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Neuro AssessmentCerebellum – function and assessmentLocated posterior and inferior to the cerebrum, Influence’s muscle tone and coordination of muscle action. Control of equilibrium and posture. Movements should be smooth*Walk, sit, stand, tip toes, heels, heel to toe, forward/backward/sidestep, Romberg’s testEyes closed, feet together swaying = (+) Pronator’s drift- stand and extend arms with palms up-assessing for strokeDystaxia-eyes closed, finger to nose, 2ndtest lying supine, heel to opposite shin up/down. Rapid Alternating Movements (RAM)- slap thigh then palm rapidly.Muscle/motor assessmentCN assessment – functionOld#1 olfactory-smellOpie#2 Optic-visionOccasionally#3 Oculomotor-extraocular movement, pupil constriction, eyelid movementsTries#4 Trochlear-Extraocular movementsTrigonometry #5 Trigeminal-mastication, jaw movementsAnd. #6 Abducens-Extraocular movementsFeels. #7 Facial-tasteVery #8 Vestibulocochlear- Hearing and balanceGloomy. #9 Glossopharyngeal-Sensory in throat, tasteVague. #10 Vagus-swallowing/gag reflexAnd #11 Spinal accessory-shoulder/head movementHypoactive. #12 Hypoglossal-Tongue movement Sensory assessment – ie Peripheral neuropathyLight touch-cotton ball, Sharp-broken tongue blade/sharp objectTemperature-hot/coldProprioceptive sensation-grasp fingers/toes-move them up/down ask pt what is the direction. Vibration-tuning fork on foot, soft tissue and boneCortical sensation-coin in hand -identify objectGraphesthesia-eyes closed trace a number/letter on palm ask what was writtenTwo-point discrimination-two unraveled paper clips touch patients simultaneously closer and closer until the patients can no longer distinguish the distance. Extinction-touch the patient, ask where it was felt.
ReflexesDiminished DTR may indicate deep coma, deep sedation or narcosis.