Neurological Screen
Original Editors - Add your name/s here if you are the original editor/s of this page. User Name
Top Contributors - Naomi O'Reilly and Jess Bell
Introduction[edit | edit source]
Add your content to this page here!
Reflexes[edit | edit source]
Several types of reflexes, including deep tendon reflexes, superficial reflexes, and pathological reflexes, can be tested as part of a physical examination and these all reveal something about the status of the elements of the nervous system that contribute to their functioning. Testing for deep tendon reflexes is most commonly used during a neurological screen using a reflex hammer to assesses the integrity of the stretch reflex arc of a specific nerve root, which provides information on the integrity of the specific nerve root.
The rehabilitation professional strikes over the tendon insertion to place a slight quick– stretch on the tendon, which will elicit a reflex response (ie, a muscle jerk response). The most common deep tendon reflexes assessed in the upper and lower extremities include the biceps, brachioradialis, triceps, patellar and the achilles tendon.
| Segmental Innervation | Nerve Supply | Muscle |
|---|---|---|
| C5-6 | Musculocutaneous | Biceps Brachii |
| C5-6 | Radial | Brachioradialis |
| C7-8 | Radial | Triceps |
| L2-4 | Femoral | Patellar |
| S1-2 | Tibial | Achilles |
Grading of deep tendon reflexes uses a 5-point scale to characterise the stretch reflex response and compare it bilaterally to the uninjured limb.
| Grade | Description |
|---|---|
| 0 | Reflex Absent |
| 1 | Somewhat Diminished or Requires Reinforcement |
| 2 | Average |
| 3 | Brisker than Average |
| 4 | Very Brisk with Clonus |
Sensation[edit | edit source]
Peripheral Nerves[edit | edit source]
Dermatomes[edit | edit source]
Dermatomes are areas of the skin whose sensory distribution is innervated by the afferent nerve fibres from the dorsal root of a specific nerve root. Assessment of dermatomes involves bilateral comparison of light touch discrimination. During dermatome testing the examiner should alter or remove the pressure applied to one side to determine whether the patient can distinguish changes in pressure.
Myotomes[edit | edit source]
Myotomes represent a group of muscles that are innervated from a single specific nerve root. Essentially, myotomes are the motor equivalent to dermatomes. Myotomes may be assessed for various muscle groups of the upper and lower extremities. Myotome testing is performed through sustained isometric contraction of a specific muscle. Common muscles tested during myotome assessment are listed below.
| Nerve Root | Upper Limb Movement | Nerve Root | Lower Limb Movement |
|---|---|---|---|
| C2 | Neck Flexion [3] | L2 | Hip Flexion |
| C3 | Neck Extension [3] | L3 | Knee Extension |
| C4 | Neck Lateral Flexion [3] | L4 | Ankle Dorsiflexion |
| C5 | Shoulder Abduction | L5 | Big Toe Extension |
| C6 | Elbow Flexion | S1 | Ankle Plantarflexion |
| C7 | Elbow Extension | S2 | Knee Flexion [3] |
| C8 | Thumb Extension | S3-4 | Anal Wink [3] |
| T1 | Finger Abduction |
Clinical Significance[edit | edit source]
Resources[edit | edit source]
References [edit | edit source]
- ↑ Rodriguez-Beato FY, De Jesus O. Physiology, Deep Tendon Reflexes.
- ↑ Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.
- ↑ 3.0 3.1 3.2 3.3 3.4 Magee, David. J (2006). "3". Orthopaedic Physical Assessment (4th ed.). St. Louis: Elsevier. pp. 121–181
