assessing the neurologic status, including cranial nerves assessment. DTR (deep tendon reflexes)

1. Neurologic Assessment
Maria Carmela L. Domocmat, RN, MSN
Instructor, Nursing Health Assessment
School of Nursing
Northern Luzon Adventist College

2. Nervous System Anatomy: Review
6/26/2011 2
Maria Carmela L. Domocmat, RN, MSN

3. http://sciencecity.oupchina.com.hk/biology/student/glossary/img/peripheral_nervous_system.jpg
6/26/2011 3
Maria Carmela L. Domocmat, RN, MSN

4. 6/26/2011 4
Maria Carmela L. Domocmat, RN, MSN

5. 6/26/2011 5
Maria Carmela L. Domocmat, RN, MSN

6. 6/26/2011 6
Maria Carmela L. Domocmat, RN, MSN

7. The right cerebral hemisphere controls movement of the left side of
the body.
6/26/2011 7
Maria Carmela L. Domocmat, RN, MSN

8. 6/26/2011 8
Maria Carmela L. Domocmat, RN, MSN

9. The cerebellum processes input from other areas of the brain, spinal cord
and sensory receptors to provide precise timing for coordinated, smooth
movements of the skeletal muscular system. A stroke affecting the
cerebellum may cause dizziness, nausea, balance and coordination
problems.
http://health.allrefer.com/pictures-images/cerebellum-function.html
6/26/2011 9
Maria Carmela L. Domocmat, RN, MSN

10. 6/26/2011 10
Maria Carmela L. Domocmat, RN, MSN

11. 6/26/2011 11
Maria Carmela L. Domocmat, RN, MSN

12. Neurologic Assessment:
OVERVIEW

13. Neurologic System Assessment
Organized into 5 major areas:
1. Mental Status
2. Cranial Nerves
3. Sensory System
4. Motor System & Cerebellar
5. Reflexes
6/26/2011 13
Maria Carmela L. Domocmat, RN, MSN

14. Mental Status and Level of
Consciousness
Observe the following:
• LOC
• posture and body movements
• dress, grooming and hygiene
• facial expression
• speech
• mood, feelings, and expressions
• thought processes and perceptions
• cognitive abilities
6/26/2011 14
Maria Carmela L. Domocmat, RN, MSN

15. Cranial Nerves
• I (olfactory)
• II (optic)
• III (oculomotor), IV (trochlear), VI (abducens)
• V (trigeminal)
• VII (facial)
• VIII acoustic/vestibulocochlear)
• IX (glossopharyngeal), X (vagus)
• XI (spinal accessory)
• XII (hypoglossal)
6/26/2011 15
Maria Carmela L. Domocmat, RN, MSN

16. Motor and cerebellar systems
assess condition and movement of muscles
evaluate balance
assess coordination
6/26/2011 16
Maria Carmela L. Domocmat, RN, MSN

17. Sensory Systems
• assess light touch, pain, and temperature
sensations
• test vibratory sensations
• sensitivity to position
• tactile discrimination (fine touch)
6/26/2011 17
Maria Carmela L. Domocmat, RN, MSN

18. Reflexes
• deep tendon
reflexes • superficial
o biceps reflexes
o brachioradialis o plantar
o triceps o abdominal reflex
o patellar o cremasteric
• Achilles reflex
6/26/2011 18
Maria Carmela L. Domocmat, RN, MSN

19. Tests for meningeal irritation or
inflammation
• Neck mobility
• Brudzinski’s sign
• Kernig’s sign
6/26/2011 19
Maria Carmela L. Domocmat, RN, MSN

20. MENTAL STATUS AND
LEVEL OF
CONSCIOUSNESS
6/26/2011 20
Maria Carmela L. Domocmat, RN, MSN

21. Observe the following
• LOC
• posture and body movements
• dress, grooming and hygiene
• facial expression
• speech
• mood, feelings, and expressions
• thought processes and perceptions
• cognitive abilities
6/26/2011 21
Maria Carmela L. Domocmat, RN, MSN

