Neurological Examination for Physiotherapists Chaitali Shah
INDEX
Page numbers followed by f refer to figure, and t refer to table
A
ABCD score 385
Abdominal reflexes, superficial 139
Abduction 81
Abductor pollicis brevis 68
Abscess 277
Acetylcholine 257
Achilles 160
reflex 154
Action research arm test 385
Adduction 70f, 81
Adductor 72, 79
reflex 155
Adipose cells 259
Agnosia 28, 359
Air conduction 45f
Akinesia 200
Allesthesia 125
Allodynia 125
Alzheimer's disease 18
American Spinal Injury Association 370
Impairment Scale 370
Amniocentesis 287
Amoss's sign 248
Amyotrophic lateral sclerosis 287
Anal reflex, superficial 142
Analgesia 125
Angiography 289
Ankle
clonus, checking of 61f
dorsiflexion 66, 73
evertors 67
girth 104
measurement 104f
jerk 154
hyperactive 154
joint 79
plantar flexors 74, 75
strength testing of 74f
Anosmia 35
unilateral 35
Anosognosia 22, 31
Anterior spinal tract, functions of 113f
Anxiety 15, 163, 225
Aphasia 7
assessment of 9
conductive 8
expressive 7
global 8
nominal 8
types of 7
Apparent leg length discrepancy 98, 98f
Appetite 16
Apraxia 29, 30, 359
constructional 30
ideomotor 29
Arm
abduction 71
motor
ability test 385
examination of 67
pushing of 68
weakness, unilateral 108
Arterial blood gas 353
Arthritis 238
rheumatoid 122
Arthrokinematics 56
Ashworth scale, modified 61, 61t, 393
Astereognosis 28
Asthenia 209
Ataxia
assessment format 338
hereditary 11
scale for assessment and rating of 402
Ataxic gait, spastic 242
Athetosis 200, 222
Atopognosia 125
Atrophy 161
Auditory agnosia 28
Autonomic
failure produces 269
function, central regulation of 259
nervous system 253, 257f, 260f
diseases of 269
peripheral 253, 258
Autopognosia 22
Axial muscles functions 212
B
Babinski's reflex 106f
Babinski's sign 60, 105, 141, 178, 180f
Balint's syndrome 28
Barrington's nucleus 274
Barthel index 385, 393, 419
Basal
ganglia lesion 200
meningitis 34, 44
Beck's depression inventory 371, 385, 464
Behavioral pain scale, modified 136
Bell's palsy 43, 362
Bell's phenomenon 43, 43f
Berg balance
scale 385, 411
test 393
Biceps 159
brachii 7375
reflex 145, 146f
strength testing of 70f
Big toe extension 72
Biopsy 289
Bladder 275, 338, 354, 361
anatomy of 271
dysfunction 273, 365
nerve supply of 272f
neurogenic 275
regulation of 272f
Blepherospasm 223, 227
Blind spot 38
Blood
pressure 380
recording 262
vessels 258
Body
righting reflex, body on 216
scheme 20, 31, 358
Bone conduction 45f
Borg's rating of perceived exertion scale 372
Botulinum toxin 223
Bowel 338, 354
Box and block test 385, 393
Brachioradialis 69
reflex 147, 148f
Bradyarrhythmia 270
Bradycardia, profound 270
Bradykinesia 200, 209, 379
Brain
influence, removal of 213
injury 421
scans 290
Brainstem 77, 125
disorders 270
intact 281f
level reflexes 335
nucleus 54
reflexes 168
Brauch-Romberg sign 230
Breathing, pattern of 278
Broca's aphasia 7
Brudzinski's cheek sign 250
Brudzinski's contralateral leg sign 250
Brudzinski's neck sign 247
Brudzinski's sign 248f
Brudzinski's symphysis sign 250
C
Calf girth 103
measurement 104f
Caloric stimulation 280
Cannon's law 268
Cardiopulmonary function 372
Carotid
baroreceptor 52
sinus reflex 51
Cauda equine 77
Causalgia 125
Central
cord 125
field defect 38
hypoventilation 270
nervous system 48, 49, 238, 253
Cerebellar
ataxia 239
degeneration 229
disease 11, 13, 14, 225
signs of 199
dysfunction 201
function 327
system 338
vestibular nucleus 39
Cerebellum, diseases of 164
Cerebral
artery, middle 77
cortex 217
palsy 238
assessment 328
vein thrombosis 133
Cerebrospinal fluid analysis 290
Cerebrovascular accident 44
Cervical
cord 77
dystonia 52
rigidity 245
spine 79, 82, 133
spondylysis 125
Chaddock sign 180, 180f
Chest girth 101
Chorea 11, 14, 200
Choreoathetosis 200
Chorionic villus sampling 287
Chvostek's sign 249
Cincinnati stroke scale 385
Clasp-knife reaction 106
Clavicle reflex 151
Clonus, demonstration of 60
Cognitive functioning scale, level of 392
