Neuro notes clinical pocket guide free download

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On the Web site you will find content regarding neurological diagnostic tests and additional information about diseases and disorders, including special tests, additional assessments, differential diagnosis, prognosis, surgery, and referrals to other health-care providers. There is also a glossary of neurological terms commonly used by PTs. Claudia B. Fenderson Wen K. If the following signs or symptoms are demonstrated, terminate examination and intervention; then immediately call for medical assistance.

If yes, how often? Do you drink alcohol? Do you use illegal drugs? Do you use illegal IV drugs? Medical Screening Have you ever experienced or been told that you have any of the following? Accessed January 16, The energy expenditure index: A method to quantitate and compare walking energy expenditure for children and adolescents. J Ped Orthopedics. Calculated as the walking heart rate minus the resting heart rate divided by the walking speed to cover 55 meters; recorded as beats per meter.

Accessed November 27, Weight kg 2. Accessed October 1, I am going to say three words. You say them back after I stop. Here they are. Now repeat those words back to me. Published by Psychological Assessment Resources, Inc. Further reproduction is prohibited without permission of PAR Inc. Handrail height Adjust height to 34—38 in. Handrail location Install handrails on both sides Ramp grade 1 in. Modify for patient with limited hand function Adjust to 30—34 in.

Functional reach: A new clinical measure of balance. J Gerontol. Validity of the multi-directional reach test: A practical measure for limits of stability in older adults. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. Two or more falls are considered to be indicative of deficits of sensory information required for standing balance.

A condition is failed if the person steps, unfolds arms, or opens eyes in eyes closed conditions. Eyes closed Condition 1. Dome used 4. Standing on foam; eyes closed 6. Effects of visual and support surface orientation references upon postural control in vestibular deficit subjects. Acta Otolaryngology.

Performance-Oriented Mobility Assessment Balance 1. Sitting balance Score 0—leans or slides in chair 1—leans in chair slightly or slight increased distance from buttocks to back of chair 2—steady, safe, upright 2. Arising from chair 0—unable without help or loses balance 1—able but uses arm to help or requires more than two attempts or excessive forward flexion 2—able without use of arms in one attempt 3. Immediate standing balance 0—unsteady, marked staggering, first 3—5 seconds moves feet, marked trunk sway, or grabs object for support 1—steady but uses walker or cane, or mild staggering but catches self without grabbing object 2—steady without walker or cane or other support 4.

Standing balance 0—unsteady 1—unsteady, but wide stance medial heels more than 4 inches apart or uses cane, walker, or other support 2—narrow stance without support 5. Turn balance degrees 0—unsteady 1—steady but steps discontinuous 2—No grabbing or staggering; steady and steps continuous 7.

Nudge on sternum patient 0—begins to fall, or examiner has to stands with feet as close help maintain balance together as possible, 1—needs to move feet, but able to examiner pushes with maintain balance light even pressure over 2—steady sternum 3 times 8.

Neck turning 0—unsteady 1—decreased ability to turn side to side to extend neck, but no staggering or grabbing 2—able to turn head at least half way side to side and be able to bend head back to look at ceiling 9.

One leg standing balance 0—unable 1—some staggering, swaying or moves foot slight 2—able to stand on one leg for 5 seconds without holding object for support Back extension ask patient 0—will not attempt or no extension to lean back as far as seen or staggers possible, without holding 1—tries to extend, but decreased ROM onto object if possible 2—good extension without holding object or staggering Bending down patient is asked to pick up small objects, such as pen, from the floor Sitting down Gait 1.

Initiation of gait patient asked to begin walking down hallway 2. Step height begin observing after first few steps: observe one foot, then the other; observe from side 3. Step length observe distance between toe of stance foot and heel of swing foot; observe from side; do not judge first few or last few steps; observe one side at a time Score 0—unable to bend down, or unable to get upright after bending down, or takes multiple attempts to upright 1—able to get object and get upright in single attempt but needs to pull self up with arms or hold onto something for support 2—able to bend down and pick up the object and is able to get up easily in single attempt without needing to pull self up with arms 0—unsafe misjudged distance; falls into chair 1—uses arms or not a smooth motion 2—safe, smooth motion 0—hesitates; multiple attempts; initiation of gait not a smooth motion 1—no hesitation; initiation of gait is single, smooth motion 0—swing foot is not completely raised off floor 1—swing foot completely clears floor by no more than 1—2 in.

Step symmetry observe middle part of the patch not the first or last steps; observe from side; observe distance between heel of each swing foot and toe of each stance foot 5. Step continuity 6. Path deviation observe from behind; observe one foot over several strides; observe in relation to line on floor if possible 7.

Trunk stability observe from behind; side-to-side motion of trunk may be normal gait pattern, need to differentiate this from instability 8. Walk stance observe from behind 9. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. Falls efficacy as a measure of fear of falling.