22. 6/26/2011 22
Maria Carmela L. Domocmat, RN, MSN

23. 6/26/2011 23
Maria Carmela L. Domocmat, RN, MSN

24. • Decorticate posture is • Decerebrate posture is an
an abnormal posturing that abnormal body posture that
involves involves
• rigidity, flexion of the arms, • arms and legs being held
• clenched fists, straight out,
• extended legs (held out • toes being pointed
straight). downward,
• arms are bent inward toward • head and neck being arched
the body backwards.
• wrists and fingers bent and • muscles are tightened and
held on the chest. held rigidly.
http://www.nlm.nih.gov/medlineplus/ency/article/003300.htm
6/26/2011 24
Maria Carmela L. Domocmat, RN, MSN

25. 6/26/2011 http://drugster.info/img/ail/938_943_1.png 25
Maria Carmela L. Domocmat, RN, MSN

26. 6/26/2011 http://loyaldavis.com/images/dec_1.jpg 26
Maria Carmela L. Domocmat, RN, MSN

27. For children under 5, the verbal response
criteria are adjusted as follow
SCORE 2 to 5 YRS 0 TO 23 Mos.
5 Appropriate words or phrases Smiles or coos appropriately
4 Inappropriate words Cries and consolable
Persistent inappropriate crying
3 Persistent cries and/or screams
&/or screaming
2 Grunts Grunts or is agitated or restless
1 No response No response
http://www.unc.edu/~rowlett/units/scales/glasgow.htm
6/26/2011 27
Maria Carmela L. Domocmat, RN, MSN

28. CRANIAL NERVES
6/26/2011 28
Maria Carmela L. Domocmat, RN, MSN

29. I (olfactory)
o abnormal finding:
inability to smell : neurogenic anosmia, olfactory
tract lesion, tumor or lesion of frontal lobe
loss of smell: congenital, nasal dse, smoking, use
of cocaine
6/26/2011 29
Maria Carmela L. Domocmat, RN, MSN

30. CN II (optic)
o visual acuity – both far and near
o confrontation test
o asses retina using ophthalmoscope
o OD – R eye; OS – L eye; OU - both eyes
6/26/2011 30
Maria Carmela L. Domocmat, RN, MSN

31. CN II (optic)
o normal finding:
round red reflex
optic disc – 1.5 mm; round or slightly oval; well-
defined margins,creamy pink
paler physiologic cup
retina – pink
6/26/2011 31
Maria Carmela L. Domocmat, RN, MSN

32. CN II (optic)
o abnormal finding:
blurred optic disc margins; dilated, pulsating veins
- Papilledema (swelling of optic nerve) – due to
increased ICP from tumor or hemorrhage
optic atrophy – brain tumors
6/26/2011 32
Maria Carmela L. Domocmat, RN, MSN

33. III (oculomotor), IV (trochlear), VI
(abducens)
o (a) inspect margin of eyelids
o (b) extraocular muscles
o (c) pupillary response to light
6/26/2011 33
Maria Carmela L. Domocmat, RN, MSN

34. CN III, IV, VI
o normal finding:
(a) eyelid covers abt 2 mm of iris
(b) eyes move smooth, coordinated motion in all
directions
(c) bilateral constriction
6/26/2011 34
Maria Carmela L. Domocmat, RN, MSN

35. CN III, IV, VI
o abnormal finding:
(a) ptosis (drooping of eyelids) – myasthenia
gravis
(b) abnormal eye movements
• nystagmus (rhythmic oscillation of the eyes) -
cerebellar disorder
• limited eye movement – increased ICP
• paralytic strabismus – paralysis of oculomotor, trochlear
or abducens nerves
6/26/2011 35
Maria Carmela L. Domocmat, RN, MSN

36. Nystagmus video
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 36

37. CN III, IV, VI
(c) dilated pupil (6-7 mm) – oculomotor
nerve paralysis
Argyll Robertson pupils – CNS syphilis,
meningitis, brain tumor, alcoholism
6/26/2011 37
Maria Carmela L. Domocmat, RN, MSN

38. Argyll Robertson pupils
6/26/2011 38
Maria Carmela L. Domocmat, RN, MSN

39. CN III, IV, VI
constricted, fixed pupils – narcotics abuse, damage
to pons
unilaterally dilated pupil unresponsive to light or
accommodation – damage to CN III
constricted pupil unresponsive to light or
accommodation – lesions of the SNS (sympathetic
nervous sys)
6/26/2011 39
Maria Carmela L. Domocmat, RN, MSN

