University of Santo Tomas

CoIIege of Nursing
Assessment of
Neurologic
System
natomy and PhysioIogy
Nervous System
Central Nervous System Peripheral Nervous System
(Brain and Spinal Cord) (Cranial and Spinal Nerves)
Somatic Autonomic
(Voluntary) (Involuntary)
Sympathetic Nervous System Parasympathetic Nervous System
Neurons
NeurogIia
Neurotransmitters
Acetylcholine ajor areas of the brain;
autonomic nervous system
Usually excitatory
Serotonin Brain stem, hypothalamus,
dorsal horn of spinal cord
Inhibitory; helps control
mood and sleep
Dopamine Substantia nigra and basal
ganglia
Usually inhibitory;
affects behavior and
fine motor
Norepinephrine Brain stem, hypothalamus Usually excitatory
Gamma-
aminobutyric
acid (GABA)
Spinal cord, cerebellum,
basal ganglia
Inhibitory; muscle and
nerve transmission
Enkephalin,
Endorphin
Nerve terminals in the spine,
brain stem, thalamus,
pituitary gland
Excitatory; pleasurable
sensation; inhibits pain
transmission
CENTR NERVOUS SYSTEM
Brain
rain
It is approx. 2% of the total body weight
It weighs approx. 1400 g in an average
young adult
In weighs an average of 1200 g in the
elderly
It is divided into three major areas:
cerebrum, brain stem and the cerebellum
Cerebrum
Cerebrum
It consists of two hemispheres that are incompletely
separated by the great longitudinal fissure
It is separated into right and left hemispheres by sulcus
It is joined at the lower portion by corpus callosum
It has wrinkled appearance due to presence of folded
layers or convolutions called gyri
It has an external of outer portion made up of gray
matter approx. 2 to 5 mm in depth and is made up of
billions of neurons and cell bodies
It has an innermost layer made up of ite matter and
is composed of nerve fibers and neuroglia
our obes of the Cerebrum
Frontal Lobe
argest lobe
Controls concentration, abstract thought,
information storage or memory, and motor
function
Contains Broca's area, a speech association
area that participates in word formation
#esponsible for large part of individual´s
affect, judgment, personality and inhibitions
Parietal Lobe
Predominantly a sensory lobe
Contains primary sensory cortex, which
analyzes sensory information and relays
the interpretation of this information to the
thalamus and other cortical areas
Controls awareness of the body in space,
orientation in space and spatial relations
Temporal Lobe
Contains auditory receptive areas
Contains a vital area called interpretative
area, which provides integration of
somatization, visual and auditory areas
Occipital Lobe
Contains visual areas, which play
important role in visual interpretation
Other reas of Cerebrum
Corpus Callosum
%hick collection of nerve fibers that
connects the two hemispheres of the brain
and is responsible for the transmission of
information from one side of the brain to
the other
Information transferred is sensory,
memory and learned discrimination
Basal Ganglia
asses of nuclie located deep in the
cerebral hemispheres
#esponsible for motor control of fine body
movements
Thalamus
ies on either side of the third ventricle
Acts primarily as a relay station for all
sensation except smell
All memory, sensation and pain impulses
pass through this section
Hypothalamus
ocated anterior and inferior to the thalamus
It includes the optic ciasm and mamillary
bodies
Plays a role in the regulation of pituitary
secretion of hormones that influence
metabolism, reproduction, stress response and
urine production
Called as hunger and satiety centers
#egulates sleep-wake cycle, blood pressure,
aggressive and sexual behaviors, and
emotional responses
Pituitary Gland
ocated at the sella turcica at the base of
the brain
Divided into anterior and posterior sections
which secrete hormones necessary in
maintaining life
rain Stem
rain Stem
Contains the midbrain, pons and medulla
oblongata
%he midbrain contains sensory and motor
pathways and serves as the center for auditory
and visual reflexes
%he pons contains motor and sensory
pathways, and controls the heart, respiration
and blood pressure
%he medulla oblongata transmits both
sensory and motor fibers, and is the body´s
respiratory center
CerebeIIum
CerebeIIum
Separated from the cerebral hemispheres
by a fold of dura matter, the tentorium
cerebelli
as both excitatory and inhibitory actions
and is largely responsible for coordination
of movement
Controls fine movement, balance, position
sense and integration of sensory input
Structures Protecting the rain
Meninges
ibrous connective tissues that cover the
brain and spinal cord
Provides protection, support and
nourishment to the brain and spinal cord
