DOCSLIB.ORG

Neurological Update for All Registered Medical Practitioners and Registered Physiotherapists

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Neurological Update for All Registered Medical Practitioners and Registered Physiotherapists Assessment of Neurological Conditions Self Directed Learning Pack (MED-CMEP~119) 4th September 2018 Assessment of Neurological Conditions Foreword This training has been produced as part of a training programme for Healthcare Professionals (HCPs) who conduct assessments for the Centre for Health and Disability Assessments on behalf of the Department for Work and Pensions. All HCPs undertaking assessments must be registered practitioners who in addition, have undergone training in disability assessment medicine and specific training in the relevant benefit areas. The training includes theory training in a classroom setting, supervised practical training, and a demonstration of understanding as assessed by quality audit. This training must be read with the understanding that, as experienced practitioners, the HCPs will have detailed knowledge of the principles and practice of relevant diagnostic techniques and therefore such information is not contained in this training module. In addition, the training module is not a stand-alone document, and forms only a part of the training and written documentation that the HCP receives. As disability assessment is a practical occupation, much of the guidance also involves verbal information and coaching. Thus, although the training module may be of interest to non-medical readers, it must be remembered that some of the information may not be readily understood without background medical knowledge and an awareness of the other training given to HCPs. MED- CMEP~119 Page 2 of 79 Assessment of Neurological Conditions Document control Superseded documents Assessment of Neurological Conditions for Registered Nurse (Pre-course Reading) – MED-RNEXNEURO~001(a) Version history Version Date Comments 6 Final 10th January 2017 Signed off by SH&S 7a draft 18th December 2017 Review and update 7 Final 25th May 2018 Final document 8a Draft 26th July 2018 Update in line with neuro examination best practice CME 8 Final 2nd August 2018 Final document 9a Draft 4th September 2018 Anatomical update 9 Final 4th September 2018 Signed off by SH&S Changes since last version Page 17 – diagram of wrist extension and flexion updates Page 19 – wrist flexors and extensors updated Outstanding issues and omissions Updates to Standards incorporated Issue control Author: Clinical Training Team Owner: Department for Work and Pensions MED- CMEP~119 Page 3 of 79 Assessment of Neurological Conditions Contents Introduction 6 Guide to using this Learning Pack 6 Section One – Neuroanatomy and Neurophysiology 9 Cells, Neurons and Neuromuscular Junctions 9 Central Nervous System 11 Peripheral Nervous System 14 Autonomic Nervous System 18 Reflexes 20 Upper Motor Neuron versus Lower Motor Neuron Lesions 21 Section Two - Neurological Examination 24 History 24 Observation 25 Examination 26 Inspection 26 Testing the Motor System 26 Tone 26 Power 27 Reflexes 28 Testing the Sensory system 33 Section Three - Specific Conditions 39 Prolapsed Intervertebral Disc and Sciatica 40 Cervical Spondylosis 45 Peripheral Neuropathy 49 Nerve Compression Syndromes / Focal Neuropathy 54 Median nerve (carpal tunnel syndrome) 54 Ulnar Nerve 57 Radial Nerve 58 Common Peroneal Nerve 59 Lateral Cutaneous Nerve of the Thigh 60 MED- CMEP~119 Page 4 of 79 Assessment of Neurological Conditions Brachial Plexus Injuries 61 Thoracic Outlet Syndrome 62 Raynaud’s phenomenon, Hand-Arm Vibration Syndrome and Vibration White Finger 69 Raynaud’s phenomenon 69 Hand-Arm Vibration Syndrome (HAVS) 70 Vibration White Finger (VWF) 70 Further Reading 71 Glossary 73 Learning Experience and Reflections Note 78 Observation Form 79 MED- CMEP~119 Page 5 of 79 Assessment of Neurological Conditions Introduction Welcome to this self directed learning module on the Assessment of Neurological Conditions. Neurological symptoms and conditions are common, resulting in disability in approximately 1 in 50 of the UK population. Approximately 10% of GP consultations are about a neurological symptom.1 The nervous system is the most elaborate bodily system. The field of neurology is correspondingly vast and complex. Neurological conditions can range from the simple to the highly complicated. The neurological system is therefore one of the most difficult systems to fully examine and assess. The focus for this training will be on some of the more common neurological conditions that are seen within our sphere of work. During the filework process of the Work Capability Assessment, advice is given on the appropriate practitioner type to complete the assessment for any cases called for a face-to-face assessment. Currently complex neurological cases are usually assessed by Registered Medical Practitioners and Registered Physiotherapists. HCPs should be aware of the document ‘Neurological Condition list by Practitioner type’ and any relevant Update to Standards, available on the internal online knowledge portal, to ensure that the current guidance on conditions which are suitable to be assessed by the various