40. CN V (trigeminal)
o motor function
o sensory function :
6/26/2011 40
Maria Carmela L. Domocmat, RN, MSN

41. CN V (trigeminal)
o motor function
temporal and master muscles contraction
(Note: may be difficult to perform and evaluate
in client without teeth)
6/26/2011 41
Maria Carmela L. Domocmat, RN, MSN

42. CN V (trigeminal)
o sensory function :
sharp or dull sensation and light touch on
forehead, chin and cheeks
• safety pin, paper clip, or cut tongue depressor; wisp
of cotton
corneal reflex (blinking reflex)
(Note: may be absent or reduced in clients who
wear contact lenses)
6/26/2011 42
Maria Carmela L. Domocmat, RN, MSN

43. Corneal refle
6/26/2011 43
Maria Carmela L. Domocmat, RN, MSN

44. CN V
o normal finding:
temporal and masseter muscles contract bilaterally
correctly identifies sharp or dull, light touch
6/26/2011 44
Maria Carmela L. Domocmat, RN, MSN

45. CN V
o abnormal finding:
inability to identify – lesions in trigeminal nerve,
lesions in spinothalamic tract or posterior columns
absent corneal reflex – lesions of CN V, lesions of
motor part of CN VII
6/26/2011 45
Maria Carmela L. Domocmat, RN, MSN

46. CN VII (facial)
o motor function
o sensory function
6/26/2011 46
Maria Carmela L. Domocmat, RN, MSN

47. CN VII (facial)
o motor function
smile, frown, wrinkle forehead, show teeth, puff out
cheeks, purse lips, raise eyebrows, close eyes tightly
against resistance
6/26/2011 47
Maria Carmela L. Domocmat, RN, MSN

48. CN VII (facial)
o sensory function
taste test – anterior 2/3 of tongue – salt, sugar, or
lemon juice
6/26/2011 48
Maria Carmela L. Domocmat, RN, MSN

49. CN VII
o abnormal finding:
inability to close eyes, wrinkle forehead, or raise
forehead along with paralysis of lower part of face
on affected side – Bell’s palsy (peripheral injury to
CN VII)
paralysis of lower part of face on opposite side
affected - central lesions that affects the upper
motor neurons ex: CVA
6/26/2011 49
Maria Carmela L. Domocmat, RN, MSN

50. Bell’s palsy
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 50

51. CN VIII acoustic/vestibulocochlear)
o hearing: acoustic/ cochlear
Whisper, Weber, Rinne tests
balance: vestibular
6/26/2011 51
Maria Carmela L. Domocmat, RN, MSN

52. CN VIII
o abnormal finding:
vibratory sound lateralizes to good ear –
sensorineural loss
AC is greater than BC but not twice as long
6/26/2011 52
Maria Carmela L. Domocmat, RN, MSN

53. CN IX (glossopharyngeal),
CN X (Vagus)
uvula and soft palate
gag reflex
ability to swallow
6/26/2011 53
Maria Carmela L. Domocmat, RN, MSN

54. CN IX & X
o abnormal finding:
soft palate does not rise – bilateral lesion of CN X
unilateral rising of soft palate, deviation of uvula to
normal side –unilateral lesion CN X
dysphagia or hoarseness – lesion CN IX or X
6/26/2011 54
Maria Carmela L. Domocmat, RN, MSN

55. CN XI (spinal accessory)
o trapezius muscle - shrug shoulders against
resistance
o sternocleidomuscle – turn head against
resistance
6/26/2011 55
Maria Carmela L. Domocmat, RN, MSN

56. CN XI
o abnormal finding:
asymmetric, drooping of shoulders – paralysis or
muscle weakness due to neck injury or torticollis
atrophy with fasciculations – peripheral nerve dse
6/26/2011 56
Maria Carmela L. Domocmat, RN, MSN

57. Torticollis
6/26/2011 57
Maria Carmela L. Domocmat, RN, MSN

58. Atrophy with fasciculations
6/26/2011 58
Maria Carmela L. Domocmat, RN, MSN

59. CN XII (hypoglossal)
o strength and mobility tongue
o protrude tongue, move to side against resistance,
put back in mouth
6/26/2011 59
Maria Carmela L. Domocmat, RN, MSN

60. CN XII
o normal finding: symmetric and smooth, bilateral
strength
o abnormal finding:
atrophy with fasciculations – peripheral nerve dse
deviation to affected side – unilateral lesion
6/26/2011 60
Maria Carmela L. Domocmat, RN, MSN

