neurological

• Orientation


  Awareness of people, time, place
• Types of memory


  • Immediate
  • Recent
  • Remote
• Level of consciousness (LOC)

  • Level I- conscious, cognitive, coherent
  • Level II- confused, drowsy, lethargic, obtunded and somnolent
  • Level III- stuporous
  • Level IV-light and deep coma
• Glasgow Coma Scale


  • Objective measure to describe LOC
  • Assesses eye opening, motor response, verbal response
• Eye opening


  1. SPONTANEOUS

  2. ON REQUEST

  3. TO PAINFUL STIMULI

  4. NO OPENING
• Best verbal response


  1. 5-ORIENTED TO TIME, PLACE, PERSON

  2. ENGAGES IN CONVERSATION, CONFUSED IN CONTENT

  3. WORDS SPOKEN BUT CONVERSATION NOT SUSTAINED

  4. GROANS ON EVOKED PAIN

  5. NO RESPONSE
• Best motor response


  1. OBEYS COMMAND

  2. 5-LOCALIZES PAINFUL STIMULI

  3. 4-FLEXION WITHDRAWAL

  4. DECORTICATE

  5. 2-DECREBRATE

  6. 1-NO RESPONSE
• Decorticate posturing


  • Rigid, extended legs
  • Arms bent and curled wrists toward center of body and balled hands against chest
• Decerebrate posturing


  • Rigid, extended legs
  • Pointed and turned in toes
  • Flexed, straight, tense arms parallel to body
  • Curled fingers
• Stereognosis


  Ability to perceive and recognize the form of an object in the absence of visual and auditory information, by using tactile information
• Agnosia


  Unable to recognize and identify objects, persons or sounds
• Apraxia


  Unable to perform tasks or movement when asked
• Agraphia


  Impairment or loss of a previous ability to write
• Romberg test


  • Tests equilibrium (balance and posture)
• Superficial reflexes


  • Pupillary reflex
  • Corneal reflex
  • Abdominal reflex
  • Cremasteric reflex
  • Anal reflex
  • Babinski reflex
• Babinski reflex


  Positive when big toe flexes upward and other toes fan out in response to stroking the sole of the foot
• Interpretation of superficial reflexes

  • Absent
  • Slightly active
  • Active
• Deep tendon reflexes


  • Ankle jerk
  • Knee jerk
• Deep tendon reflex response

  1. Hyperactive, very brisk

  2. Normal response, average

  3. Diminished, low response

  4. No response
• Kernig's sign


  • Elicits pain or limited extension when knee is flexed to 90 degrees and hip is flexed to 90 degrees
• Brudzinski's sign


  • Elicits hip and knee flexion with passive flexion of the neck
• Oculocephalic reflex or doll's eye phenomenon

  • Holding the person's eyelids open and rotating the head from side to side causes conjugate eye movement to the opposite side
• Oculovestibular reflex or caloric ice water test

  • Irrigating the semi-circular canals of the ear with ice water causes conjugate movement or nystagmus, an accurate method of brainstem functioning
• Broca's area


  Motor speech center, results in expressive or motor aphasia
• Wernicke's area


  Auditory speech center, results in receptive aphasia
• Global or mixed aphasia


  Combination of expressive and receptive aphasia
• Visual speech center


  Located in the occipital lobe