Neurology

Neuro was one of the more difficult subjects for me to grasp as a new therapist. One thing I found that helped was to start with a comprehensive checklist of focal deficits to check during an evaluation. It helped me not to miss anything and helped my evaluations looks more comprehensive. As with everything on this site, this is meant to be a quick guide for you and not something overwhelming. Over time, you might find yourself interested in getting down to the nitty gritty details.

Charting

BP parameters - generally stroke patients have permissive hypertension and hemorrhage patients have to stay under a certain systolic blood pressure Lines: CSF drain/lumbar drains need to be clamped before moving

General Neuro Evaluation

R and L strength differences Sensation (numbness, tingling) Fine motor coordination - touch your thumb to each finger Lower extremity coordination - rub your heel against your shin Sitting and standing balance (watch out for pushers syndrome) Vision - diplopia, hemianopsia, field cuts Diadochokinesia - flipping hand palm up/ palm down as fast as you can Cognition - alert and oriented to name, place, date, reason for hospitalization, name the months of the year backwards Spasticity evaluation - quickly flex and extend supported elbow joint. Any resistance or involuntary movement? Neglect - tends to not pay attention to one side

Basic Concepts to know

• The side of the body that is impacted is usually the opposite side of the stroke or hemorrhage. For example, if the stroke is on the R, the L side of the body will usually have the issues
• Behaviorally, patients with R side strokes are more impulsive. Patients with L side strokes are more anxious.
• Areas of the brain and what may be affected in addition to motor control:
  • Frontal - cognition
  • Parietal/temporal - hearing, language (trouble with comprehension and/or speaking)
  • Occipital - vision
  • Cerebellar strokes - 3 Ds: Diplopia, dysdiadochokinesia, dysmetria
  • Pons - balance