NEUROEVAL PART 1

ASIA Impairment Scale - universal classification tool used for patients with SCI

Sensory level - Graded 0, 1, 2 and NT

● 0 - Absent
● 1 - Patient has altered sensation, either sensation is decreased or impaired or
hypersensitivity
● 2 - Normal
● NT - Not testable

Motor level - most caudal level with grade of at least 3

Neurological level - most caudal, intact sensation and antigravity muscle function strength
Grade 3 or more on both sides of body, provided that there is normal intact sensory motor
function on the above levels

STEPS IN CLASSIFICATION
● Determine sensory levels for right and left sides - Most caudal intact dermatome for both
pinprick and light touch sensation
● Determine motor levels for right and left sides - Lowest key muscle function that has a
grade of at least 3 in supine testing provided that key muscle functions above intact or
graded 5
● Determine neurological level of injury - LLI is the most caudal segment with intact
sensation and antigravity muscle function strength provided that above level are intact
● Determine whether injury is complete or incomplete - Injury is determine COM or INC if
there is a presence or absence of sacral sparing. If there is voluntary or no voluntary
anal contraction, and all S4 and S5 sensation is 0 and deep anal pressure is also
absent, the injury is complete. Otherwise, injury is INCOMPLETE.

ASIA IMPAIRMENT SCALE GRADING

● ASIA A - COMPLETE, meaning no sensory or motor function is preserved in the sacral
segments of S4 and S5.
● ASIA B - SENSORY INCOMPLETE, no motor function is preserved below neurological
level, including voluntary anal contraction. Only sensory function is preserved, including
S4 and S5, pin prick, light touch and deep anal pressure
● ASIA C - MOTOR INCOMPLETE, motor function is preserved at S4 - S5 or voluntary
anal contraction or patient has incomplete sensory status and less than the half of key
muscle functions below the neurological level of injury have muscle grade of at least 3
● ASIA D - MOTOR INCOMPLETE,
● ASIA E - NORMAL

UPRIGHT MOTOR CONTROL TEST (UMCT)

 ● Develop as a clinical test of voluntary control of affected lower limb in standing to predict
functional ability of patients with stroke.
● Used to identify the presence of lower limb dysfunction or muscle weakness in stroke
patients and other neurological conditions
● Provides information on the ability of patient to bear weight on and unload the affected
lower limb in standing
● Has 6 subtests: 3 for extension control, 3 for flexion control

REFLEX INTEGRITY
● SUPERFICIAL CUTANEOUS REFLEX - LIGHT STROKE ON SKIN INNERVATED BY
SAME MUSCLES SEGEMENTS RECEIVING SAME INPUT FROM CUTANEOUS
RECEPTORS, IT INVOLVES PLANTAR AND ABDOMINAL REFLEXES
● To elicit Plantar reflex, stroke the sole of the foot along the lateral border and up across
the ball of the foot. Response is flexion of big toe and sometimes other toes will also flex
or no response at all.The Abnormal response for this reflex is extension of big toe with
fanning of other big toes. This is called positive Babinski sign, and indicates upper motor
neuron lesion
● Upper and lower abdominal reflexes are mediated by T8-T12
● With the patient in supine, make a brisk like stroke on each quadrant on the abdomen
near the umbilicus. This will result in a localized contraction under the stimulus

PRIMITIVE TONIC REFLEXES GRADED:

0 - ABSENT
1 - CHANGE IN TONE OR SLIGHT TRANSIENT WITH NO MOVEMENT OF EXTREMITIES
2+ - VISIBLE MOVEMENT OF EXTREMITIES
3+ - EXAGGERATED FULL MOVEMENT OF EXTREMITIES
4+ - OBLIGATORY AND SUSTAINED MOVEMENT LASTING MORE THAN 30 SECS

SENSORY EXAMINATION
● Somatosensory is sensation receive from skin and musculoskeletal system
● Examination of sensory function involves testing sensory integrity by determining
patient’s ability to interpret
● Sensory Exam should be performed in individuals with signs and symptoms of sensory
dysfunction, for those injuries affecting either the peripheral nervous system or CNS or
both
● Is done using the pattern of skin segment innervation by dorsal roots or peripheral nerve
roots

SUPERFICIAL SENSATION
● Exteroceptors are responsible for detecting superficial sensations, responsible for
perception of pain, temperature, light touch and pressure
● Receive stimuli from external environment via skin and subcutaneous tissue
PROPRIOCEPTORS - DEEP SENSATION, receives stimuli from muscles to detect position
sense, movement awareness and vibration

SPINAL PATHWAYS
● Anterolateral Spinothalamic Tract - initiates self protective reaction and response to
stimuli that are harmful, contains slow conducting fibers of small diameter, concern
with transmission of thermal and nociceptive information.
● Dorsal Column Medial Lemniscal - contains fast conducting fibers of large diameter

TYPES OF SENSORY RECEPTORS

CUTANEOUS RECEPTORS
● FREE NERVE ENDINGS - found throughout the body
● Hair follicle endings - located at base of each hair follicle, these receptors are sensitive
to mechanical movement and touch
● MERKEL’S DISKS - located below epidermis, with high density in fingertips, sensitive to
low intensity touch and pressure
● RUFFINI ENDINGS - located in deeper layer of epidermis, slowly adapting, important in
skin deformation such as tension or stretch and joint position sense
● KRAUSE END BULB - located in dermis and play an important role in perception of
touch and pressure
● MEISSNER’S CORPUSCLE - located in dermis, discriminative touch, recognition of
texture
● PACINIAN corpuscle - located in subcutaneous layer of skin, and in deep tissues of body