61. MOTOR AND
CEREBELLAR SYSTEMS
6/26/2011 61
Maria Carmela L. Domocmat, RN, MSN

62. Condition and movement of muscles
o size and symmetry muscle grps
o strength and tone
o note unusual involuntary movement (i.e,
fasciculations, tics, tremors)
6/26/2011 62
Maria Carmela L. Domocmat, RN, MSN

63. o normal finding
muscles- fully developed
symmetric size (bilateral sides may vary 1 cm from
each other)
relaxed muscles contract voluntarily; show mild,
smooth resistance to passive movement
equally strong against resistance, without flaccidity,
spasticity, rigidity
no fasciculations, tics, tremors
elderly –hand tremor or dyskinesia (repetitive
movements of lips, jaw, tongue)
6/26/2011 63
Maria Carmela L. Domocmat, RN, MSN

64. o abnormal finding
muscle atrophy – dses of lower motor neurons or
muscle disorders
soft, limp, flaccid muscles
fasciculations - muscle twitching
tics – twitch of face, head or shoulders – stress,
neurologic disorder
tremors – rhythmic, oscillating movements –
Parkinson’s dse, cerebellar dse, multiple sclerosis (with
movement), hyperthyroidism, anxiety
6/26/2011 64
Maria Carmela L. Domocmat, RN, MSN

65. Fasciculations
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 65

66. Tics
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 66

67. Tremors
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 67

68. o abnormal finding
unusual bizarre face, tongue, jaw, lip
movements – chronic psychosis, long term
use of psychotropic drugs
slow, twisting movements in extremities and
face – cerebral palsy
brief, rapid, irregular, jerky movements (at
rest) - Huntington’s chorea
6/26/2011 68
Maria Carmela L. Domocmat, RN, MSN

69. Balance, Gait
o walk normally
o tandem walk – heel-to-toe walk
o romberg test
o hop with one foot
o elderly – may be difficult to perform
6/26/2011 69
Maria Carmela L. Domocmat, RN, MSN

70. o normal finding:
steady gait, opposite arms swing
maintains balance with little difficulty
elderly – may be very difficult
(-) Romberg test - erect with minimal swaying
hops without losing balance
6/26/2011 70
Maria Carmela L. Domocmat, RN, MSN

71. o abnormal finding
(+) Romberg test – swaying, moving feet apart to
prevent fall – dse of posterior columns, vestibular
dysfunction, cerebellar disorders
6/26/2011 71
Maria Carmela L. Domocmat, RN, MSN

72. Coordination
Point-to-point
Rapid Alternating Movements (RAM)
6/26/2011 72
Maria Carmela L. Domocmat, RN, MSN

73. o Point-to-point
finger-to-nose test
Finger- nose- to-finger
heel-to-shin test
Note: dominant side may be more coordinated than
nondominant side
6/26/2011 73
Maria Carmela L. Domocmat, RN, MSN

74. 6/26/2011 74
Maria Carmela L. Domocmat, RN, MSN

75. 6/26/2011 75
Maria Carmela L. Domocmat, RN, MSN

76. http://cloud.med.nyu.edu/modules/pub/neurosurgery/coordination.html
6/26/2011 76
Maria Carmela L. Domocmat, RN, MSN

77. Rapid Alternating Movements
(RAM)
Thumb to Fingers
Hands on Lap
6/26/2011 77
Maria Carmela L. Domocmat, RN, MSN

78. 6/26/2011 78
Maria Carmela L. Domocmat, RN, MSN

79. Rapid Alternating Movements
(RAM)
normal finding:
• elderly – may be difficult – bcoz decreased reaction
time and flexibility
abnormal finding:
• inability to perform – cerebellar dse, upper motor neuron
weakness, extrapyramidal dse
• dysdiadochokinesia -
6/26/2011 79
Maria Carmela L. Domocmat, RN, MSN

80. Dysdiadochokinesia
impairment of the ability to make movements
exhibiting a rapid change of motion that is caused by
cerebellar dysfunction
6/26/2011 80
Maria Carmela L. Domocmat, RN, MSN

81. SENSORY SYSTEM
6/26/2011 81
Maria Carmela L. Domocmat, RN, MSN

82. Light Touch, Pain, and Temperature Sensations
Vibratory sensations
Proprioception (sensitivity to position)
Tactile discrimination (fine touch)
6/26/2011 82
Maria Carmela L. Domocmat, RN, MSN

