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Neurological Assessment Tools Glasgow Coma Scale Eye Opening Verbal Response Motor Response Score Obeys 6 Oriented Localizes 5 Spontaneously Confused. Withdraws 4 To sound Inappropriate Abnormal Flexion Uses words 3 To pressure Makes sounds Abnormal Extension (without word) 2 No eye opening No vocalization No Movement 1 /4 /5 /6 /15 Motor Scoring Scale 5 Able to overcome strong resistance (normal strength) 4 Able to overcome mild resistance (mild weakness) 3 Supports limb against gravity but not resistance 2 Moves but not against gravity 1 Muscle flicker but no movement 0 No muscle movement /5 Score Revised: January 29, 2020 Reviewed: January 21, 2021 Deep Tendon Reflexes ▪ Motor weakness associated with increased tone and deep tendon reflexes (3 or 4+), and/or with clonus suggest an upper motor neuron cause for the weakness. ▪ Motor weakness associated with flaccid paralysis and decreased deep tendon reflexes (< 2+) suggest lower motor neuron cause for the weakness. Biceps Brachii Tendon C5, C6 Triceps Tendon C7, C6 Plantar Reflex (Babinski) Brachioradialis Tendon C6, C5 Clonus: Oscillations between flexion and extension Quadriceps Tendon (knee jerk) L4, L3, L2 Achilles Tendon (ankle jerk) S1 Motor Assessment/Spinal Cord Testing Level of Function: C4: Shrug shoulder C4, C5: Abduct shoulder C5: Bend elbow C6, C7: Extend wrist C7: Straighten elbow C7, C8: Bend wrist toward palm Motor Assessment/Spinal Cord Testing Level of Function: C8: Bend fingers toward palm at first digit joint T1: Spread fingers apart L2, L3: Bend hip L3, L4: Straighten knee L4, L5: Dorsiflexion (pull toes toward nose) S1, S2: Plantar flexion (point toes downward) Sensory Assessment/Spinal Cord Testing Test sensation twice, once for pin and once for light touch . Use a whisp of tissue for light touch and blunt end needle for pain/pin. Record the highest level of sensation using the dermatome chart below. Test each dermatome on L and R side in anatomical descending order. Ask patient to close eyes so they cannot see you touching them. Reviewed: January 21, 2021 Morganb.

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Retained Neonatal Reflexes | the Chiropractic Office of Dr
Retained Neonatal Reflexes | The Chiropractic Office of Dr. Bob Apol 12/24/16, 1:56 PM Temper tantrums Hypersensitive to touch, sound, change in visual field Moro Reflex The Moro Reflex is present at 9-12 weeks after conception and is normally fully developed at birth. It is the baby’s “danger signal”. The baby is ill-equipped to determine whether a signal is threatening or not, and will undergo instantaneous arousal. This may be due to sudden unexpected occurrences such as change in head position, noise, sudden movement or change of light or even pain or temperature change. This activates the stress response system of “fight or flight”. If the Moro Reflex is present after 6 months of age, the following signs may be present: Reaction to foods Poor regulation of blood sugar Fatigues easily, if adrenalin stores have been depleted Anxiety Mood swings, tense muscles and tone, inability to accept criticism Hyperactivity Low self-esteem and insecurity Juvenile Suck Reflex This is active together with the “Rooting Reflex” which allows the baby to feed and suck. If this reflex is not sufficiently integrated, the baby will continue to thrust their tongue forward, pushing on the upper jaw and causing an overbite. This by nature affects the jaw and bite position. This may affect: Chewing Difficulties with solid foods Dribbling Rooting Reflex Light touch around the mouth and cheek causes the baby’s head to turn to the stimulation, the mouth to open and tongue extended in preparation for feeding. It is present from birth usually to 4 months.