Collagen vascular disease 133
Color agnosia 28
Coma 390
causes of 277
deep 162
recovery scale 390
scales 390
Complex multiple tics 224
Consciousness, level of 278
Consensual reflex 36
Constipation 16, 269, 276
Contraction 259
Convergence and facilitation theories 130
Conversion disorder 239
Coordination test 207, 342
Cord, hemisection of 125
Corneal reflex 40, 41f, 282
Corneomandibular
reflex 177
response 177f
Cortical
influence, removal of 213
loss 125
Corticospinal system, lesions of 163
Cough
normal 13
reflexes 282
Cover test 39
Cranial nerve 34, 35, 38, 40, 44, 50, 5255, 365
abnormalities 34, 336
assessment 358
examination 34
observation 321
Creatinine phosphokinase 368
Cremasteric reflex 140, 140f
Cutaneous reflexes, superficial 138
Cutaneous sensory receptors 112
D
Daily living
activities of 361, 374
index, Barthel activities of 420
scale, Schwab and England activities of 381
Dallas pain questionnaire 393
Deafness 7
conductive 46t
Deep sensory receptors, function of 111f
Deep tendon reflexes 143, 171, 326, 334, 341, 353, 360, 364, 367
abnormalities of 158
examination of 159t
Degeneration, reaction of 107
Deltoid reflex 150
Delusions 16
Depression 82, 373, 385
Dermatome 119, 122
hypothesis, common 130
Diabetes mellitus 122, 273
Diffuse cerebral speech 13
Digestive tract 258
Direct reflex 36
Dix-Hallpike test 49f
Dizziness 260
Doll's eye’ reflex 279
Dorsiflex foot 93, 94
Double simultaneous stimulation 117
Duchenne muscular dystrophy 366
Dysarthria 7, 10, 14
ataxic 11
myasthenic 12
rigid 11
spastic 10
types of 10
Dysautonomia 271
Dysdiadochokinesia 208, 340
Dysesthesia 125
Dyskinesias 379
orofacial 227
painful 379
Dysmetria 208, 340
Dysphonia 7, 13, 14
Dysprosodic speech 9
Dyssynergia 209, 340
Dysthyroid eye 35
Dystonia 59, 63, 201, 223
early morning 379
focal 63
oromandibular 223
segmental 63
Dystrophy, facioscapulohumeral 42
E
Ear, external 52
Edelmann great toe phenomenon 250
Edema 322
neurogenic pulmonary 270
Edinger-Westphal nucleus 253
Elbow 81
extension 66, 68, 71
flexion 66, 68, 71, 73, 434
Electroencephalography 293
Electromyography 294, 368
Electronystagmography 295
Emotions 470
Encephalopathy, metabolic 281f
Endocrine 277
Energy 470
Equilibrium coordination tests 207
Erector spinae 89
Erythema 266
Exophthalmos, causes of 35
Extensor carpi ulnaris/radialis 73
Extensor digitorum 68
brevis 72, 79
longus 79
Extensor hallucis longus 72, 79
reflex 157
Extensor synergy 66f, 67f, 360, 424, 430, 449
Extracranial pressure disorders 133
Extrapyramidal system, lesions of 59, 163
Eye
for far vision, adjustment of 259
for near vision, adjustment of 259
movements 226, 321
normal closure of 43f
response 390
Eyeball, muscle producing movement of 40f
F
Facial
expression 321, 376
muscle of 42
myokymia 227
nerve 42, 249f
pain rating scale 135f
palsy 395
paralysis 12
Fainting 261
False Romberg's sign 231
Fast alternating hand movements 404
Fat stores 259
Fatigue 385
severity scale 385, 467
Fatty acids 259
Femoral nerve 71
Fever, rheumatic 223
Fibers 55
Fibrillation, ventricular 270
Fibromyalgia 133
Fine motor development 306, 306f
Finger
abduction 68, 71
strength testing of 70f
agnosia 23, 24f, 31
extension 68, 71
flexion 66, 68, 71
nose test 199, 203, 203f
taps 377
to finger test 199
Flaccid
limb 70
paralysis, acute 364
Flat foot 233
Flexion 70f, 81, 82, 184, 367
abnormal 64f
synergy 65, 66, 360
Flexor 78, 79
carpi ulnaris/radialis 73
digitorum longus and brevis 79
hallucis longus 79
synergy 66f, 67f, 424, 429, 449
Floor reaction force 233
Fluoroscopy 288
Foot
dorsiflexion 72
drop 229
eversion 72
inversion 72
length 100
plantar flexors 93
Forearm
girth 101, 101f
length 96
measurement 97f
pronation 66
supination 66
Fracture 239
Free nerve ending 111, 112
Frontal lesion, unilateral 35
Frontal release signs 171, 327
Fugl-Meyer assessment 385, 423, 424
Fugl-Meyer test 385
Functional
ambulation inventory 370