practitioner types is followed. Learning Pack Objectives Through completion of this learning pack, you should enhance your knowledge of: Neuroanatomy and neurophysiology Neuro-terminology Neurological examinations required in the context of disability assessments Specific neurological conditions Guide to using this Learning Pack Any case examples in this Learning Pack are fictitious and have been solely designed to support learning activities. There is a glossary at end of this Learning Pack which you may find useful. It contains definitions of neurological and medical terms used within this Learning Pack. 1 https://www.nice.org.uk/guidance/gid-cgwave0800/documents/final-scope (Accessed online 26/7/18) MED- CMEP~119 Page 6 of 79 Assessment of Neurological Conditions A Learning Experience and Reflections Note is provided at the end of the Learning Pack to aid reflective practice. The following symbols are used to assist you in completing the learning activities included in this Learning Pack: Indicates you should record / write your views and comments Suggests the approximate time needed to complete any particular learning activity Learning Pack Information for Registered Nurses and Registered Occupational Therapists This Learning Pack is intended as Pre-course reading for the neurological examination training course for Registered Nurses and Registered Occupational Therapists who are already trained and approved in performing face-to-face Work Capability Assessments (WCA). Following completion of this reading you will progress to a facilitated learning event. Within each section there are several questions with text boxes to assist self reflection and aid learning. You should make a note of your answers and bring this document with you to the facilitator-led event. All the answers are found in the body of text, but you should first attempt to recall the information before reviewing the main body of text to check for definitive answers. These may be discussed further during the facilitator-led event. You also have to complete and pass a Multiple Choice Questionnaire (MCQ) before attending the facilitator-led event. The MCQ is completed online and you will receive an automatic e-mail, to your work e-mail address, from ‘The Test Factory’ containing the link to access this. If you do not receive this e-mail, please contact your Training Support Manager in your local Business Support Centre (BSC). The MCQ is split into sections and once you have completed reading each small part of this pre-course reading document, you will need to complete the relevant MCQ for that particular part. You are allowed access to your reading material at all times; the tests are all ‘open book tests’. There are 53 questions in total. Once you have completed all the parts of the MCQ test, your score will be automatically displayed. A score of 84% (45 questions correct) or above indicates a pass. If you fail the MCQ, you will be allowed to re-sit the test once. You will need to contact the Training Support Manager in your local BSC to arrange re-assignment of the test. Once the test has been re-assigned to you, you will receive a further e-mail from the Test Factory with the link to access the on-line re-sit. You should however re-read the pre-course reading before attempting the re-sit of the test. MED- CMEP~119 Page 7 of 79 Assessment of Neurological Conditions This pre-course reading must be read and the online MCQ completed and passed prior to attending the facilitator-led event. If the MCQ is not completed, or a satisfactory score in the MCQ is not reached, then you will not be able to progress to the facilitator-led event. This facilitator-led event will not cover the majority of the topics in the pre-course reading again, but will build on the knowledge within this document to develop the skills necessary to assess claimants with specific neurological conditions. It is anticipated that this pre-course reading and associated questions will take you about 3.5 hours in total. You may find it easier to break the reading into smaller amounts. 3.5 CPD points are allocated for the completion of this pre-course reading and associated questions. Learning Pack Information for Registered Medical Practitioners and Registered Physiotherapists This Learning Pack is intended as a neurological update for all Registered Medical Practitioners and Registered Physiotherapists. As Registered Medical Practitioners and Registered Physiotherapists, you should be more familiar with neurological terminology, examination and conditions, and therefore this Learning Pack should take you approximately 3 hours to complete. This includes 20 minutes for the completion of a Multiple Choice Questionnaire. This Learning Pack can be completed in one go or at smaller separate “sittings”. It is important that you complete learning activities in the order they are given; by doing so you will reflect, consolidate and build on your learning throughout. You will be asked to interact at various stages during this learning opportunity – writing your responses in the boxes provided – all answers are found in the body of text, but you should first attempt to recall the information before reviewing the main body of text to check for definitive answers.