DEEP RECEPTORS - located in muscles, tendons or joints

MM. RECEPTORS
● Muscle spindles - monitor changes in muscle length and velocity
● Golgi tendon organs - located at proximal and distal tendinous insertion of the muscle
● Free Nerve endings - located at fascia of muscle
● Pacinian - fascia of muscle

NEUROEVAL PART 2

● COORDINATION - ability to execute smooth, accurate and controlled movements

COORDINATION IMPAIRMENTS
● ASTHENIA
● DYSARTHRIA - disorder of speech. Speech: slow, slurred, hesitant
● DYSDIADOCHOKINESIA - impaired ability perform rapid alternating movements
● DYSMETRIA - inability to judge distance
● DYSSYNERGIA - movement decomposition. Movement is perform on a sequence of
component parts rather than single smooth or activity
● GAIT ATAXIA - wide BOS, arms held away from body, unsteady, irregular and staggering
gait
 ● NYSTAGMUS - rhythmic quick oscillatory eye movement
● REBOUND PHENOMENON - loss of check reflex
● TREMOR - involuntary oscillatory movement, result in alternating contraction of
opposing mm. Groups
3 types of tremor:
● Intention/ Kinetic - occurs during voluntary motion, increases as limb approaches
its target for speed of movement is increased
● Postural/Static - back n forth oscillatory movement during standing, while up and
down oscillatory movements of limb when it is held against gravity
● Titubation - rhythmic oscillation of head, either side to side or forward -
backward, or may have some rotary movement
BASAL GANGLIA PATHOLOGY
● AKINESIA - inability to initiate movement
● ATHETOSIS - characterized by slow, involuntary, worm-like movements in distal UE
● BRADYKINESIA - decrease amplitude and velocity of voluntary movement
● CHOREA - involuntary, rapid, irregular jerky movement
● DYSTONIA - sustained, involuntary contraction of agonist and antagonist mm, common
in trunk and extremities
● HEMIBALLISMUS - large amplitude sudden violent, freely motion of arm and leg on one
side of body
● HYPER/HYPOKINESIS - increase/decrease muscle activity or movement
● RIGIDITY - increase mm. Tone cause by resistance to passive movement
● RESTING TREMOR - Involuntary, rhythmic oscillatory movements, present at rest

ROMBERG SIGN, POSITIVE IF INABILITY TO MAINTAIN STANDING BALANCE W/ FEET

TOGETHER WHEN EYES ARE CLOSED

NON- EQUILIBRIUM COORDINATION TEST

● FINGER TO NOSE
● FINGER TO THERAPIST FINGER
● FINGER TO FINGER
● ALTERNATE NOSE TO FINGER
● FINGER OPPOSITION
● MASS GRASP
● SUPINATION/PRONATION
● TAPPING (HAND & FOOT)
● POINTING AND PAST POINTING
● ALTERNATE HEEL TO KNEE, HEEL TO TOE
● TOE TO EXAMINER’S FINGER
● HEEL ON SHIN
● DRAW CIRCLE
● FIXATION OR POSITION HOLDING
STANDARDIZED INSTRUMENTS UE COORDINATION
● JEBSEN- TAYLOR HAND FUNCTION- 7 SUBTEST OF FUNC SKILLS, WRITING,
GUARD TURNING, PICKING UP SMALL OBJECTS, SIMULATED FEEDING,
STACKING, PICKING UP LARGE WEIGHT OBJECTS
● MINNESOTA MANUAL DEXTERITY TEST - placing and turning task, requires use of
board and round discs
● Minnesota rate of manipulation - 5 operations: placing, turning, displacing, one hand turn
and placing and two hand turn and placing
● PURDUE - placements of pins, collars. 4 subtests - R hand prehension, L hand
prehension, Both hands prehensions, Assembly
● Crawford - pins, collars and screws. Use of tweezers, required to place both pins and
place collars over pins. Screws must be place with fingers and screw it with screwdriver

Sensory Organization Test Scoring

1- Minimal sway
2 - Mild sway
3- Moderate sway
4 - Loss of balance

Berg Balance Scale (BBS) - static and dynamic balance assessment stability
● Used in balance for patients with stroke
● Sensitive measure of functional balance in older adults
● Score of <45 indicates a risk of recurrent/multiple falls

POMA - static and dynamic balance assessment for elderly

● Score of 19-24 indicates moderate risk for falls
● <19 indicates high risk for falls

Func. Reach Test - quick screening of balance or problems in older adults, measure max
distance person can reach forward beyond arms length, while maintaining fixed BOS
● Uses level yard stick on wall level patients acromion process
● Subtract measurement from initial measurement

Get Up and Go Test - quick measure of dynamic balance and mobility

● Scored using 5 pt. Scale
● 1- Normal
● 2 - Very slightly normal
● 3- Mildly abnormal
● 4- MODERATELY ABNORMAL
● 5 - SEVERELY ABNORMAL

Time up and go test - in >10 seconds, healthy individuals can complete the task
11-20 sec. Are normal for frailed elderly or individuals with disability
>30 secs. - high risk for falls
Cogwheel rigidity - upper ext. More common
Dystonia - putamen problems patients