balance grades 285
exercise capacity 385
independence measure 349, 370, 372, 385
reach test 371, 385, 457
modified 457
Fundoscopy 283
G
Gag reflex 50, 282
Gait 48, 200, 320, 336, 361, 372, 378, 402
abnormal 238
rating scale, modified 337
assessment rating scale 460
cycle 233
disturbances 201, 209
evaluation 327
examination 340
freezing of 348
hyperkinetic 244
index, dynamic 385, 473
level surface 473
myopathic 243
normal 232
pattern 337
phases of 233
physiology of 231
prerequisites of 232
section 418
speed 473
terminology 236
Gastrocnemius 72, 244
length testing of 95f
Gastrointestinal tract 256
Gastronomies 74
Genetic testing 287
Genitourinary autonomic regulation, tests of 268, 269
Genuine stress incontinence 275
Geriatric depression scale 371
Girth examination 365, 367
Glabellar tap 174, 175f
Glasgow coma scale 215, 364, 367, 390
Glossopharyngeal nerve 50
Gluteal
girth measurements 103f
reflex 141, 157
Gluteus
maximus 71, 74, 75
medius 7274
minimus 72
Glycogen stores 259
Glycogenolysis 259
Golgi tendon organ 111
Gowers’ maneuver 397, 398f
Graphesthesia 118
Grasp 167f, 310
Grasset and Gaussel, phenomenon of 198
Gravitational force 233
Gravity, center of 210
Great toe 79
Gross motor development 302, 305f
Guillain-Barré syndrome 270
Guilland's sign 250
H
Hair-follicle ending 112
Hallpike's test 48
Hallucinations 17
Hamilton depression rating scale 385
Hamstrings, length testing of 93f
Hand
length 96
measurement 97f
small muscles of 71
Head 227
extension of 184
girth 100
measurement 100f
injury 390
position, abnormal 52
retraction 175
up tilt table testing 263
Headache 133, 263
Hearing loss, unilateral 44
Heart 258
rate 262
Heavy metal poisoning 225
Heel
knee test 204, 205f
strike 23
to shin test 200
Hemianopia, bitemporal 38
Hemiballismus 200, 223
Hemifacial spasm 227
Hemophilia 239
Hemorrhage 133, 277
subarachnoid 277
Herpetic infection 43
Higher mental functions 15, 323
Hip 367
abductors 72, 90
length testing of 91f, 92f
strength testing of 74f
adductors 72, 91
extension 71
adduction 66
extensor 74
strength testing of 74f
external rotators 93
length testing of 94f
flexor 73, 84, 85f, 92
length testing of 92f
joint 79
Hoehn and Yahr staging, modified 380
Horn cell, anterior 77
Horner's syndrome 35, 270
Hoyne's sign 248
Huntington's chorea 222
Huntington's disease 244, 287
Hydrocephalus 229
Hyperalgesia 125
Hyperextension 367
Hyperkinesia 201
Hyperlordosis 367
Hyperreflexia 156
Hypersomnolence 380
Hypertension
labial 263
paroxysmal 270
severe 133
Hypertonia 59
mild to moderate 59
severe 59
Hypoalgesia 125
Hypoesthesia 126
Hypoglossal nerve 53
Hypokinesia 201, 379
Hypotension, orthostatic 269
Hypothalamic disorders 270
Hypothyroidism 122
Hypotonia 58, 59, 62, 200, 209
I
Iliopsoas 71, 73, 74
Incontinence 274276
Infection 239, 273
Infectious disease 133
Inferior gluteal nerve 71
Inflammation 277
Injury 277
extent of 355
Insomnia 380
Interosseous nerve, posterior 68
Involuntary movements, abnormal 222
Ischemia, cerebrovascular 133
J
Jaw jerk 42, 42f
Joint
integrity 56
mobility 56
movements 81, 82, 83
receptor 111
K
Kernig's sign 246, 247, 247f
Kinesthesia 115
Knee 367
extensors, strength testing of 74f
flexion 66, 72, 74
girth 103
measurements 104f
jerk 152, 160
joint 79
straighten 94
Krause's end-bulb 112
Kurtzke expanded disability status scale 393
Kurtzke functional system scores 393
L
Labyrinthine-righting reflex 216
Landau reflex 183, 184f
Larynx 52
examination of 50
Lasègue sign 247
Latissimus dorsi 66
reflex 151
Leg weakness, unilateral 108
Leminiscal system 112
Levator scapulae 88
length testing of 88f
Libido 16
Lid retraction 35
Limb
ataxia 340
position of 146, 147, 148, 150, 151, 152, 153, 158
voluntary movement of 389
Lip smacking 227
Lipolysis 259
Liver 259
Lomadtse sign 251
Long thoracic nerve 68
Los Angeles prehospital stroke screen 385
Lovett method 75
Lower extremity 66, 325, 385
categories 461
total 455
Lower limb 65, 204