Composed of dura mater, arachnoid and
pia mater
Dura mater
utermost layer
%ough, thick, inelastic, fibrous and gray in
color
as four extensions: falx cerebri,
tentorium, falx cerebelli and
diapragma sellae
Arachnoid
iddle membrane
Extremely thin, delicate membrane which
resembles a spider web
Appears white because of absence of blood
supply
Contains the coroid plexus, which
produces the cerebrospinal fluid (CS)
Contains aracnoid villi, which absorb CS
Pia mater
Innermost membrane
%hin, transparent layer that hugs the brain
closely and extends into every fold of the
brain´s surface
CerebrospinaI Iuid (CS
Clear and colorless fluid with a specific gravity of
1.007
Cushions and nourishes the brain
Produced in the ventricles and is circulated around
the brain and the spinal cord by the ventricular
system
%he organic and inorganic contents of CS are
similar to those of plasma but differs in
concentration
Analyzed for presence of protein, glucose, chloride
and immunoglobulins
Normally contains minimal number of WBCs and
no #BCs
CerebraI CircuIation
%he brain requires 20% of the oxygen of
the body
%he brain requires 65-70% of the glucose
in the body
%he brain requires 1/3 of the cardiac output
%he brain does not store nutrients and has
a high metabolic demand that requires high
blood flow
%he brain lacks additional collateral blood
flow, which may result in irreversible
damage when blood flow is occluded
rteriaI SuppIy
%he arterial blood supply to the brain is
provided by to internal carotid arteries
and to vertebral arteries
At the base of the brain, a ring is formed
between the vertebral and internal carotid
arterial chains called circle of Willis
%he arterial anastomosis along the circle of
Willis is a frequent site of aneurysms
CIipping of neurysm
Craniotomy
Venous Drainage
%he veins of the brain reach the brain´s
surface and join larger veins which empty
into the dural sinuses
Dural sinuses are vascular channels lying
within the tough dura mater
%he network of the sinuses carries venous
outflow for the brain and empties into the
internal jugular veins, which return the
blood into the heart
Cerebral veins and sinuses are unique
because they don´t have valves
Iood-rain arrier
ormed by the endothelial cells of the brain
capillaries, which form continuous tight
junctions, creating a barrier to macro
molecules and many compounds
All substances entering the CS must filter
through the capillary membranes of the
choroid plexus
ften altered by trauma, cerebral edema
and cerebral ypoxemia
Spinal Cord
SpinaI Cord
Serves as a connection between the brain and
the periphery
Approx. 45 cm (18 in) long and about the
thickness of a finger
Extends from the foramen magnum at the base
of the skull to the lower border of the first
lumbar vertebra, where it tapers to a fibrous
band conus medullaris
Below the second lumbar space are nerve roots
that extend beyond the conus, which are called
cauda equina
Contains gray matter, located at the center,
and white matter on its sides
Sensory and Motor Pathways:
The SpinaI Tract
iber bundles with a common function are
called tracts
%here are six (6) ascending tracts
conducting sensation such as perception of
touch, pressure, vibration, position and
passive motion from the same side of the
body
Ex. Spinocerebellar tracts conduct
sensory impulses from muscle spindles,
providing necessary input for coordinated
muscle contraction
%here are eigt (8) ascending tracts, seven
of which are engaged in motor function
Examples:
1. Corticospinal tracts (2)- voluntary muscle
activity
2. Vestibulospinal tracts (3)- autonomic
functions such as sweating, pupil dilation and
circulation
3. Corticobulbar tract - voluntary head and
facial muscle movement
4. Rubrospinal and reticulospinal tracts -
involuntary muscle movement
VertebraI CoIumn
Surrounds and protects the spinal cord and
consists of 7 cervical, 12 toracic, 5
lumbar and 5 sacral
Nerve roots exit from the vertebral column
through the intervertebral foramina
Separated by disks, except for the first and
second cervical, sacral and coccygeal
vertebrae
Each vertebra has a ventral solid body and
a dorsal segment or arch, which is posterior
to the body
PERIPHER NERVOUS SYSTEM
Cranial Nerves
%here are 12 pairs of cranial nerves that
emerge from the lower surface of the brain
and pass through the foramina in the skull
%hree (3) are entirely sensory ( CN I, II,
VIII), five (5) are motor (CN III, IV, VI)
and four (4) are mixed (CN V, VII, IX, X)
%hey are numbered in the order in which
they arise from the brain
CraniaI Nerves
Cranial Nerves Functions Abnormal Findings