J Gerontology. Gait level surface tive devices, good speed, no Instructions: Walk at your evidence of imbalance, normal normal speed from here to the gait pattern next mark 20 ft 2—Mild Impairment: Walks 20 ft, uses assistive devices, slower speed, mild gait deviations 1—Moderate Impairment: Walks 20 ft, slow speed, abnormal gait pattern, evidence for imbalance 0—Severe Impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance 3—Normal: Able to smoothly 2. Gait with horizontal head smoothly with no change in gait turns 2—Mild Impairment: Performs Instructions: head turns smoothly with slight Begin walking at your normal change in gait velocity, i.

Construction and validation of the 4-item dynamic gait index. Phys Ther. National spinal cord injury statistical system. Accessed August 21, Do you turn over from your back to your side without help? From lying in bed, are you able to get up to sit on the edge of the bed on your own? Could you sit on the edge of the bed without holding on for 10 seconds? Can you using hands and an aid if necessary stand up from a chair in less than 15 seconds, and stand there for 15 seconds?

Observe patient standing for 10 seconds without any aid. Are you able to move from bed to chair and back without any help? Can you walk 10 meters Can you manage a flight of steps alone, without help? Do you walk around outside alone, on pavements?

If you drop something on the floor, can you manage to walk 5 Can you walk over uneven ground grass, gravel, dirt, snow, or ice without help?

Can you get in and out of a shower or bath unsupervised, and wash yourself? Are you able to climb up and down four steps with no rail but using an aid if necessary? Could you run 10 meters A fast walk is acceptable. Administer the following pediatric assessments as appropriate for age: Bruininks Oseretsky Test of Motor Proficiency 2nd ed.

The pain drawing as an aid to the psychological evaluation of patients with low back pain. Explain and use Scale for patient self-assessment. Accessed May 4, , with permission. Lying quietly, normal position moves easily. No cry, awake or asleep Consolability Content, relaxed Scoring 1 Occasional grimace or frown, withdrawn, disinterested Uneasy, restless, tense Squirming, shifting back and forth, tense 2 Frequent to constant quivering chin, clenched jaw Kicking, or legs drawn up Arched, rigid, or jerking Moans or whimpers; Crying steadily, occasional complaint screams, or sobs; frequent complaints Reassured by Difficulty to console occasional touching, or comfort hugging, or being talked to, distractible Source: Merkel SI, et al.

Pediatr Nurs. Does the patient require digital stimulation, laxatives, or enemas to have a bowel movement? Can the patient perform digital stimulation or insert enemas to facilitate bowel movements independently? What is the frequency of bowel movements each day? What is the frequency of voiding each day? How many accidental voidings occur in a day? Is a small or large amount of urine lost? What protective devices are used?

Can the patient don the protective device independently? What is the daily fluid intake? Without looking at the object, have the patient name it. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J. Index of activities of daily living.

The distribution of CP includes diplegia, quadriplegia, and hemiplegia. Pain can be manifested by changes in blood pressure, oxygen saturation, heart rate, and respiration as well as change in tone and facial expression.

Precautions The immobility and lack of weight-bearing activities is associated with reduced bone mass, osteopenia, osteoporosis, and fracture. Describe strength in terms of functional abilities and ability to perform motions in and out of synergistic patterns.

All fours forearms hands 4 pt kneeling plantigrade standing All fours Equil. Sym T. Body Derotative with rotation and support Standing up from supine without support rotates rotates out of into sitting sitting Body Rotative Asym. The child is required to make a musical note of any pitch and intensity by blowing air through pouted lips. Three attempts are allowed after demonstration of the test by examiner i.

The child is required to roll a tennis ball under the sole of the preferred foot with or without footwear in spiral fashion around 6 matchboxes placed 30 cm apart. The ball is to touch a maximum of 3 matchboxes before disqualification. Three attempts are allowed before failure. Test 4 Throw, clap hands, then catch tennis ball. If able to catch the ball after 4 claps, the child is then required to catch the ball with one either hand after 4 claps.

Three attempts are allowed before failure at any point. Score: Expressed in one of the following seven categories: 1. Cannot catch the ball with both hands.

Can catch the ball with both hands after 0 claps. Can catch the ball with both hands after 1 clap. Can catch the ball with both hands after 2 claps. Can catch the ball with both hands after 3 claps. Can catch the ball with both hands after 4 claps. Can catch the ball with preferred hand after 4 claps. Test 5 Tie one shoelace with double bow single knot. The wooden beads are 3 cm in diameter with a bore of 0.

The beads are patented Kiddicraft toys that can be readily purchased. Test 7 Pierce 20 pinholes. The child is supplied with a stylus long hatpin and asked to pierce two successive rows of 0. Test 8 Posting box. The posting box is a patented Kiddicraft toy that can be readily purchased. Source: Gubbay, SS. The Clumsy Child: A study of developmental apraxic and diagnostic ataxia.