active movement in 80
dermatomes 121f
length 96, 99f
synergy pattern 67f
Lower motor neuron 11, 63, 104, 105, 106f
lesion 107
signs of 107
Lower urinary tract symptoms, irritative 361
Lumbar
puncture 290
spine 82
Lumbosacral radiculopathy 244
Lungs 258
M
Magnetic resonance imaging 296
Mandibular lower lip 40
Manual muscle testing 52, 69, 75, 76
chart 78t
Masseter, palpation of 41f
Maxillary cheek 40
McGill pain questionnaire 371, 410
Median nerve 68, 159
Medical Research Council Scale 73t
Medulla reflexes 214
Meissner's corpuscle 112
Memory 18, 357
Meningeal irritation 247f
signs of 245
Meningism 245, 277
Meningoencephalitis 277
Mental state 15, 16
examination 16
Merkel's disks 112
Metabolic disease 133
Micturition, process of 273
Mid arm girth 101, 101f
Mini-mental state examination 371, 385, 406
Monotonus speech 14
Moro reflex 182, 183f, 335
Motor
aphasia 7
assessment 340, 360
examination 376
function 56, 385, 454
assessments 346
examination of 56
neuron disease 11, 44, 52
program 56
recovery, stages of 70t
responses 282, 391
sensory link 138
system examination 56, 107
Mouth, twisting of 227
Movement combining synergies 449
Multidimensional scales 136
Multidirectional reach test 371
Multiple sclerosis 11, 34, 125, 225, 238, 393
functional composite 393
quality 393
Multiple single nerve lesions 122
Multiple system atrophy 269
Muscle 11, 71, 77
activation deficits 69, 76
antigravity 212
biopsy 368
flickering of 227
group 73, 78
intermittent spasm of 227
length
assessment technique 83
testing 86t
lower-quarter 84
observation 325
power 364, 367
grade 78
receptor 111
spindles 111
stretch reflexes 158, 326
tone 364, 367
wasting of 42, 320, 367
Muscular force 233
Myasthenia gravis 35, 44
Myelitis, transverse 125
Myelography 297
Myoclonus 14, 224
Myofascial disorders 133
Myositis 239
Myotomes 71t, 73t
Myotonic disorders 162
N
Narcosis 162
Nasolabial folds 43
National Institutes of Health Stroke Scale 385
Nausea 261
Near vision chart 37
Neck
extensors 74, 79
flexors 73, 74, 79
girth 100
measurements 100f
Nerve 71
conduction velocity test 294, 369
musculocutaneous 159
palsy 35
Neurogenic bladder
hyperactive 274
types of 273
Neurological diagnostic test 286
Neurology, cardinal rule of 213
Neuromas 131
Neuromuscular
function, normal 59
integrity 59
junction 77
Neuropathy, diabetic 162
Neurosonography 300
Nonequilibrium coordination tests 206
Norepinephrine 257
Nose-finger test 404
Nuchal rigidity 245
Nystagmus 48, 49, 199
downbeating 49
fatigable 49
upbeating 49
O
Obturator nerve 72, 155
Occipitocervical junction disorders 133
Olfactory nerve 34
Ophthalmoplegia, bilateral internuclear 281f
Opisthotonus 65
posture 65f
Optic 36
nerve 35
Optical righting
reaction 187, 188f
reflex 217
Orbicularis oculi reflex 174, 174f
Organ failures 277
Orthostasis 380
Oxford method 75
P
Pacinian corpuscle 111, 112
Pain 114, 126, 393, 470
acute 131
assessment 134, 136, 318
chronic 131
classification of 126
deep 127
neuropathic 128
peripheral 126
psychosomatic 129
referred 129
scales 135
somatic 126, 127
thalamic 128
visceral 127
Palatal paralysis 12
Palate, muscle of 52
Pallanesthesia 126
Pallor 263, 269
Palmar
grasp 167f, 171, 172f
reflex 335
interosseous 68
reflex 138
Palmomental reflex 173f
Papilloedema 283
Paralysis
emotional 44
periodic 161
progression of 364
Paraphasia 9
Paresis 76
Paresthesia 126
Parkinson's disease 63, 64, 182, 287, 342, 371, 372
questionnaire 372
Parkinsonian gait 242
Parotid
gland 42
tumors 44
Paroxysmal positional vertigo, benign 48
Passively raise test leg 93
Patellar 160
clonus, checking of 61f
reflex 152, 153f
Pectoralis major 88
length testing of 89f
Pectoralis reflex 150, 150f
Pendular reflex 170
Peripheral nerve 124
deep 72
injury 368
lesion 161
palsy 229
superficial 72
Peroneal reflex 158
Peroneus
brevis 72
longus 72
Persistent urinary incontinence, structural causes of 275t
Phantom pain 131
Pharynx 52
examination of 51