I. Olfactory Smell Anosmia
(absence of smell)
II. Optic Vision Papilledema; blurred
vision; scotoma;
blindness
III. Oculomotor Pupil constriction;
elevation of upper lid
Anisucuria; pinpoint
pupils; fixed, dilated
pupils
IV. Trochlear Eye movement;
controls superior
oblique
Nystagmus
V. Trigeminal Controls muscles of
mastication;
sensations for the
entire face
%rigeminal neuralgia
(%ic douloureux)
VI. Abducens Eye movements;
controls the lateral
rectus muscle
Diplopia; ptosis of the
eyelid
VII. Facial Controls muscles for
facial expression;
anterior 2/3 of the
tongue
Bell´s palsy; ageusia
(loss of sense of taste)
on the anterior 2/3 of
the tongue
VIII. Acoustic/
Vestibulocochlear
Cochlear branch
permits hearing;
vestibular branch
helps maintain
equilibrium
%innitus; vertigo
IX. Glossopharyngeal Controls muscles of the
throat; taste of
posterior 1/3 of the
tongue
oss of gag reflex;
drooling of saliva;
dysphagia; dysphonia;
posterior third ageusia
X. Vagus Controls muscles of the
throat; PNS stimulation
of thoracic and
abdominal organs
oss of gag reflex;
drooling of saliva;
dysphagia; dysarthria;
bradycardia; increased
Cl secretion
XI. Spinal Accessory Controls
sternocleidomastoid and
trapezius muscles
Inability to rotate the
head and move the
shoulders
XII. Hypoglossal ovement of the tongue Protrusion of the
tongue; deviation of
the tongue to one side
of the mouth
Spinal Nerves
Composed of 31 pairs of spinal nerves: 8
cervical; 12 toracic; 5 lumbar; 5 sacral;
and 1 coccygeal
%he dorsal roots are sensory and transmit
impulses from specific areas of the body, known
as dermatomes, to the dorsal ganglia
%he sensory fibers maybe somatic, carrying
information about pain, temperature, touch, and
position sense (proprioception) from the
tendons, joints and body surfaces
ibers can also be visceral, carrying information
from the visceral organs
%he ventral roots are motor and transmit
impulses from the spinal cord to the body
%hese fibers can either be somatic or
visceral
%he visceral fibers include autonomic
fibers that control the cardiac muscles and
glandular secretions
UTONOMIC NERVOUS SYSTEM:
Sympathetic Nervous System vs.
Parasympathetic Nervous System
Structure or Activity PNS SNS
Pupil of the Eye Constricted Dilated
Circulatory System:
#ate and force of heart beat Decreased Increased
Blood Vessels
In the heart muscle
In skeletal muscle
In abdominal viscera and skin
Blood pressure
Constricted
*
*
Decreased
Dilated
Dilated
Constricted
Increased
Respiratory System:
Bronchioles
#ate of breathing
Constricted
Decreased
Dilated
Increased
Structure or Activity PNS SNS
Digestive System:
Peristalsis
uscular sphincters
Secretion of salivary gland
Secretions of stomach,
intestine and pancreas
Conversion of liver
glycogen to glucose
Increased
#elaxed
%hin, watery
Increased
*
Decreased
Contracted
%hick, viscid
*
Increased
Genitourinary System:
Urinary bladder
uscular walls
Sphincters
Contracted
#elaxed
#elaxed
Contracted
Structure or Activity PNS SNS
Integumentary System:
Secretion of sweat
Pilomotor muscles
*
*
Increased
Contracted
Adrenal Medullae * Secretion of
catecholamines
Neurologic Assessment
DeveIopmentaI Considerations
Infants and Children
%he growth of the nervous system is rapid
during the fetal period
During infancy, the neurons mature, which
allows more complete actions to take place
1. cerebral cortex thickens
2. brain size increases
3. myelinization occurs
%he advances in the nervous system are
responsible for the cephalocaudal and
proximodistal refinement of development,
control and movement
%he neonate has several reflexes at birth:
sucking, stepping, startle (oro) and
Babinski reflexes
Babinski and tonic neck reflexes are normal
until two (2) years of age
By about one (1) month of age, the
reflexes begin to disappear
Pregnant Women
%he pressure of the growing uterus on the nerves of the
pelvic cavity produces neurologic changes in the legs
As pressure is relieved in the pelvis, the changes in the
lower extremities are resolved
As the fetus grows, the center of gravity of the female
shifts, and the lumbar curvature of the spine is
accentuated
%his change in posture can place pressure on roots of
nerves, causing sensory changes in the lower extremities
yperactive reflexes may indicate pregnancy-induced
hypertension (PIH)
Older Adults
Impulse transmission decreases
#eflexes diminish and coordination weakens
Senses decrease (hearing, vision, smell, taste
and touch)
uscle mass decreases
Gait becomes short, shuffling, uncertain and
unsteady
ocused Interview
General Questions:
Explain what brings you here today.
