Neurological Screen: Difference between revisions
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== Reflexes == | == Reflexes == | ||
Reflex testing may involve the assessment of deep tendon reflexes, superficial reflexes, and pathological reflexes. Testing for deep tendon reflexes typically involves the use of a reflex hammer and assesses the integrity of the stretch reflex arc of a specific nerve root and provides further 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. | |||
{| cellspacing="1" cellpadding="1" border="1" width="800" | |||
|+'''Table.1''' Deep Tendon Reflexes <ref>Rodriguez-Beato FY, De Jesus O. Physiology, Deep Tendon Reflexes.</ref> | |||
|- | |||
! scope="col" |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. | |||
{| cellspacing="1" cellpadding="1" border="1" width="800" | |||
|+Table.2 Deep Tendon Reflex Grading Scales <ref>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.</ref> | |||
|- | |||
! scope="col" |'''Grade''' | |||
!'''Description''' | |||
|- | |||
|0 | |||
|Reflex Absent | |||
|- | |||
|1 | |||
|Somewhat Diminished or Requires Reinforcement | |||
|- | |||
|2 | |||
|Average | |||
|- | |||
|3 | |||
|Brisker than Average | |||
|- | |||
|4 | |||
|Very Brisk with Clonus | |||
|} | |||
== Sensation == | == Sensation == | ||
== Dermatomes == | == Dermatomes == | ||
Dermatomes are areas of the skin whose sensory distribution is innervated by 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. | [[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 == | == Myotomes == | ||
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. | [[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. | ||
{| cellspacing="1" cellpadding="1" border="1" width="800" | {| cellspacing="1" cellpadding="1" border="1" width="800" | ||
|+'''Table. 1''' Myotomes | |+'''Table. 1''' Myotomes | ||
|- | |- | ||
! scope="col" |Nerve Root | ! scope="col" |Nerve Root | ||
Line 26: | Line 77: | ||
!Nerve Root | !Nerve Root | ||
!Lower Limb Movement | !Lower Limb Movement | ||
|- | |||
|C2 | |||
|Neck Flexion <ref name=":0">Magee, David. J (2006). "3". ''Orthopaedic Physical Assessment'' (4th ed.). St. Louis: Elsevier. pp. 121–181</ref> | |||
|L2 | |||
|Hip Flexion | |||
|- | |||
|C3 | |||
|Neck Extension <ref name=":0" /> | |||
|L3 | |||
|Knee Extension | |||
|- | |||
|C4 | |||
|Neck Lateral Flexion <ref name=":0" /> | |||
|L4 | |||
|Ankle Dorsiflexion | |||
|- | |- | ||
|C5 | |C5 | ||
|Shoulder Abduction | |Shoulder Abduction | ||
| | |L5 | ||
| | |Big Toe Extension | ||
|- | |- | ||
|C6 | |C6 | ||
|Elbow Flexion | |Elbow Flexion | ||
| | |S1 | ||
| | |Ankle Plantarflexion | ||
|- | |- | ||
|C7 | |C7 | ||
|Elbow Extension | |Elbow Extension | ||
| | |S2 | ||
| | |Knee Flexion <ref name=":0" /> | ||
|- | |- | ||
|C8 | |C8 | ||
|Thumb Extension | |Thumb Extension | ||
| | |S3-4 | ||
| | |Anal Wink <ref name=":0" /> | ||
|- | |- | ||
|T1 | |T1 | ||
|Finger Abduction | |Finger Abduction | ||
| | | | ||
| | | | ||
|} | |} | ||
== Clinical Significance == | |||
== Resources == | == Resources == | ||
[[Category:Understanding Basic Rehabilitation Techniques Content Development Project]] | [[Category:Understanding Basic Rehabilitation Techniques Content Development Project]] |
Revision as of 19:56, 14 April 2023
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Introduction[edit | edit source]
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Reflexes[edit | edit source]
Reflex testing may involve the assessment of deep tendon reflexes, superficial reflexes, and pathological reflexes. Testing for deep tendon reflexes typically involves the use of a reflex hammer and assesses the integrity of the stretch reflex arc of a specific nerve root and provides further 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]
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