Phasic postural reflexes 210
Plantar
flexion 72, 79
grasp 167f
muscle reflexes 158
reflex 141
response
abnormal 141f
normal 141f
warts 238
Plexus 77
Poliomyelitis 363
Polyneuropathy 77
Polysomnogram 299
Porphyria 270
Positron emission tomography 129, 298
Postural tremor 225, 376
Posture, functions of 210
Prehospital stroke assessment tools 385
Pressure 115
sores, site of 354
ulcers 238
Primitive reflexes, examination of 165t
Pronator reflex 151
Prosopagnosia 28
Prostatic hyperplasia, benign 273
Pseudo-bulbar palsy 11, 44
Psychogenic disorders 163
Psychological disorder 239
Ptosis, causes of 35
Pupil
constriction of 259
dilation of 259
Pupillary light reaction 36
Pursuit eye movement 39
Pyramidal system, lesions of 163
Q
Quadratus lumborum 89
length testing of 90f
Quadriceps 160
femoris 71, 73
muscle 244
reflex 152
Quadriplegic index 370
R
Radial nerve 69, 159
Raimiste leg sign 197
Ramsay Hunt syndrome 43
Ranchos los amigos scale 392
Rand 36-item health survey 372
Receptors, types of 110f
Reflex 217
abdominal 139f, 142
activity, normal 451
assessment 341, 353, 360
center 140, 141, 150, 151, 157, 158
deep 164
dynamic 216
exaggerated 145, 147, 154, 156
hyperactivity 162
hypoactive 161
integrity 138
interscapular 138
midbrain
level 335
righting 216
myotactic 159, 160
neck righting 216
normal 427, 433
oculocardiac 51
oculocephalic 279
oculovestibular 279, 280
pathologic 170, 178, 342, 360
postural 211f
righting 180, 182, 212
rooting 335
scapulohumeral 149, 149f
spread 145, 155, 169
superficial 138, 140, 142, 143, 334, 341, 353, 360
Respiratory
abnormalities 270
dysfunction 354
examination 353
insufficiency 365, 368
muscle 368
Rhomboids 69
Riddoch's test 340
Rinne's test 44, 45f, 46t
Romberg sign 230, 342
use of 231
Root 71
innervations 71t, 73t
Ruffini ending 11, 112
S
Saccadic eye movements 38
Sarcoidosis 44
Scalene 73
Scapula, retraction of 69
Scapular
elevation 66
protraction 66
retraction 66
Schirmer's test 268
Schrijver-Bernhard reflex 251
Schultz's sign 249
Sciatic nerve 72
Scoliosis 367
Scotoma 38
Seizures 269, 277, 336
Sensation 365
deep 109, 115, 327
gradation of 119
superficial 109, 114
visceral 126
Sense of smell, loss of 35
Sensorineural loss 46
Sensory 40
aphasia 8
assessment 109, 341
ataxia 240
integrative approach 32
loss
patterns of 122, 123f
thalamic 125
motor approach 23, 30
nerves 271
pathway 113f
receptor
classification of 110
deep 111t
signals, transmission of 113t
system, classification of 109
testing 351
Serratus anterior 66, 68
Sexual function 276
Shin splints 239
Shoulder 78, 81
abduction 66, 68, 71, 73
strength testing of 70
adduction 66
elevators 73
observation 322
Sickness impact profile 372
Simple body agnosia 22
Simultanagnosia 28
Single nerve root 77
Single photon emission computed tomography 299
Sinus
arrest 270
tachycardia 270
Sinusitis 133
Six-minute walk test 372, 385
Skew deviation 279
Skin response 266
Sleep disturbance 16
Slow relaxing reflex 170
Small muscles, grading of 76
Snellen's chart 37
Soderbergh pressure reflex 251
Soleus
length testing of 95f
muscles 244
Somatoagnosia 22, 31
Somatosensory evoked potentials 296
Spasmodic torticollis 224
Spastic hemiparesis, gait of 241
Spasticity 60, 393
Spatial relation 25, 31
disorders 24, 358
Speech 7, 336, 374, 376
disorder of 13
disturbance 403
emotional component of 9
hiccup 14
slurred 13
spontaneous 9
staccato 14
Spinal
accessory nerve 52
cord 212
abnormalities 238
injury 273, 349, 370
reflex 214
tumors 273
level reflexes 335
reflexes 165
syndrome, anterior 125
tap 290
Spine 367
Spinothalamic tract 112
Static postural reflexes 210, 212
Stereognosis 116
Sternocleidomastoid 52, 73, 87
fasciculation of 52
hypertrophy of 52
wasting of 52
Stimulation, two points of 249
Stimulus 140142, 149, 150, 171, 184
Stretch reflex 214
Stroke 277
assessment format 356
impact scale 385
rehabilitation assessment of movement 385, 386
scales 385
specific quality of life scale 385