ave you had a change in your ability to
carry out your daily activities?
Do you have any chronic disease such as
diabetes mellitus or hypertension?
Questions Related to Illness, Infection or
Injury:
ave you ever been diagnosed with a
neurologic illness?
ave you ever had an infection of the
neurologic system?
ave you ever had an injury to your head
or back?
Questions Related to Symptoms or
Behaviors:
Do you have fainting spells? Do you have a
history of seizures or convulsions?
as you vision changed in any way?
Do you have numbness or tingling in any
part of your body?
MentaI Status
rientation to four (4) spheres: person,
time, place and event
emory: Immediate recall, recent memory
and remote memory
Immediate recall: Ask client to repeat your
questions.
Recent memory: Ask the client about events
that occurred few minutes, few hours.
Remote memory: Ask the client about
events in the remote past, or historical
events that can be answered by the general
population.
eveI of Consciousness
It is the most sensitive indicator of the
changes in neurologic status of the client
%he center of wakefulness is ascending
reticular activating system (A#AS)/reticular
formation
Assess both the wakefulness and content of
thought
TooIs for ssessment of MentaI
Status
Mini-Mental State Examination
Assesses cognitive status via interview
Addenbrooke's Cognitive Examination
Determines early dementia
Confusion Assessment Method
Assesses for delirium
Cornell Scale for Depression in Dementia
Assesses behavioral problems
eveI of Consciousness
Level I: Conscious, cognitive, coherent ( 3 C´s)
Level II: Confused, drowsy, lethargic, obtunded,
somnolent
Level III: Stuporous, responds only to noxious, strong or
intense stimuli (e.g. sternal pressure, trapezius pinch,
pressure at the base of the nail, and very strong light or
very loud sound)
Level IV:
Light Coma: #esponse is only grimace or withdrawing of
limb from pain; primitive and disorganized response to
painful stimuli
Deep Coma: Absence of response to even the most
painful stimuli
LEVEL OF
CONSCIOUSNESS
LEVEL Response
Alert #esponds fully & appropriately to
stimuli
Lethargic Drowsy, responds to questions then
fall asleep
Obtunded pen eyes, responds slowly,
confused
Stuporous Arouses from sleep only from painful
stimuli
Comatose Unarousable with eyes closed
Iasgow Coma ScaIe (CS
It is an objective measure to describe level
of consciousness
It is based on the client´s response in three
areas: eye opening, motor response and
verbal response
Score
Eye pening Spontaneous opening
%o verbal command
%o pain
No response
4
3
2
1
otor #esponse beys verbal commands
ocalizes pain
Withdraws from pain
lexion (decorticate rigidity)
Extension (decerebrate rigidity)
No response
6
5
4
3
2
1
Verbal #esponse riented
Confused
Inappropriate words
Incoherent
No response
5
4
3
2
1
Glasgow Coma Scale (GCS)
Decerebrate Posturing versus
Decorticate Posturing
CraniaI Nerve Testing
CN I (Olfactory):
Usually
neglected/omitted
Ask patient to sniff a
mild stimulus
(e.g. coffee, cigarette)
Inferior frontal lobe
disease (e.g.