Load more

Recommended publications
  • The Phenomenon of Multiple Stretch Reflexes
    Henry Ford Hospital Medical Journal Volume 34 Number 1 Article 6 3-1986 The Phenomenon of Multiple Stretch Reflexes Robert D. Teasdall Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Teasdall, Robert D. (1986) "The Phenomenon of Multiple Stretch Reflexes," Henry Ford Hospital Medical Journal : Vol. 34 : No. 1 , 31-36. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol34/iss1/6 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. The Phenomenon of Multiple Stretch Reflexes Robert D. Teasdall, MD* Multiple stretch reflexes occur in muscles adjacent to or remote from the tap. The response may be ipsilateral or bilateral. These reflexes are encountered not only in normal subjects with brisk stretch reflexes but particularly in patients with lesions of the upper motor neuron. The concussion obtained by the blow is conducted along bone to muscle. Muscle spindles are stimulated, and in this manner independent stretch reflexes are produced in these muscles. This mechanism is responsible for the phenomenon of multiple stretch reflexes. The thorax and pelvis play important roles in the contralateral responses by transmitting these mechanical events across the midline. (Henry FordHosp Med J 1986;34:31-6) ontraction of muscles remote from the site of f)ercussion is Head and neck Cencountered in patients with brisk stretch reflexes.
    [Show full text]
  • REFLEXES the Stretch Reflex Physiological Stretch Reflex Are Present in a Healthy Individual
    REFLEXES The stretch reflex Physiological stretch reflex are present in a healthy individual. The evocation of reflex: by tapping of neurological hammer on the respective tendon The tapping: only one reasonably strong, painless, fast, accurate The muscle groups, that are investigated: relaxed The position and the grip: the best one position and one grip for the examination of all reflexes on the limb Reinforcement maneuvers to improve the evoking: • Placing the therapist's fingers on the tendon (stretching) and tapping on the fingers • Jendrassik's maneuver - clinch the hands together and try to break away or the patient to clench their teeth or the isometric contraction on the opposite limb = on the basis of the phenomenon of irradiation • A distraction: eg. calculation: from 100 gradually subtract 7 • Change positions: in lying supine the response is the lowest, in sitting or standing the excitability of the central nervous system increases and the responses are higher Response: Normoreflexia = the muscle contraction with an adequate motion Hyperreflexia = increased response, muscle contraction with significantly large movement = response even with slight tapping of hammer = the reflex zone (area of inducing) is extended beyond the tendon = in central paresis, in disorders of the extrapyramidal system, in cerebellar lesions with pendulum movements Hyporeflexia = the decreased response (only contraction happens but not to move), necessary sharper tap and reinforcement maneuver Areflexia = no response = in peripheral paresis Rate the reflex
    [Show full text]
  • Testing the Reflexes
    Page 1 of 6 ESSENTIALS Testing the reflexes 1 2 A J Lees neurologist , Brian Hurwitz former general practitioner 1The National Hospital, Queen Square, London WC1N 3BG, UK; 2King’s College London, London WC2B 6LE, UK with muscles via the nerve roots, plexuses, peripheral nerves, What you need to know and neuromuscular junction) and an upper motor neurone lesion • Tendon reflex testing allows lower and upper motor neurone lesions to (due to damage upstream from the anterior horn cell, including be distinguished reliably the corticospinal tracts, the brain stem, and motor cortex). This • Interpret reflexes alongside a clinical history and any abnormalities of distinction is the first stage in locating the site of neurological power, tone, and sensation found on examination damage. • Reflex testing is essential if you suspect spinal cord and cauda equina compression, acute cervical or lumbar disc compression, or acute There are situations where all the neurological symptoms occur inflammatory demyelinating polyradiculoneuropathy above the neck (such as bulbar symptoms due to motor neurone disease) where reflex testing is also essential. Eliciting the deep tendon reflexes is a vital component of Box 1 lists some clinical scenarios where testing the deep tendon medical assessments in general practice (where 9% of medical reflexes is discriminatory when coming to a diagnosis. problems are believed to be neurological in origin1) and in hospital (where 10-20% of admissions have a primary Box 1: Presentations in general practice where tendon reflex
    [Show full text]
  • Problem Based Neurosurgery
    Problem Based Neurosurgery 7830tp.indd 1 12/9/10 4:55 PM This page intentionally left blank Problem Based Neurosurgery Sam Eljamel The University of Dundee, UK NEW JERSEY t LONDON t SINGAPORE t BEIJING t SHANGHAI t HONG KONG t TAIPEI t CHENNAI 7830tp.indd 2 12/9/10 4:55 PM Published by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. PROBLEM BASED NEUROSURGERY Copyright © 2011 by World Scientific Publishing Co. Pte. Ltd. All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. ISBN-13 978-981-4317-07-8 ISBN-10 981-4317-07-1 Typeset by Stallion Press Email: [email protected] Printed in Singapore. JQuek - Problem Based Neurosurgery.pmd 1 3/2/2011, 4:40 PM b1009_FM.qxd 11/12/2010 10:48 AM Page v b1009 Problem Based Neurosurgery Disclaimer The author provided a summary of information he thought rele- vant to students, doctors in training and other health care professionals learning about neurosurgical disorders.