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The Corneomandibular Reflex1
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.34.3.236 on 1 June 1971. Downloaded from J. Neurol. Neurosurg. Psychiat., 1971, 34, 236-242 The corneomandibular reflex1 ROBERT M. GORDON2 AND MORRIS B. BENDER From the Department of Neurology, the Mount Sinai Hospital, New York, U.S.A. SUMMARY Seven patients are presented in whom a prominent corneomandibular reflex was observed. These patients all had severe cerebral and/or brain-stem disease with altered states of consciousness. Two additional patients with less prominent and inconstant corneomandibular reflexes were seen; one had bulbar amyotrophic lateral sclerosis and one had no evidence of brain disease. The corneomandibular reflex, when found to be prominent, reflects an exaggeration of the normal. Therefore one may consider the corneomandibular hyper-reflexia as possibly due to disease of the corticobulbar system. The corneomandibular reflex consists of an involun- weak bilateral response on a few occasions. This tary contralateral deviation and protrusion of the was a woman with bulbar and spinal amyotrophic lower jaw during corneal stimulation. It is not a lateral sclerosis. The other seven patients hadProtected by copyright. common phenomenon and has been rediscovered prominent and consistently elicited corneo- several times since its initial description by Von mandibular reflexes. The clinical features common to Solder in 1902. It is found mostly in patients with these patients were (1) the presence of bilateral brain-stem or bilateral cerebral lesions who are in corneomandibular reflexes, in some cases more coma or semicomatose. prominent on one side; (2) a depressed state of con- There have been differing opinions as to the sciousness, usually coma; and (3) the presence of incidence, anatomical basis, and clinical significance severe neurological abnormalities, usually motor, of this reflex.
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Normal Plantar Response: Integration of Flexor and Extensor Reflex Components
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.26.1.39 on 1 February 1963. Downloaded from J. Neurol. Neurosurg. Psychiat., 1963, 26, 39 Normal plantar response: integration of flexor and extensor reflex components LENNART GRIMBY From the Department of Neurology, Karolinska Institute, Serafimerlasarettet, Stockholm, Sweden The reflexes elicited by painful stimulation of the the suprasegmental control of the reflex centres, the plantar surface of the foot have been studied receptive field of the reflex is limited to the skin area extensively for a long time and the relation between where it is adequate for protective purposes, viz., the reflexes obtained in normal and in pathological the ball of the great toe. cases has been the subject of considerable debate. An Previous investigations (Eklund et al., 1959; excellent survey of previous investigations is to be Kugelberg et al., 1960) have shown that the main found in the review by Walshe (1956). As in most difference between the electromyographic pattern of studies of human reflexes, the technique commonly a flexor plantar response and that of an extensor used has, however, not permitted an exact deter- plantar response is that the reflex plantar flexion of mination of the latency values of the reflexes, and the great toe is associated with activity in the short it has thus not been possible to judge with certainty hallux flexor and reciprocal inhibition of the guest. Protected by copyright. to what extent the movements studied have been voluntary activity in the short hallux extensor, purely spinal and to what extent of cerebral origin. whereas, conversely, reflex dorsiflexion of the great By means of brief electric stimuli and an electro- toe is accompanied by activity in the short hallux myographic recording technique these latency values extensor and reciprocal inhibition of the voluntary can, however, be exactly determined, and in this way activity in the short hallux flexor.
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Neurologic Assessment Skills for the Acute Medical Surgical Nurse
on230103.qxd 1/20/2004 12:01 PM Page 3 Neurologic Assessment Skills for the Acute Medical Surgical Nurse Janet T. Crimlisk ▼ Margaret M. Grande Practical and efficient neurologic assessment skills are vital for when neurologic conditions are changing and what acute care nurses. During an acute neurologic event, the should be the nurse’s immediate response? nurse needs a focused assessment of the pertinent history and symptom analysis and an immediate head-to-toe survey, Review of Central Nervous System eliciting any abnormal signs to identify and correctly report the medical problem. When a patient requires routine moni- To identify appropriate assessment information and toring of neurologic signs, the nurse’s role includes a neuro- apply these skills, a brief overview of the central nervous system (CNS) is presented. The CNS consists of the brain, logic assessment, collecting and assimilating that data, inter- which comprises the cerebrum, cerebellum, and brain- preting the patient problem, notifying the physician when stem (see Figure 1). The brain consists of two central appropriate, and documenting that data. This article presents hemispheres, right and left, which form the largest part of an overview of a staff nurse’s neurologic assessment, explains the brain. There are four main lobes: frontal (Broca’s common neurologic tests performed at the bedside, identifies area, judgment, insight, problem solving, and emotion), an efficient way to perform the assessment, and indicates temporal (auditory, comprehension, speech, and taste), what to include and document when “neuro signs” are parietal (sensory and proprioception), and occipital ordered. (vision). In the central part of the cerebrum is the dien- KEY WORDS: Neurologic assessment, Education, Medical surgi- cephalon, which surrounds the third ventricle and forms cal nurse the central core and contains the thalamus and the hypo- thalamus (the autonomic nervous system regulator).