meningioma)
Significant if unilateral
anosmia is detected
CN II (Optic):
Check visual acuity
using Snellen´s
chart
ptic disk should
be examined
urther %ests:
1. Perimetry
2. %angent screen
3. Visual evoke
potential
CN II (Optic):
ptic disk
examination
CN III, IV, VI (Oculomotor,
Trochlear, Abducens):
inimum #equirement:
1. Describe size & shape of
pupils
2. Check reactivity of pupils
to light and
accommodation
3. Check extraocular
movements and observe
for any paresis and
nystagmus
NR: PE##A
CN V (Trigeminal):
inimum Essential:
A. Sensory testing- wisp of
cotton
B. Corneal reflex is done if
patient is unable to follow
commands or has altered
sensorium
NR: bilateral blinking
C. Motor Testing - Palpate
masseter and temporalis
muscles as the client
clenches teeth, open and
close mouth
NR: equal muscle strength,
resistance, symmetrical
movement
CN VII (Facial):
Search for facial
symmetry at rest and
with movement
%est for the following:
1. eyebrow elevation
2. forehead wrinkling
3. eye closure
4. smiling
5. cheek puff
NR: symmetrical and
resistant to pressure;
can identify taste
CN VIII
(Vestibulocochlear):
Check ability to hear a
finger rub or whispered
voice with each ear
Rinne Test (air vs. bone
conduction)
Weber Test (laterality of
lesion)
urther test: Audiometry
Rinne Test
Place the stem of
vibrating tuning fork on
the mastoid process
(behind the ear) when
the sound is no longer
heard
Shift the vibrating end
near the ear canal and
signal again until the
sound is no longer heard
NR: Air Conduction > Bone
Conduction
eber Test
Put the vibrating tuning fork
at the middle of the client´s
head
NR: bilateral tone conduction
through the bone; equal
sounds
AR: ateralization
Poor ear: conductive hearing
loss
Good ear: sensorineural
hearing loss
CN IX, X
(Glossopharyngeal
& Vagus):
Position & symmetry of
palate & uvula at rest and
with phonation
Gag reflex is checked by
stimulating posterior
pharyngeal wall on each
side
NR: uvula, soft palate
midline and symmetrical;
presence of gag reflex; +
taste sensation at the
posterior 1/3 of the
tongue
CN XI (Spinal Accessory):
Shoulder shrug
ead rotation to each
side against resistance
NR: movements equally
strong on both sides
CN XII (Hypoglossal):
inimum requirement is
to inspect:
tongue for atrophy
Position with protrusion
Strength when
extended against inner
surface of the cheek on
each side
NR: no wasting tremors;
able to move tongue
smoothly
Sensory unction
%he center for sensory perception is located
in the parietal lobe, which enables us to
perceive pressure, temperature, texture
and pain
%he ability to perceive sensory stimuli is
called stereognosis
%he inability to perceive sensory stimuli is
called agnosia
ssessment of Sensory unction:
Test for SpinothaIamic Tract
1. Assess the client´s ability to identify light
touch.
Anesthesia: inability to perceive sense of
touch
Hyperestesia: increased sensation
Hypoestesia: decreased sensation
2. Assess the client´s ability to distinguish the
difference between sharp and dull.
Analgesia: Absence of pain sensation
Hypalgesia: Decreased pain sensation
3. Assess the client´s ability to distinguish
temperature.
Test for Posterior CoIumn Tract
4. Assess the client´s ability to feel
vibrations.
%uning fork over bony prominences such as
toes, ankle, knee, iliac crest, spinal
process, sternum or elbows.
5. Assess for fine discriminations (fine
touch).
%est for Stereognosis: ability to identify
objects without seeing them
%est for Grapestesia: ability to perceive
writing on the skin
%est for To Point Discrimination: ability
to identify the distance between two points
%est for Topognosis: ability to identify the
area that has been touched
%est for Position Sense of joint movement:
great toe is dorsiflexed, plantar flexed or
abducted
Test for Stereognosis
Test for raphesthesia
Test for Position Sense
Motor unction
%he regulating mechanisms for motor
function are as follows:
1. Motor center (frontal lobe): responsible
for voluntary, purposeful, coordinated
movements.