Strümpell, tibialis sign of 196
Sucking reflex 335
Superficial reflexes, examination of 142t
Superior gluteal nerve 72, 157
Supination 78, 81
Suprascapular nerve 69
Supraspinatus 69
Swallowing 374
Sweat imprint test 267
Sweating 260, 263, 269, 322
Swinging light test 36
Sydenham's chorea 222, 244
Symmetrical tonic
labyrinthine 168
neck 168
reflex 184, 185f
Sympathetic skin responses 266, 267
Syncope, neurocardiogenic 264
Synergy, movement out of 426, 432, 450
Syphilis 273
Syringomyelia 125
T
Tachyarrhythmias, ventricular 270
Tachycardia 263
Tactile
agnosia 28
localization 116
object recognition 116
Tardive dyskinesia 224
Ten meter walk test 372
Tendonitis 239
Tensor fascia lata reflex 157
Teres major 66
Terson syndrome 283
Thalamic syndrome 126
Therapist's
appearance 3
grasping 148
task 3
Therapy, complications of 379
Thermalgesia 126
Thermanesthesia 126
Thermhyperesthesia 126
Thermography 300
Thermoreceptors 110
Thermoregulatory sweat test 266, 267
Thomas test, modified 84, 85f
Thoracic cord 77
Thoracolumbar spine 79, 82
Thought disorder 373
Thumb
abduction 68
extension 71
reflex 152
Thyrotoxicosis 225
Tibial
length measurements 99
nerve 72, 158
Tibialis
anterior 72, 73
reflex 158
posterior 72
reflex 158
Tics 224
Tinetti assessment tool 393, 417
Tinetti's performance-oriented mobility assessment 371
Toe
dorsiflexion 66
extension of 72
flexion, normal 106f
plantar flexion 66
Tone
dynamic evaluation of 57
static evaluation of 57
Tonic
deviation 279
labyrinthine
prone reflex 186f
supine reflex 186f
neck
asymmetrical 168, 185f
reflex 183, 184, 194, 214, 215f
plantar reflex 251
reflexes 164, 168
examination of 168t
Total sensation score 456
Toxic exposures 133
Toxins 277
Traction reflex 167f
Training approach, transfer of 23, 28, 31
Transcortical
motor aphasia 8
sensory aphasia 8
Transcranial Doppler ultrasound 300
Trapezius 52, 73
Trauma 35, 133, 238
Tremor 200, 209, 225, 227, 340, 346, 376
symptomatic complaint of 376
Triceps
associated contralateral contraction of 197
reflex 146, 147f
strength testing of 70f
surae reflex 154
Trigeminal nerve 40
over face 41f
Tripod sign 248
Trousseau's sign 251, 252f
True leg length discrepancy 98, 98f
Trunk
extensors 79
flexors 79
girth 101
Tubular vision 38
Tumor 11, 277
Turning test 50
Twelve minute walk test 372
Two points discrimination 117
Tympanic membrane 52
U
Ulnar
deviation 81
nerves 68
Upper
arm length 96
measurement 97f
brainstem tumor 11
extremity 66, 325
function 385
limb 65
active movement in 80
dermatomes 121f
girth 101, 101f
length 95
synergy pattern 66f
motor neuron 52, 59, 104, 106f
lesion 105, 107
unilateral 44
trapezius 87
Urge incontinence 274
Urinary
bladder 259
incontinence 269
Urination, frequency of 275
Uterine ultrasound 287
V
Vagus nerve 52
stimulation of 260
Valsalva maneuver 264
Vascular autonomic regulation 262
Vasculitis 133
Vasovagal
reflex 260
syncope 261
Vertical ground reaction force 347
Vestibular system 32
Vestibulocochlear nerve 44
Vestibulo-ocular reflex 39, 40
Vision 15, 336
Visual
analog fatigue scale 467
evoked potentials 296
field, normal 27f
motor development 306
Vital signs 317
Vomiting 270
intractable 270
reflex 51
W
Waddling gait 243
Waist girth measurement 103f
Walkie-talkie test 372
Walking velocity 237
Wartenberg's sign 148f, 196
Weber's test 44, 46, 46t, 47f
Weight
gain 16
loss 16
Wernicke's aphasia 8
Western neurosensory stimulation profile 390
Wheelchair skills test 370
Wilson's disease 63
Withdrawal syndromes 133
Wolf motor function test 385
Wrist 67, 78, 81, 451
extension 71, 73
reflex 152
flexion 66, 71, 73
reflex 152
girth 101, 101f
Writer's cramp 223
Y
Yawning 51
Z
Zygomatic arch 249f
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Chapter Notes

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History1

 
STRUCTURE AND PURPOSE OF HEALTH HISTORY
  • Purpose of interview is to gather information from the patient.