    [Show full text]
  • Glossary of Common Neurologic Terms
    Glossary of Common Neurologic Terms ABCs Term referring to airway, breathing, and with agraphia) or without writing deficits circulation management of a patient with (alexia without agraphia). impaired consciousness or breathing. Steps Allodynia Nonpainful cutaneous stimuli caus- include ensuring airway access, delivering ing pain. oxygen either nasally or via intubation if Amnesia Partial or complete loss of the ability needed, and establishing intravenous access to learn new information or to retrieve previ- plus others. ously acquired knowledge. Absence seizure or petit mal seizure Typically Amaurosis fugax Transient monocular blind- begins with arrest of speech and the abrupt ness. This usually comes from an internal onset of loss of awareness without loss of carotid artery embolus temporarily occluding muscle tone or falling followed by seconds of the ophthalmic artery. staring without being able to communicate. Amyotrophic lateral sclerosis Progressive The individual then becomes alert but does neurodegenerative fatal disorder affecting not recall the episode. primarily upper and lower motor neurons in Accommodation Sensory nerves having the spinal cord and motor cortex. dynamic firing rates that decline with time Amyotrophy Wasting of muscles usually from even though the stimulus is maintained. denervation. Acute disseminated encephalomyelitis Anal reflex Reflexive contraction of anal (ADEM) Complex monophasic illness, sphincter upon perianal sensory stimulation. particularly in children, that often follows a Aneurysm Abnormal dilatation or bulging of recent infection or occasionally vaccination an intracranial artery wall, usually at bifurca- characterized by an abrupt encephalopathy tions of the circle of Willis. often with obtundation, hemiparesis, ataxia, Anisocoria Unequal pupil size. cranial nerve palsies, visual impairment, and Ankle jerk Deep tendon reflex (Achilles reflex) seizures.
    [Show full text]
  • The Neurologic Diagnosis
    The Neurologic Diagnosis A Practical Bedside Approach Jack N. Alpert Second Edition 123 The Neurologic Diagnosis Jack N. Alpert The Neurologic Diagnosis A Practical Bedside Approach Second Edition Jack N. Alpert Department of Neurology University of Texas Medical School at Houston Houston, TX USA ISBN 978-3-319-95950-4 ISBN 978-3-319-95951-1 (eBook) https://doi.org/10.1007/978-3-319-95951-1 Library of Congress Control Number: 2018956294 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
    [Show full text]
  • Miller MRCS Neuro
    Motor, Reflex, Coordination and Sensory Screening Examination K. Jeffrey Miller, DC, FACO, MBA Chiropractic Orthopaedist Miller 2002 10/01/2018 MillerCopyright 2002-2017 • “Specializing in Spine and Nerve Rehabilitation” 10/01/2018 MillerCopyright 2002-2017 Motor Function Lower Motor Neuron Testing 10/01/2018 MillerCopyright 2002-2017 Handedness • Right or Left Handed • Ambidextrous • Shoulder Height-levelness – Dominant side lower • Grip Strength – Dominant side stronger by 10% – Female grip strength is 50% of males Miller 2002 10/01/2018 MillerCopyright 2002-2017 Handedness • Impairment Rating – Non-dominant often rated lower • Side Posture Adjusting – Farfan’s Torsion Test – Side of handedness up • Pseudoambidexterity Miller 2002 10/01/2018 MillerCopyright 2002-2017 Handedness Pseudoambidexterity Miller 2002 10/01/2018 MillerCopyright 2002-2017 Handedness Pseudoambidexterity Miller 2002 10/01/2018 MillerCopyright 2002-2017 True Ambidexterity • Both ambidextrous and multilingual, 20th president James Garfield could write Greek with one hand while writing Latin with the other. Miller 2002 10/01/2018 MillerCopyright 2002-2017 Bilateral Hand Shake • Quick Assessment of Lower Cervical and Upper Thoracic Nerve Root Motor Function • C5-T1 Miller 2002 10/01/2018 MillerCopyright 2002-2017 Miller 2002 10/01/2018 MillerCopyright 2002-2017 Bilateral Hand Shake Test • Flexion of the Shoulder-C5 • Extension of The Elbow and Fingers-C7 • Extending the Thumb-C6 • Spreading the Fingers-T1 • Bringing the Fingers Together-T1 • Flexing the Fingers-C8
    [Show full text]
  • A Abdominal Reflex, 156 Abdominal Wall, T9-12 And, 135, 153 Abduction External Rotation In, 15 of Forefoot, 295–296 of Hip, 20