Apraxia: inability to perform fine motor
movements
Agraphia: inability to write
2. Cerebellum: responsible for equilibrium,
sense of posture and direction
Romberg Test: done to assess sense of
equilibrium
et the client stand with both feet together
and eyes closed
Ataxia: uncoordinated movement
characterized by wide-base stance and
swaying manner of walking
3. Extrapyramidal System
It maintains balance, posture and regulates
locomotion
General appearance: presence of
involuntary, unpurposeful and uncoordinated
movements; asymmetry of the face; muscle
dystrophy
Muscle power: weakness (paresis);
paralysis (plegia)
Muscle tone: flaccidity (hypotonicity);
rigidity (hypertonicity)
Muscle volume: loss of muscle volume
(atrophy); increase in muscle volume
(hypertrophy)
Movement: slow muscle movement not
associated with weakness (bradykinesia);
absence of muscle movement (akinesia)
Coordination: assessed by %N% (finger-
to-nose test) or % (heel to knee to toe
test)
Station and gait: station is posture; gait
is manner of walking
Motor System
Tone:
Spasticity
initial resistance to quick movement of a joint which then
diminishes by the end of the movement
Rigidity
steady resistance through the entire movement of a joint
Flaccidity
markedly diminished tone; suggests lower motor neuron
disease, but may be observed acutely following upper
motor neuron disease, such as stroke
ssessment of Motor unction
Balance Test (Gait)
eel-to-toe walk
Romberg's Test
Assess coordination and equilibrium (CN VIII)
If swaying greatly increases or if the client falls,
disease of the posterior column of the spinal
cord is suspected
Finger-to-nose Test
With the eyes closed, the client with cerebellar
disease will reach beyond the tip of the nose
because the position sense is affected
Rapid Alternating Action Test
Inability to perform the task may indicate
upper motor neuron weakness
Heel-to-shin Test
Inability to perform the test may indicate
disease or lesion of the posterior spinal
tract
Tests of rapid alternating movements. A. Finger-nose-finger testing.
B. Pinching the thumb and the little finger together (the thumb and the
index finger can also be used). C. Tapping one hand on the back of the
other D. One-hand clapping.
#apid alternating prone-supine-prone positions of the hand on
the thigh
ower limb coordination.
A. Heel tapping.
B. Heel sliding.
inger-to-nose test.
. ormal . Ataxia C. Ìntention tremor
RefIex Testing
Reflexes are fast, predictable, unlearned,
innate, and involuntary responses to stimuli
ccurs at the level of the spinal cord but
interpreted a the brain
%he center for reflex act is the spinal cord
%he cerebral cortex determines the motor
response
Interpretation of RefIexes
0 = No response
1+= Diminished
2+= Normal
3+= Brisk, above normal
4+= yperactive
nee Jerk RefIex
Types of RefIexes
1. Superficial Reflexes
Pupillary Reflex:
Direct light reflex is elicited by applying light
stimulus, moved side to side into the pupil; this results
to constriction of the pupils
Consensual light reflex results to simultaneous
constriction of both pupils even if light is applied to one
pupil only
Accommodation reflex results to constriction of
pupils when gaze is shifted from a distant object to a
near object
%he pupillary reflexes are represented by PE##A
(pupils equal, round, reactive to light, accommodation)
A fixed and dilated pupil in a client who had
previously reactive pupils is a neurologic emergency.
Notify the physician immediately.
Abdominal Reflex (T8,T9, T10 for upper
and T10,T11 for lower): results to
contraction of the side of the abdomen when
stroked with blunt object
Cremasteric Reflex: elicited by downward
stroking of the inner thigh of the male;
elevation of scrotum on the same side occurs
Babinski Reflex: elicited by stroking the sole
of the foot from the heel upwards; plantar
flexion ( - Babinski) is the normal result
among adults
2. Deep Tendon Reflexes
Ankle jerk reflex (S1) is produced by
tapping the tendon of Achilles; plantar
flexion of the foot occurs
nee jerk/patellar reflex (L2, L3, L4) is
produced by tapping the quadriceps femoris
just below the patella; it results to leg
extension
Deep Tendon Reflex
#eflex muscle contraction mediated by lower
motor reflex arc
Hyperreflexia = Upper motor neuron lesion
Hyporeflexia = ower motor neuron lesion
Clonus = severe hyperreflexia; repeated
rhythmic contraction elicited by striking a
tendon/dorsiflexing the ankle
3. Reflexes to assess meningeal irritation
ernig's sign:
%he client is placed in supine position.
lex the knee.
%he client attempts to extend the leg.
Pain is experienced.
Brudzinki's sign:
%he client is placed in a supine position
Passively flex the neck
Spontaneous flexion of the hips occurs, and
resistance and pain on the neck are
experienced
4. Other Reflexes
Reflex Segment
Biceps C5, C6
%riceps C6, C7
Brachioradialis C5, C6
Plantar 5, S1
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