83. Light Touch, Pain, and Temperature
Sensations
scatter stimuli – distal and proximal parts of all
extremities and trunk to cover most of dermatomes
6/26/2011 83
Maria Carmela L. Domocmat, RN, MSN

84. Dermatomes
6/26/2011 84
Maria Carmela L. Domocmat, RN, MSN

85. 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 85

86. 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 86

87. o abnormal finding
anesthesia – absence of touch sensation
hypesthesia – decreased sensitivity to touch
hyperesthesia –increased sensitivity to touch
analgesia – absence of pain sensation
hypalgesia – decreased sensitivity to pain
hyperalgesia – increased sensitivity to pain
6/26/2011 87
Maria Carmela L. Domocmat, RN, MSN

88. • Vibratory sensations
o tuning fork – bony surface fingers or big toe
o usually decreased by 70
6/26/2011 88
Maria Carmela L. Domocmat, RN, MSN

89. • Proprioception (sensitivity to position)
o Note: if position sense is intact distally, then it is
intact proximally
o normal finding
some – sense position of great toe may be reduced
o abnormal finding
inability to identify directions – posterior column dse,
peripheral neuropathy (e.g., diabetes, chronic alcohol
abuse)
6/26/2011 89
Maria Carmela L. Domocmat, RN, MSN

90. Tactile discrimination (fine touch)
Tests for lesions of the sensory cortex
Stereognosis
Point Locations
Graphestesia
Two-Point Discrimination
Extinction
6/26/2011 90
Maria Carmela L. Domocmat, RN, MSN

91. 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 91

92. http://cloud.med.nyu.edu/modules/pub/neurosurgery/sensory.html
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 92

93. REFLEXES
6/26/2011 93
Maria Carmela L. Domocmat, RN, MSN

94. Deep tendon reflexes
o biceps
o brachioradialis
o triceps
o patellar
6/26/2011 94
Maria Carmela L. Domocmat, RN, MSN

95. Biceps reflex
elicited by placing your thumb on the biceps
tendon and striking your thumb with the reflex
hammer and observing the arm movement.
Repeat and compare with the other arm.
6/26/2011 95
Maria Carmela L. Domocmat, RN, MSN

96. Briceps reflex
6/26/2011 96
Maria Carmela L. Domocmat, RN, MSN

97. Brachioradialis reflex
striking the brachioradialis tendon directly
with the hammer when the patient's arm is
resting.
Strike the tendon roughly 3 inches above
the wrist.
Note the reflex supination. Repeat and
compare to the other arm.
The biceps and brachioradialis reflexes are
mediated by the C5 and C6 nerve roots.
6/26/2011 97
Maria Carmela L. Domocmat, RN, MSN

98. Brachioradialis reflex
http://img.medscape.com/fullsize/migrated/408/540/mos5854.01.fig6.jpg
6/26/2011 98
Maria Carmela L. Domocmat, RN, MSN

99. Triceps reflex
strike the triceps tendon directly with the
hammer while holding the patient's arm with
your other hand.
Repeat and compare to the other arm
.The triceps reflex is mediated by the C6 and C7
nerve roots, predominantly by C7.
6/26/2011 99
Maria Carmela L. Domocmat, RN, MSN

100. Triceps reflex
6/26/2011 100
Maria Carmela L. Domocmat, RN, MSN

101. Patellar reflex
With the lower leg hanging freely off the edge of the bench, the knee jerk is
tested by striking the quadriceps tendon directly with the reflex hammer.
Repeat and compare to the other leg.The knee jerk reflex is mediated by the
L3 and L4 nerve roots, mainly L4.
Insult to the cerebellum may lead to pendular reflexes. Pendular reflexes are
not brisk but involve less damping of the limb movement than is usually
observed when a deep tendon reflex is elicited. Patients with cerebellar injury
may have a knee jerk that swings forwards and backwards several times. A
normal or brisk knee jerk would have little more than one swing forward and
one back. Pendular reflexes are best observed when the patient's lower legs
are allowed to hang and swing freelly off the end of an examining table.
6/26/2011 101
Maria Carmela L. Domocmat, RN, MSN