London: WB Saunders, Seizures may occur in the presence of precipitating factors such as a high temperature febrile seizures , alcohol or drug withdrawal, and hypoglycemia. Therefore, assessment should be based on the medical conditions for which a referral was made. The age of onset and course of disease varies with each type. Discussion of medical issues, feeding problems, and other health-related problems Tests and Measures Descriptions of tests and measures are found in Tab 2.

Walks and climbs stairs without assistance 2. Walks and climbs stairs with aid of railing 3. Walks and climbs stairs slowly with aid of railing more than 25 seconds for eight standard steps 4.

Walks, but cannot climb stairs 5. Walks assisted, but cannot climb stairs or get out of chair 6. Walks only with assistance or with braces 7. In wheelchair: sits erect and can roll chair and perform bed and wheelchair ADL 8. In wheelchair: sits erect and is unable to perform bed and wheelchair ADL without assistance 9.

In wheelchair: sits erect only with support and is able to do only minimal ADL Management of progressive muscular dystrophy. The following conditions are listed together because the neonatal assessment process for each diagnostic category is similar.

This section includes: Hypoxic Ischemic Encephalopathy HIE Hypoxic ischemic encephalopathy HIE is caused by either hypoxia diminished oxygen supply or ischemia a reduction of blood supply that results in cell destruction.

Sequelae of HIE vary and may include a weak suck, irritability, cognitive impairment, varying degrees of cerebral palsy CP accompanied by hypotonicity, spasticity, or athetosis. In moderate HIE, the infant may be extremely lethargic, exhibit seizures and weak Moro and suck reflexes. Intraventricular Hemorrhage IVH IVH results from factors that include unstable respiratory status, hypoxemia, and an inability to tolerate change in blood pressure. A grading system of hemorrhage is used in which grade I represents an isolated bleed and IV involves intraventricular bleeding in addition to periventricular hemorrhagic infarction.

A grade of IV carries the most significant risk of mental retardation, seizures, and CP. Periventricular Leukomalacia PVL PVL is the necrosis of the periventricular cerebral white matter of the brain, which is responsible for motor control and muscle tone in the lower limbs.

One of the primary long-term neurological consequences of PVL is spastic diplegia, often accompanied by intellectual and visual-motor deficits. Medical Red Flags Infants seen in the neonatal care unit are extremely fragile. Health professionals working with this population must recognize the physiological and behavioral signs of distress that indicate that the neonate is struggling to maintain homeostasis.

At such times, intervention should cease or be modified. It is the leading cause of mental retardation in females, although it can also affect males. Tests and Measures Descriptions of tests and measures are found in Tab 2.

Refer to section on Epilepsy in this tab. SBS can result in serious, sometimes fatal, injury and disability. Refer to appropriate sections, i.

Patient pulls self 1. Supine to into side-lying with intact arm, moves side-lying affected leg with intact leg. Arm is left starting behind.

Shoulder protracts and arm flexes forward. Must not use hands. Supine to sit up. Patient assisted to side-lying. Patient controls head position throughout. Therapist gives standby help by assisting legs over side of bed. Balanced sitting 4.

Sitting to standing Score 1 Sits only with support. Therapist should assist patient into sitting. Weight should be well forward at the hips, head and thoracic spine extended, weight evenly distributed on both sides. Feet supported, together on floor. Do not allow legs to abduct or feet to move. Have hands resting on thighs, do not allow hands to move onto plinth. Feet supported on floor. Do not allow patient to hold on.

Do not allow legs and feet to move, support affected arm if necessary. Hand must touch floor at least 10 cm [4 in. Patient must reach sideways, not forward. Do not allow uneven weight distribution. Full extension of hips and knees. Walking 1 Stands on affected leg and steps forward with other leg. Weight-bearing hip must be extended. Therapist may give standby help. Upper arm 1 Lying, protract shoulder girdle with arm in function elevation therapist places arm in position and supports it with elbow in extension.

Therapist should place arm in position and patient must maintain position with some external rotation. Therapist may assist supination of forearm. Therapist should place arm in position and patient must maintain position with some external rotation and elbow extension. Do not allow excess shoulder elevation. Patient must maintain position with some external rotation.

Do not allow pronation. Therapist should have patient sitting at a table with forearm resting on table. Patient is asked to lift object off the table by extending the wrist.

Do no allow elbow flexion. Therapist should place forearm in midpronation-supination, i. Patient is asked to lift hand off table. Do not allow elbow flexion or pronation. Elbow unsupported and at right angle. Three-quarter range is acceptable. Advanced hand activities Score 4 Reach forward, pick up large ball of 14 cm 5 in.

Ball should be on table so far in front of patient that he has to extend arms fully to reach it.