Download Neurologic System

Neurologic System
The Motor System and the Cerebellar
Function
Motor Pathways &
Type of Movements
• Corticospinal or Pyramidal Tract
– Voluntary, skilled, discrete, purposeful (writing)
• Extrapyramidal Tracts
– Maintain muscle tone and control body movements
(walking)
• Cerebellar System
– Coordinates movement, maintains equilibrium and
posture….Operates on subconsious level
Question for Thought
• Describe 3 major motor pathways in the
CNS including the type of movements
mediated by each?
Chapter 21
• Cerebral Cortex
Figure 21-1. p. 688.
Upper and Lower Motor Neurons
• Upper motor neurons
• All descending motor neurons that impact on the
lower motor neurons
• Located in the CNS
• Convey impulses from motor areas of cerebral
cortex to lower motor neurons in the cord
• Diseases = CVA, Cerebral palsy, Multiple sclerosis
Upper and Lower Motor Neurons
• Lower motor neurons
• In the peripheral nervous system
• 12 cranial nerves
• 31 pairs of spinal nerves and all branches
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Final direct contact with the muscles
Movement translated into action
Reflex arc
Examples = cranial nerves, spinal nerves
Diseases = spinal cord lesions, poliomyelitis, ALS
Question for Thought
• Differentiate an upper motor neuron from a
lower motor neuron?
Subjective Data
• In the Interview
– Any shakes or tremors in the hands or face?
• Worsen with anxiety, fatigue
• Relieved with activity, alcohol
• ADL’s affected
– Weakness
• Where? When? Why?
Subjective Data
• Incoordination
• Balance, falling,
• Legs give out
• Clumsy
• Numbness/ Tingling
• Describe ( pins and needles)
• Significant past history
• TIA’s, Atrial Fib.
Assessment of Motor System
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Body position
Involuntary movements
Muscle size ( bulk)
Muscle tone
Muscle strength
Body Position
• Observe during movement
• Observe at rest
Involuntary Movements
• Tremors, tics, fasciculations, myoclonus
• Note:
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Location
Quality
Rate
Rhythm
Amplitude
Involuntary Movements
• Note the involuntary movement in relation
to :
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Posture
Activity
Fatigue
Emotion
Other factors
Terms to Describe Movement
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Flexion
Extension
Abduction
Adduction
Pronation
Supination
More Terms for Movement
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Circumduction
Inversion
Eversion
Rotation
Protraction
Terms of Movement Continued
• Retraction
• Elevation
• Depression
Muscle Size
• Compare size and contour
– Atrophy
• Unilateral/bilateral
• Proximal/distal
Muscle Tone
• A relaxed muscle maintains a slight residual
tension referred to as muscle tone.
• Hypo tonic, Flaccidity.
• Spasticity.
• Lead-pipe rigidity.
Muscle Strength
• Test muscle strength by asking the client to
move actively against your resistance or to
resist your movement.
• A muscle is strongest when shortest and
weakest when longest.
Terms to Describe Strength
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Weakness (paresis)
Paralysis (plegia)
Hemiparesis
Hemiplegia
Paraplegia
Quadriplegia
Grading Muscle Strength
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Scale 0-5
0 - no muscular contraction
1 – slight contraction
2 – Full ROM, gravity eliminated
Grading Muscle Strength
• 3 – Full ROM against gravity
• 4 – Full ROM against gravity, some
resistance
• 5 – Full ROM against gravity full resistance
without evident fatigue = Normal Muscle
Strength
Cerebellar Function
• Balance tests
– Gait
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Observe normal walk
Tandem Walking ( heel – to- toe )
Romberg Test (stand, feet together, arms at side, close eyes)
Shallow knee bend or hop on one leg
• What findings would you expect to see when
assessing gait and balance in an older adult?
Cerebellar Function
• Coordination and Skilled Movements
– RAM ( Rapid alternating movements)
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Pat Knees
Thumb to each finger
Finger to finger
Finger to nose
Heel to shin
Question for Thought
• List and describe 3 tests of cerebellar
function?
Charting Sample
• For Normal Muscle Strength (objective)
– Able to maintain flexion against resistance and
without tenderness
• For Motor ( objective)
– No atrophy, weakness or tremors. Gait smooth
and coordinated, able to tandem walk, negative
Romberg. RAM, finger-to-nose smoothly intact