Tendon hammer
Neurotip
Cotton wool
Tuning fork (128Hz)
| Подготовьте оборудование
Неврологический молоточек
Нейротип
Вата
Камертон (128Hz)
|
Құрал-жабдықтарды дайындаңыз
Неврологиялық балғашық
Нейротип
Мақта
Камертон (128Hz)
|
Inspection
Observe for clues around the bed – walking stick / wheelchair
General appearance – any limb deformity or posturing?
Scars
Wasting of muscles
Involuntary movements – dystonia/chorea/myoclonus
Fasciculation – lower motor neurone lesions
Tremor – Parkinson’s
| Осмотр
Обратите внимание на прикроватные предметы– трость /инвалидная коляска
Общий вид – любая деформация или патологическое положение конечности?
Шрамы
Атрофия
Насильственные движения – дистония/хорея/миоклонус
Фасцикуляции – поражение нижнего моторного нейрона
Tремор – паркинсонизм
|
Жалпы қарау
Науқас төсегінің маңайындағы қосымшаларды бақылаңыз- мүгедектік арба, таяқ, зәр шығару катетері
Жалпы қалпы- қолдың кезкелген деформациясы немесе патологиялық қалпы?
Тыртықтар
Бұлшық ет атрофиясы
Еріктен тыс қозғалыстар- дистония /хорея / миоклонус
Фaсцикуляциялар
Tремор – Паркинсон ауруы
|
Gait
1. Ask the patient to walk to the end of the room and back – assess posture, arm swing, stride length, base, speed, symmetry, balance and for abnormal movements.
Some common types of gait abnormality to observe for:
Ataxic: broad-based and unsteady. As if drunk. From cerebellar pathology or a sensory ataxia. Often won’t be able to tandem gait either. With a sensory ataxia, the patients watch their feet intently to compensate for proprioceptive loss. In a cerebellar lesion, may veer to one side.
Parkinsonian: small, shuffling steps, stooped posture and reduced arm swing (initially unilateral). Several steps taken to turn. Appears rushed (festinating) and may get stuck (freeze). Hand tremor may be noticeable.
High-stepping: (either unilateral or bilateral) caused by foot drop (weakness of ankle dorsiflexion). Also won’t be able to walk on their heel(s).
Waddling gait: shoulders sway from side to side, legs lifted off ground with the aid of tilting the trunk. Caused by proximal lower limb weakness, e.g. myopathy.
Hemiparetic: one leg held stiffly and swings round in an arc with each stride (circumduction).
Spastic paraparesis: similar to above but bilateral – both are stiff and circumducting. Feet may be inverted and “scissor”.
2. Tandem (heel-to-toe) gait – ask to walk in a straight line heel-to-toe – an abnormal heel-to-toe test may suggest weakness, impaired proprioception or a cerebellar disorder
3. Heel walking – assesses dorsiflexion power
| |