    Index A Acromioclavicular joint (ACJ), Abdominal reflex, 156 10 Abdominal wall, T9-12 and, arthritis of, 1 135, 153 dislocation of, 1 Abduction O’Brien’s test and, 36 external rotation in, 15 subluxation of, 5 of forefoot, 295–296 tests for, 38 of hip, 204–205 Acromion, 11 internal rotation in, 17 Active dorsiflexion, 291 in shoulder, 13–14 Active eversion, 292 of thumb, 105 Active inversion, 291 Abductor digiti minimi, 115 Active plantarflexion, 290 hypothenar eminence and, Adam’s test, 165 117 Adduction muscle insertion for, 122 of forefoot, 295 T1 and, 152 of hip, 205 Abductor pollicis, 115, 118 in shoulder, 14 muscle insertion for, 122 Adductor brevis, 209 Abductor pollicis brevis (APB), Adductor gracilis, 209 105, 111 Adductor longus, 209 Abductor pollicis longus Adductor magnus, 209 (APL), 97, 102 Adhesive capsulitis, 1, 3 muscle insertion for, 105 Adson’s test, 161 Abductor tendinitis, groin Anal reflex, 156 pain and, 189 S2-4 and, 182 Acetabular labrum, 190 Anatomical snuffbox, 88–89 Achilles’ tendon, 288 Ankle, 259–310 reflex, 307 hip and, knee and, 223 S1 and, 181 injury mechanisms for, 259 tendinitis in, 277 muscle testing for, 298–305 ACJ. See Acromioclavicular pain sites for, 259 joint range of movement for, ACL. See Anterior cruciate 290–292 ligament special tests for, 308–310 314 INDEX Ankle (cont.) grind test and, 131 swelling in, 261, 277 of hip, 191 Ankylosing spondylitis, 135, of MTP, 298 136 of radiohumeral joint, 44 chest expansion and, 145 Arthrogryposis, pes cavus and, relieving factors for, 163 269 stiffness and, 190 ASIS, 191, 200 Antalgic gait, 192, 227 Ataxia, 192 foot and, 278 Avascular necrosis (AVN) Anterior apprehension test, 34 groin pain and, 189 Jobe’s relocation test and, 34 of lunate, 62 pectoralis major and, 34 swelling from, 261 Anterior cruciate ligament AVN.
    [Show full text]
  • Neurological Update
    MEDICAL SERVICES PROVIDED ON BEHALF OF THE DEPARTMENT FOR WORK AND PENSIONS Training & Development Neurological Update Self-Directed Learning Pack (for all Registered Medical Practitioners and Registered Physiotherapists) MED-CMEP~119 Version: 3 Final 23 April 2013 Medical Services Foreword This training has been produced as part of a training programme for Health Care Professionals (HCPs) approved by the Department for Work and Pensions Chief Medical Adviser to carry out benefit assessment work. All HCPs undertaking assessments must be registered practitioners who in addition, have undergone training in disability assessment medicine and specific training in the relevant benefit areas. The training includes theory training in a classroom setting, supervised practical training, and a demonstration of understanding as assessed by quality audit. This training must be read with the understanding that, as experienced practitioners, the HCPs will have detailed knowledge of the principles and practice of relevant diagnostic techniques; therefore such information is not contained in this training module. In addition, the training module is not a stand-alone document, and forms only a part of the training and written documentation that the HCP receives. As disability assessment is a practical occupation, much of the guidance also involves verbal information and coaching. Thus, although the training module may be of interest to non-medical readers, it must be remembered that some of the information may not be readily understood without background
    [Show full text]
  • NEUROLOGICAL EXAMINATION Professor Yasser Metwally
    1 www.yassermetwally.com NEUROLOGICAL EXAMINATION Professor Yasser Metwally www.yassermetwally.com 2013 2 Preface Thank you for using my publication, this publication is directed to undergraduate students and neurologist in training. Its primary aim is how to elicit neurological signs and symptoms and how to group these signs and symptoms into a single clinical diagnosis for each patient. This publication is simple a guide and not a substitute for clinical experience. Postgraduate neurologists get their information from the patients they attend and not from papers, for them patients are the primary source of information and from them, they get their clinical experience. I hope you will find this publication as useful as I truly wish. This publication is free of charge and can be distributed on the following conditions 1- It is distributed free of charge 2- It s not changes in any way Professor Yasser Metwally Professor of neurology, Ain Shams University Cairo, Egypt www.yassermetwally.com My web site | My video channel | Facebook neurological videos 3 INDEX 1-A guide to neurological examination 2-Skills of eliciting clinical neurological signs 3-Neurological examination slides 4-Papilledema versus papillitis 5-Fundus examination My web site | My video channel | Facebook neurological videos 4 Professor Yasser Metwally www.yassermetwally.com A GUIDE TO NEUROLOGICAL EXAMINATION Starting in medical school neurologic examination has remained intimidating for many physicians. The examination has been perfected over many decades thanks to our French and German founding fathers. It has led to eponyms (e.g. - Babinski sign, Hoffmann reflex) different techniques of detecting subtle signs of weakness (e.g.