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Overshunting-Associated Myelopathy: Report of 2 Cases
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THE BABINSKI REFLEX.1 by C
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Clinical Tests and Differential Diagnosis of Cervical Spondylotic Myelopathy 39
Clinical Tests and Differential Diagnosis of Cervical 05 Spondylotic Myelopathy Jesus Lafuente Introduction MRI, and clinical symptoms is essential for a correct diagnosis. Anterior-posterior width Cervical spondylotic myelopathy (CSM) is reduction, cross-sectional evidence of cord a disabling disease caused by a combina- compression, obliteration of the subarach- tion of mechanical compression and vascu- noid space, and signal intensity changes to lar compromise of the spinal cord. It is the the cord found on MR imaging are consid- most common cause of spinal dysfunction ered the most appropriate parameters for in older patients.1 The onset is often insidi- confirmation of a spinal cord compression ous with long periods of episodic, stepwise myelopathy.4 In some occasions when the progression and may present with different diagnosis is still not clear, the use of other symptoms from one patient to another.2 CSM studies could help, such as diagnostic elec- is a clinical diagnosis that may involve broad- trophysiology and cerebrospinal fluid (CSF) based gait disturbances first, associated with examination. weakness of the legs, and then spasticity.3 As spinal cord degeneration progresses, lower motor neuron findings in the upper extremi- Clinical Tests ties, such as loss of strength, atrophy, and CSM is the most common cause of spinal difficulty in fine finger movements, may cord dysfunction in the world. A meticu- present.3 Additional clinical findings may lous physical examination of patients with include: neck stiffness, shoulder pain, pares- cervical pathology can relatively make the thesia in one or both arms or hands, radicu- distinction between radiculopathy or mye- lopathy, a positive Hoffman and/or Babinski lopathy easy.
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1985;18:606-10. the Unaffectedside Causesflexion Ofthe Thigh on The
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.51.9.1163 on 1 September 1988. Downloaded from Guillain-Barrt~syndrome. a model of random conduction bl ock1 6 1163 size of compound sensory or muscle action potentials, 15 Young RR, Cracco RQ. Clinical neurophysiology of and length of nerve segmnent. Neurology 1986;36: conduction in central motor pathways. Ann Neurol 647-52. 1985;18:606-10. 13 Lee GJ, Ashby P, Whiite DG, Aquayo AJ. Analysis of 16 Olsson T. Vascular permeability in the peripheral ner- motor conduction velocity in the human median nerve vous system. In: Dyck PJ, Thomas PK, Lambert EH, by computer stimulation of compound muscle action Bunge R, eds. Peripheral Neuropathy. Philadelphia: potentials. Electroencephalogr Clin Neurophysiol W B Saunders, 1984:579-99. 1975;39:225-37. 17 Dumas M, Schwab ME, Thoenen H. Retrograde axonal 14 Sumner AJ. The physiological basis for symptoms in transport of specific macromolecules as a tool for Guillain-Baffr' syndrome. Ann Neurol 1981l;suppl 9: characterising nerve terminal membranes. J Neurobiol 28-30. 1979;1O: 179-97'. Babinski's Sign Amongst the founders of the celebrated Soci6t6 de Neurologie de Paris were, Pierre Marie, Dejerine, Brissaud and Babinski. Born on 17 November 1857 in the Boulevard Montparnasse, Josef Francois Babinski graduated in Paris, was an intern to Vulpian and became chef de clinique under Charcot in 1885. He failed to secure Charcot's as post (largely the result of an guest. Protected by copyright. internecine dispute between Charcot and Bouchard), but from 1880 to 1927 he headed the neurological, strictly male clinic at the H6pital de la Pitie' where both Charcot and Vulpian had previously worked.
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The Plantar Reflex
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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
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Review of the Reflexes and Neurological Signs in the Lower Extremity
University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1938 Review of the reflexes and neurological signs in the lower extremity Frank H. Tanner University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Tanner, Frank H., "Review of the reflexes and neurological signs in the lower extremity" (1938). MD Theses. 709. https://digitalcommons.unmc.edu/mdtheses/709 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. A Review of the Reflexes and Neurological Signs in the Lower Extremity• by Frank H. Tanner Senior thesis presented to the College of Medicine, University or Nebraska, Omaha, 1938. Table of Contents Page Introduction • • • • • • • • • • • • • • • • • • • •• 1 Scope of this paper • • • • • • • • • • • • • • • 1 Outline of this paper • • • • • • • • • • • • • • 2 Evolution of Reflex Action • • • • • • • • • • • 4 Characteristics of Reflex Action. • • • • • • •• 6 Chronological History ••••••• •• • • • • • • • • 8 General Use and Value of Reflexes ••••• • • • ••• 17 The Deep Reflexes or Tendon and Periosteal Reflexes. • 24 Knee Jerk •
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Neuropsychiatry Block Spinal Cord Functions and Reflexes
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