102. Patellar reflex
http://cloud.med.nyu.edu/modules/pub/neurosurgery/reflexes.html
http://www.brown.edu/Courses/Bio_160/Projects2000/Polio/Reflexcopy.jpg
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 102

103. Ankle reflex
elicited by holding the relaxed foot with one
hand and striking the Achilles tendon with the
hammer and noting plantar flexion. Compare to
the other foot.The ankle jerk reflex is mediated
by the S1 nerve root.
6/26/2011 103
Maria Carmela L. Domocmat, RN, MSN

104. Plantar or Achilles
http://www.beltina.org/pics/achilles_tendon.jpg
6/26/2011 104
Maria Carmela L. Domocmat, RN, MSN

105. Rate the reflex with the following scale:
5+ Sustained clonus
4+ Very brisk, hyperreflexive, with clonus
3+ Brisker or more reflexive than normally.
2+ Normal
1+ Low normal, diminished
0.5+ A reflex that is only elicited with reinforcement
0
6/26/2011 No response 105
Maria Carmela L. Domocmat, RN, MSN

106. http://www.wrongdiagnosis.com/bookimages/8/2546.png
6/26/2011 106
Maria Carmela L. Domocmat, RN, MSN

107. deep tendon reflexes are graded as
follows:
0 = no response; always abnormal
1+ = a slight but definitely present
response; may or may not be normal
2+ = a brisk response; normal
3+ = a very brisk response; may or may
not be normal
4+ = a tap elicits a repeating reflex
(clonus); always abnormal
6/26/2011 107
Maria Carmela L. Domocmat, RN, MSN

108. Superficial reflexes
o Plantar reflex
o Abdominal reflex
o Cremasteric reflex
6/26/2011 108
Maria Carmela L. Domocmat, RN, MSN

109. Plantar reflex
The plantar reflex (Babinski) is tested by coarsely
running a key or the end of the reflex hammer up
the lateral aspect of the foot from heel to big toe.
Normal finding : toe flexion.
Abnormal finding:
(+) Babinski's sign - toes extend and separate
indicative of an upper motor neuron lesion affecting
the lower extremity in question.
6/26/2011 109
Maria Carmela L. Domocmat, RN, MSN

110. Plantar reflex
6/26/2011 110
Maria Carmela L. Domocmat, RN, MSN

111. Abdominal reflex
6/26/2011 111
Maria Carmela L. Domocmat, RN, MSN

112. Abdominal reflex
6/26/2011 112
Maria Carmela L. Domocmat, RN, MSN

113. Cremasteric reflex
6/26/2011 113
Maria Carmela L. Domocmat, RN, MSN

114. Cremasteric reflex
6/26/2011 114
Maria Carmela L. Domocmat, RN, MSN

115. Other tests

116. Hoffman response
elicited by holding the patient's middle finger between the
examiner's thumb and index finger.
Ask the patient to relax their fingers completely. Once the
patient is relaxed, using your thumbnail press down on the
patient's fingernail and move downward until your nail "clicks"
over the end of the patient's nail.
Repeat this maneuver multiple times on both hands.
Normal finding: nothing occurs.
Abnormal finding:
(+) Hoffman's response - other fingers flex transiently after the "click".
indicative of an upper motor neuron lesion affecting the upper extremity
in question.
6/26/2011 116
Maria Carmela L. Domocmat, RN, MSN

117. Hoffman response
6/26/2011 117
Maria Carmela L. Domocmat, RN, MSN

118. Hoffmann's sign, which is elicited by flicking the distal phalanx of the long
finger.
A negative response, as shown here, is no motion of the thumb.
A positive response is flexion of the thumb at the interphalangeal joint.
6/26/2011 118
Maria Carmela
http://img.medscape.com/fullsize/migrated/408/540/mos5854.01.fig6.jpg L. Domocmat, RN, MSN

119. Test of Clonus
Test clonus if any of the reflexes appeared
hyperactive. Hold the relaxed lower leg in your
hand, and sharply dorsiflex the foot and hold it
dorsiflexed. Feel for oscillations between flexion
and extension of the foot indicating clonus.
Normally nothing is felt.
6/26/2011 119
Maria Carmela L. Domocmat, RN, MSN

120. Tonus video
6/26/2011 120
Maria Carmela L. Domocmat, RN, MSN

121. 6/26/2011 121
Maria Carmela L. Domocmat, RN, MSN