  • To establish trusting and supporting relationship with the patient.
  • To offer information and counseling.
  • Identifying data:
    • Such as age, birthplace, occupation
    • It will give you basic information about the person and what the likely problem might be.
  • Source of referral:
    • It helps in understanding the patient's possible motivation.
    • Introductory information also includes the date and in rapidly changing circumstances the time.
    • The source of history whether it be the patient, family, friends.
    • A letter of referral or the past medical record also deserves comment. It helps the therapist to assess the value and possible biases of information.
  • Chief complaints:
    • These are one or more symptoms or other concerns for which the patient is seeking care or advice.
    • Use simple words in patient's own language.
    • Main aim of asking is to make the patient independent in his day-to-day life and hence chief complaints are given as inability to eat, difficulty in dressing, difficulty in walking.
    • Complaints will consist of the ultimate outcome of all abnormality.
    • Nothing can give more pleasure to the patient than getting rid of the chief complaints.
    • Complete relief from chief complaint is main aim of any intervention towards which whole assessment gets directed.
  • Present illness:
    • It includes how the patient thinks and feels about the illness.
    • How the illness has affected the patient's daily life and function.2
  • Past history:
    • Patient's childhood illness and any history of adult medical illness.
    • It includes previously done surgeries, obstetric or gynecologic events, psychiatric condition, accidents and injuries, transfusions, etc.
  • Health maintenance:
    • Includes immunizations and screening, examinations, lifestyle issues and safety practices.
  • Family history:
    • Helps to assess the patient's risk of developing certain diseases and may also suggest family experiences relevant to the patient's concern.
    • Many neurological problems have genetic basis so a detailed family history is very important in making the diagnosis.
  • Personal and social history:
    • It suggests contributory factors in patient's illness and helps the therapist to evaluate the patient's source of support, likely reaction to illness, coping mechanism, strength and fears.
    • For these, the environment in which the patient normally lives, his/her financial circumstances, family and carers in the community, are all important to the current and future care.
  • Review of the systems:
    • Therapist should ask for common symptoms in each major body system and, thus, try to identify problems that the patient has not mentioned.
    • A fairly general question that introduces each system or subsystem is helpful, e.g.
      • How are your ears and hearing?
      • How about your lungs and breathing?
      • Any trouble with your heart?
      • How is your digestion?
 
IMPORTANT CONSIDERATIONS DURING INTERVIEW
Things to be considered before beginning the interview:
  • Reviewing the chart:
    • Medical chart may give you valuable information about past diagnosis and treatment.
    • Therapist should look at identifying data, the problems list, medication list and other specific detail such as documentation of allergies.3
  • Therapist's task:
    • Therapist must clarify goals for the interview.
  • Therapist's behavior:
    • Just as therapist observe the patient throughout the interview, the patient could be watching the therapist. Therapist send message through her words and behavior.
    • Posture, gesture, eye contact and words can all express interest, acceptance, attention and understanding.
    • Negative reaction such as this is normal and undustable, should not be expressed. Guard against them not only when talking with the patient but also when discussing the patient with the colleagues in the hall or at other public place.
  • Therapist's appearance: Cleanliness, neatness, conservative dress and a name tag are necessary to the patient.
  • Note taking: Note taking should not divert therapist's attention from the patient. When patient is talking about sensitive or disturbing material put your pen down and, especially be aware of maintaining eye contact.
  • The environment: As private and, comfortable as possible.
 
THE STAGES OF INTERVIEW
  • Greeting the patient and establishing rapport.
  • Inviting patient story.
  • Establishing agenda for interview.
  • Generating and testing hypothesis about nature of problem by expanding and clarifying the patient's story.
  • Creating shared understanding of problem.
  • Negotiating a plan of further diagnostic evaluation, treatment and patient education.
  • Planning for follow-up and closing interview.
