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? Review of Anatomy & Physiology
? Assessment
u
J Contains
approximately more
than 20 billion nerve
cells, or Neurons
? ©ach neuron is composed of a cell body
called a soma
soma,,
? a major fiber called an axon
axon,,
? and a system of branches called
dendrites..
dendrites
? Axons, also called nerve fibers, are
covered with myelin, a protective
sheath of substance made of fats and
protein which serves as insulation
? Neuroglial cells are twice as numerous
as neurons and account for half of the
brain's weight. Neuroglia (from
îreek for ´glueµ) provide structural
support to the neurons
Structures
Protecting the
Brain
ahe brain is contained
in the rigid skull.
Protective membranes
between the brain
and the cranium
Meninges
Layers:
Dura mater
Arachnoid
mater
Pia mater
Cerebrospinal
fluid A clear
liquid that
bathes the
entire brain
and fills a
series of four
cavities, called
ventricles..
ventricles
Approximately
500ml
500 ml of CSF is
produced each
day..
day
ahe BRAIN, Anatomy & Physiology
? From the outside, the brain appears as three
distinct but connected parts:
? !
!
2. Cerebellum
J coordinates body movements
J maintains posture and balance by
controlling muscle tone and sensing
the position of the limbs.
3. Brain Stem
J regulates breathing and blood pressure.
pressure.
J It includes three main structures lying
between and below the two cerebral
hemispheres
the midbrain
midbrain,,
pons
pons,, and
medulla oblongata
oblongata..
? Running up the brain stem from the medulla
oblongata through the pons and the midbrain is
a netlike formation of nuclei known as the
J reticular formation
formation..
controls respiration, cardiovascular
function, digestion, levels of alertness, and
patterns of sleep«
sleep«
Cranial
Nerves
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XI Spinal a
XII Hypo ² Hypoglossal
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Consciousness
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8 2
Consciousn
ess
Consciousness
state of awareness of self &
environment
1st and most sensitive indicator of
neurologic change U
2 Components:
Awareness / Content (cognition &
affect)
? cerebral cortex
orientation (3 spheres: aPP)
Rattention span
Rlanguage
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Rmemory "
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? FORMS OF
SaIM LI
ü©RBAL
üOIC© LOC
SHO a
üerbal aactile
aACaIL© Pain
aO CH Conscious (+) (+) (+)
aAP/ SHAK©
Lethargic (+) (+) (+) *
PAIN Stuporous ( -) ( -) (+)
S P©RFICIAL
D©©P
Comatose ( -) ( -) ((--)
Ê
J Midbrain
? Pupillary
Assessment
J Size
J Reaction
J Shape
Ê
´ N=1.5--6mm (3.5
1.5
avg.)
J Anisocoria
J N=17%;
J Abn=Herniation
Abn=Herniation
«
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BRaL J +,(Õ -#
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Direct Consensual Light -
response
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Reflex
es
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? Corneal
J Pons
J Medulla
? îag/ Cough
J Medulla
J CN IX
J CN X«
©mergen
cy
& 2
a
a:
a
2
ù Ask to count
backward from 100,
subtracting by seven
each time (µ100, 93,
86«µ).
ù Name 3 unrelated
objects (e.g. car, garbage
can, alarm clock) then
ask for these words
?
again for within a few
minutes
ù !&0
0
? )
1#
"2
Logic, Judgment, Reasoning &
decision--making ability
decision
ù aest for Logic & Judgment
spread wide.
J Scissors gait ² short, stiff steps with thighs
overlapping.
J Foot drop - lifts knee high then slaps foot
down
J Parkinsonian shuffle ² accompanied by
stooped posture
Spastic paralysis - arms flexed & held to the
Cerebellar function
Balance
? Romberg·s test
J arms at sides, feet together,
J eyes closed for 20 seconds.
J ½atch for loss of balance.
J Stand close enough to prevent falling.
N=slight swaying.
Abn
J loss of balance
J (+) Romberg
cerebellar ataxia, alcohol intoxication, MS,
impaired visual functioning, or loss of
proprioception.
dysfunction
? Finger-to
Finger-to--nose coordination test
J Ask to touch index finger to nose then to the examiner·s
outstretched vertical finger to different points.
Abn=Dyssnergy, Dysmetria (misjudgment of distance,
speed & force of movement = cerebellar dysfunction«
Sensory function
ß Superficial Pain & aouch Sensation
J test distal points on arms & legs
J ©yes closed.
(distal to proximal).
J Ask to say ´nowµ when each sensation is felt.
aemperature sensitivity
- 2 test tubes (1 filled with hot & 1 with cold
water, along the same routes.
Abn=Peripheral nerve problem: paresthesia &
impairment in touch sensation (Anesthesia,
Hypoanesthesia).
? üibratory sensation
;
2
; @ A
2 & &
? :
Cortical sensation
(stereognosis, graphesthesia, 2- 2-point
? Stereognosisdiscrimination)
² recognizing objects by feel.
J ©yes closed. Identify familiar objects (e.g. key). Repeat on
other hand with different object.
Abn=Astereognosis = parietal lobe problems
? Cremasteric Reflex
a12 ² L2
For genitourinary complaints only in men.
Lightly stroke the inner thigh
N=scrotal elevation on the stimulated side
? Anal Reflex
S3
S3--S5
îently touching around the anus with a cotton swab
or gloved finger
N=contraction of rectal sphincter«
Deep aendon Reflexes
Biceps, ariceps, Patellar, Achilles,
Brachioradialis
? Requires practice & a relaxed client.
Sitting with feet dangling. ©asier if used
with distractions.
? Pointed hammer ² small tendons
? Flat end ² larger tendons
? Compare bilateral responses
DaR îRADINî
? If any of the DaRs are hyperactive = test
for ankle clonus(rhythmic contraction).
? Lift 1 of the client·s legs & support the DaR îRAD© Response
flexed knee with non-
non-dominant hand.
îrasp the foot & quickly dorsiflex the 0 Absent reflex
toes.
1+ Diminished
J N=(-)Pain & involuntary movement
N=(- 2+ Normal
J Abn= Clonus=motor neuron 3+ Slightly
dysfunction increased
4+ Hyperactive
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