocular eye movements
assess eye movement of the patient in 6 positions
- gaze tracing
- trace an H pattern with my hand
- ask pt to follow my hands with his eyes
- Pt should NOT move his head
Cranial nerve V trigeminal
- sensory examination
with a piece of cotton I will run the cotton on pt face evaluating:
- Ophtalmic branch
- Maxillary branch
- Mandibular branch

Assess bilaterally
Cranial nerve V trigeminal
- motor assessment
- palpate masseter musc bilaterall and ask pt to clinch teeth lightly.
- or ask pt to move jaw from side to side
Cranial n. VII facial
- facial motor testing
ask pt to
- raise eyebrows
- open eyes vs. resistance
- frown
- smile
- puff cheeks
- show teeth
Cranial n. VIII vestibulocochlear
- Weber test
for lateralization
- use tuning fork
- tap fork on hand
- place base of fork on top of pt head
- - ask. pt Where does the sound appear to be coming from?
(nl is midline)
Cranial n. VIII vestibulocochlear
- Rinne test
compare air vs. bone conduction
- tap tuning fork
-place in pt mastoid process
-ask pt to tell you when he can no longer hear the sound
- then move the fork near the same ear, and ask if he can hear the vibration
- repeat process in other ear

NOTE AC>BC
Cranial n. VIII vestibulocochlear
- gross auditory acuity
Ask pt to cover one ear
- rub fingers next to non occluded ear
- ask pt if sound is heard

Repeat on opposite ear
Cranial N. X and XII
- motor testing
- sensory componet
- ask pt to swallow
- ask pt to say AHH and observe uvula

- sensory test for GAG reflex
Cranial n. XI, Accessory N.
- ask pt to shrug shoulder vs. resistance
Note strength and contraction of trap

- ask pt to turn head vs. resistance
Note: strength of SCM musc.

Assess bilaterally
Cranial n. XII Hypoglossal n.
- motor testing
- Inspect pt. tongue lying in floor of mouth
- note asymmetry, atrophy, fasciculations.
- ask pt to protrude tongue
- finally ask pt to move tongue from side to side
Lower extremity motor testing
- HIP
- pt supine
- test bilaterally
--flexion of hip: by placing hand on pt thigh and ask pt to raise leg vs. resistance
- hip extension: ask pt to push posterior thigh vs my hand
Lower extremity motor testing
- thigh
Patient sitting up:

ADDuction of hip: place my hand bw pt legs ask pt to try to bring legs together

ABDuction: ask pt to spread legs vs my resistance
Upper extremity motor testing
ask pt to flex arm vs. resistance
- ask pt to extend vs. resistance

- done bilaterally
Lowe extremity motor testing
- legs
ask pt to flex leg vs. resistance
- ask pt to extend vs. resistance

--done bilaterally
lower extremity motor testing
- feet
ask pt to dorsiflex vs. resistance
- ask pt to plantarflex vs. resistance

-- done bilaterally
Biceps reflex evaluation
- flex pt arm partially
- strike tendon to elicit a reflex
- or place thumb firmly over biceps and strike thumb to elicit a biceps reflex
Triceps reflex evaluation
-flex pt arm at elbow
- tap triceps tendon with hammer
- assess bilaterally
brachioradialis reflex
- pt hand resting in a relaxed position in his lap.
- strike the radius 1-2inches above the wrist
- assess bilaterally
patellar tendon reflex
- pt sitting up w feet dangling from exam table
- strike patellar tendon
*optional to place hand on quadriceps
achilles reflex
- all socks need to be removed
- dorsiflex pt foot at ankle
- strike achilles tendon

- assess bilaterally
plantar or babinski reflex
- pt supine
- strike from sole to ball of foot curving medially (w end of reflex hammer)
- assess bilaterally

(normal toes curl down)
Assess rapid alternating movements
1- pronate and supinate rapidly
2- touch thumb to each finger
3- slap wrist agains thigh

- done bilaterally
finger to nose movements
ask pt to touch my finger and then his nose, while i move finger randomly in multiple movements
assessing GAIT
ask pt to walk, turn and comeback
- heel to toe (tandem walk)
Romberg test
ask pt to stand with feet together
- ask pt to close eyes for 20sec
--I stand behind patient to provide support for imbalance
-
Pronator drift test
ask pt to stand with eyes closed
- ask pt to extend arms with palms up for 20secs
--I stand behind pt
Sensory testing
demostrate to pt the difference bw dull vs. sharp
- ask pt to keep eyes closed
- test both arms and legs
- bilateral on both upper and lower extremities