 
KEY POINTS WHILE TAKING HISTORY
  • Ask open-ended question like what concerns bring you here today?
  • How can I help you?
  • At the initial part of the interview using responses called continue works best. They include nonverbal cues such as head nodding and verbal phrases such as go on or I see.
  • Question should proceed from general to specific.4
  • Use the language that is uneatable and appropriate to the patient.
  • In general, an interview moves back and forth from open-ended question to direct question and then onto another question.
 
ATTRIBUTES OF SYMPTOM
  • Location
Where is it? Does it radiate?
  • Its quality
What is it like?
  • Its quantity or severity
How bad is it?
  • Its timing
When did it start? How long does it last?
  • The setting in which it occurs, including environmental factors, personal activities, emotional reactions or other circumstances that may have contributed to the illness.
  • Factors that make it better or worse.
  • Associated manifestation.
 
ELICITING THE PATIENT'S PERSPECTIVE
  • Patient's thoughts about the nature and cause of problem.
  • Patient's feeling about the problem especially fear.
  • Patient's expectation.
  • Effect of problem on patient's life.
  • Similar experiences in patient's personal or family history.
  • Any step that the patient has taken to address the problem.
 
SOAP PROTOCOL FOR ASSESSMENT
The SOAP note (an acronym for Subjective, Objective, Assessment, and Plan) is a method of documentation employed by healthcare providers to write out notes in a patient's chart, along with other common formats, such as the admission note.
  • Subjective component:
    • Initially, it is the patient's chief complaint. This is a very brief statement of the patient (quoted) as to the purpose of the office visit or hospitalization.5
    • If this is the first time a therapist is seeing a patient, the therapist will take a history of present illness. This describes the patient's current condition in the narrative form.
    • The history or states of experienced symptoms is/are recorded in the patient's own words. All information pertaining to subjective information is communicated to the healthcare provider by the patient or his/her representative.
    • It will include all pertinent and negative symptoms under review of body systems. Pertinent medical history, surgical history, family history, and social history, along with the current medications, smoking status, drug/alcohol/caffeine use, level of physical activity and allergies, are also recorded.
      A SAMPLE history is one method of obtaining this information from a patient.
      Subsequent visits for the same problem briefly summarize the history of present illness (HPI), including pertinent testing, results, referrals, treatments, outcomes and follow-ups.
      The mnemonic below refers to the information a physician should elicit before referring to the patient's ‘old charts’ or ‘old carts’.
    • Onset, Location, Duration, Character (sharp, dull)
    • Alleviating/aggravating factors
    • Radiation
    • Location onset (when and mechanism of injury—if applicable) Chronology (better or worse since onset, episodic, variable, constant, etc.), Quality (sharp, dull)
    • Severity:
      • Modifying factors (what aggravates/reduces the symptoms—activities, postures, drugs, etc.). Additional symptoms (unrelated or significant symptoms to the chief complaint). Treatment (has the patient seen another provider for this symptom?)
  • Objective components:
    • The objective section of the SOAP includes information that the healthcare provider observes or measures from the patient's current presentation. The objective component includes: vital signs and measurements, such as weight.
    • Findings from physical examinations, including basic cardiac and respiratory systems, the affected systems, possible involvement of other systems, pertinent normal findings and abnormalities.6
    • Results from laboratory and other diagnostic tests already completed.
    • Medication list obtained from pharmacy or medical record.
  • Assessment:
    • A medical diagnosis for the purpose of the medical visit on the given date of the note written is a quick summary of the patient with main symptoms/diagnosis, including a differential diagnosis, a list of other possible diagnoses usually in order of most likely to least likely.
    • The assessment will also include possible and likely etiologies of the patient's problem. It is the patient's progress since the last visit, and overall progress towards the patient's goal from the physician's perspective.
    • In a pharmacist's SOAP note, the assessment will identify what the drug-related/induced problem is likely to be and the reasoning/evidence behind it.
    • This will include etiology and risk factors, assessments of the need for therapy, current therapy, and therapy options. When used in a problem-oriented medical record, relevant problem numbers or headings are included as subheadings in the assessment.
  • Plan:
    • The plan is what the healthcare provider will do to treat the patient's concerns, such as ordering further lab, radiological work up, referrals given, procedures performed, medications given and education provided.
    • The plan will also include goals of therapy and patient-specific drug and disease-state monitoring parameters. This should address each item of the differential diagnosis.
    • For patients who have multiple health problems that are addressed in the SOAP note, a plan is developed for each problem and is numbered accordingly, based on severity and urgency for a therapy.
    • A note of what was discussed or advised with the patient as well as timings for further review or follow-up are generally included.
    • Often the assessment and plan sections are grouped together.