    [Show full text]
  • Deep Tendon Reflex: the Tools and Original Article Techniques
    Deep Tendon Reflex: The Tools and Original Article Techniques. What Surgical Neurology Residents Should Know OOI Lin-Wei1,3,4, Leonard LEONG Sang Xian1,3,5, Vincent TEE Wei Shen3, CHEE Yong Chuan1,2,3, Sanihah Abdul HALIM1,2,3,6, Submitted: 12 Sep 2020 Abdul Rahman Izani GHANI1,3,6, Zamzuri IDRIS1,3,6, Jafri Malin Accepted: 7 Dec 2020 1,3,6 ABDULLAH Online: 21 Apr 2021 1 Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 2 Neurology Unit, Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 3 Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 4 Department of Neurosurgery, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia 5 Department of Neurosurgery, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia 6 Brain Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia To cite this article: Ooi L-W, Leong LSX, Tee VWS, Chee YC, Halim SA, Ghani ARI, Idris Z, Abdullah JM. Deep tendon reflex: the tools and techniques. What surgical neurology residents should know. Malays J Med Sci. 2021;28(2): 48–62. https://doi.org/10.21315/mjms2021.28.2.5 To link to this article: https://doi.org/10.21315/mjms2021.28.2.5 Abstract The deep tendon reflex (DTR) is a key component of the neurological examination. However, interpretation of the results is a challenge since there is a lack of knowledge on the important features of reflex responses such as the amount of hammer force, the strength of contraction, duration of the contraction and relaxation.
    [Show full text]
  • Reflexes BMJ 2019
    BMJ: first published as 10.1136/bmj.l4830 on 14 August 2019. Downloaded from BMJ 2019;366:l4830 doi: 10.1136/bmj.l4830 (Published 14 August 2019) Page 1 of 6 Practice PRACTICE ESSENTIALS Testing the reflexes A J Lees neurologist 1, Brian Hurwitz former general practitioner 2 1The National Hospital, Queen Square, London WC1N 3BG, UK; 2King’s College London, London WC2B 6LE, UK with muscles via the nerve roots, plexuses, peripheral nerves, What you need to know and neuromuscular junction) and an upper motor neurone lesion • Tendon reflex testing allows lower and upper motor neurone lesions to (due to damage upstream from the anterior horn cell, including be distinguished reliably the corticospinal tracts, the brain stem, and motor cortex). This • Interpret reflexes alongside a clinical history and any abnormalities of distinction is the first stage in locating the site of neurological http://www.bmj.com/ power, tone, and sensation found on examination damage. • Reflex testing is essential if you suspect spinal cord and cauda equina compression, acute cervical or lumbar disc compression, or acute There are situations where all the neurological symptoms occur inflammatory demyelinating polyradiculoneuropathy above the neck (such as bulbar symptoms due to motor neurone disease) where reflex testing is also essential. Eliciting the deep tendon reflexes is a vital component of Box 1 lists some clinical scenarios where testing the deep tendon medical assessments in general practice (where 9% of medical reflexes is discriminatory when coming to a diagnosis. 1 problems are believed to be neurological in origin ) and in on 18 August 2019 by Michael John Haydon McCarthy.
    [Show full text]