Additional Information
Book Details
Abstract
Neurological Assessment is a quick reference tool to identifying those all important links to pathology and physiology – crucial for efficient clinical reasoning and ultimately better patient care. Based around one potential sub-problem encountered by neurologically-impaired patients, each assessment chapter begins with a Summary Bite and then provides photographic guidance on how to examine and define the problem with an explanation as to why it is important to assess it. All sections give detailed reasoning on any possible findings from the assessment technique and an example of how to record the procedure. Blank notes areas throughout encourage the clinician to reflect on the technique carried out and to consider the overall impression from the patient, so facilitating the process of clinical reasoning.
Part of the Physiotherapist’s Toolbox Series – unlock your key skills! Perfect for use on placement and in the clinic.
- Highly illustrated with clear step-by-step guidance
- Includes five main pathologies and basic neuroanatomy to support clinical reasoning
- Primarily aimed at guiding clinical assessment
- Hints, Tips and Caution boxes provide easy to digest small packages of information essential to clinical practice
- All sections follow the same structure and format for ease of use
- Spiral-binding allows for easy, lie-flat reference
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Neurological Assessment | i | ||
| Copyright page | iv | ||
| Table of Content | v | ||
| Acknowledgements | viii | ||
| Introduction | ix | ||
| Aim | ix | ||
| Content | ix | ||
| Structure of the text | x | ||
| Use of this text | x | ||
| 1 Pathology (key facts) | 1 | ||
| Introduction | 1 | ||
| Definition | 1 | ||
| Epidemiology | 1 | ||
| Aetiology | 1 | ||
| Pathology | 1 | ||
| Signs and symptoms | 2 | ||
| 1 Cerebrovascular accident | 3 | ||
| Definition | 3 | ||
| Epidemiology | 3 | ||
| Prevalence | 3 | ||
| Age | 4 | ||
| Gender | 4 | ||
| Aetiology | 4 | ||
| Ischaemia (80% of strokes) | 4 | ||
| Haemorrhage (20% of strokes) | 4 | ||
| Intracranial haemorrhage | 4 | ||
| Intra-axial | 4 | ||
| Extra-axial | 4 | ||
| Intracerebral haemorrhage | 5 | ||
| Transient ischaemic attack (TIA) | 5 | ||
| Pathology | 5 | ||
| Thrombosis formation | 5 | ||
| Atheroma formation | 5 | ||
| Aneurysm formation | 6 | ||
| Arteriovenous malformation | 7 | ||
| Outcome and prognosis | 7 | ||
| Signs and symptoms | 8 | ||
| Physical | 8 | ||
| Speech (S3.16) | 8 | ||
| Swallow (S3.16) | 8 | ||
| Sensorimotor | 8 | ||
| Cognitive and perceptual (S3.16, 17, 18, 33Chapter 16Chapter 17Chapter 18Chapter 33) | 8 | ||
| Secondary complications | 9 | ||
| References and Further Reading | 9 | ||
| 2 Multiple sclerosis | 10 | ||
| Definitions | 10 | ||
| Benign MS | 10 | ||
| Relapsing remitting MS | 11 | ||
| Secondary progressive MS | 11 | ||
| Primary progressive MS | 11 | ||
| Epidemiology | 11 | ||
| Prevalence | 11 | ||
| Age | 11 | ||
| Gender | 11 | ||
| Geography | 11 | ||
| Aetiology | 11 | ||
| Environmental factors | 12 | ||
| Viral infection | 12 | ||
| Vitamin D deficiency | 12 | ||
| Other factors: environmental | 12 | ||
| Genetic factors | 12 | ||
| Familial | 12 | ||
| Specific genes | 12 | ||
| Pathology | 12 | ||
| The process of demyelination | 12 | ||
| Axonal loss | 13 | ||
| Outcome and prognosis | 13 | ||
| Signs and symptoms | 13 | ||
| Physical | 14 | ||
| Speech (S3.16) | 14 | ||
| Swallow (S3.16) | 15 | ||
| Sensorimotor | 15 | ||
| Cognitive and perceptual (S3.16, 17, 18, 33Chapter 16Chapter 17Chapter 18Chapter 33) | 15 | ||
| Secondary complications | 15 | ||
| References and Further Reading | 15 | ||
| 3 Parkinson’s disease | 17 | ||
| Definition | 17 | ||
| Epidemiology | 17 | ||
| Prevalence | 17 | ||
| Ethnic background | 17 | ||
| Age | 17 | ||
| Gender | 18 | ||
| Aetiology | 18 | ||
| Environmental factors | 18 | ||
| Toxins | 18 | ||
| Recreational drug abuse | 18 | ||
| Head trauma | 18 | ||
| Genetic | 18 | ||
| Pathology | 18 | ||
| Outcome and prognosis | 19 | ||
| Signs and symptoms | 19 | ||
| Motor | 19 | ||
| Sensory | 20 | ||
| Cognitive | 21 | ||
| Other | 21 | ||
| Secondary complications | 21 | ||
| References and Further Reading | 22 | ||
| 4 Motor neuron disease | 23 | ||
| Definition | 23 | ||
| Amyotrophic lateral sclerosis (ALS) | 23 | ||
| Progressive muscular atrophy (PMA) | 24 | ||
| Primary lateral sclerosis (PLS) | 24 | ||
| Progressive bulbar palsy (PBP) | 24 | ||
| Epidemiology | 24 | ||
| Prevalence | 24 | ||
| Age | 24 | ||
| Gender | 24 | ||
| Aetiology | 24 | ||
| Familial MND | 24 | ||
| SOD1 (superoxide dismutase1) (20% of all familial cases) | 25 | ||
| Other genes | 25 | ||
| Sporadic MND | 25 | ||
| Pathology | 26 | ||
| Cellular mechanisms | 26 | ||
| Aggregation (clumping) | 26 | ||
| Oxidative stress | 26 | ||
| Glutamate toxicity | 26 | ||
| Mitochondria failure | 26 | ||
| Transport disruption | 26 | ||
| Abnormal glial cells | 26 | ||
| Outcome and prognosis | 27 | ||
| Signs and symptoms | 27 | ||
| Motor | 27 | ||
| Amyotrophic lateral sclerosis (ALS) | 27 | ||
| Progressive muscular atrophy (PMA) | 27 | ||
| Primary lateral sclerosis (PLS) | 28 | ||
| Progressive bulbar palsy (PBP) | 28 | ||
| Secondary complications | 28 | ||
| References and Further Reading | 28 | ||
| 5 Guillain–Barré syndrome | 30 | ||
| Definition | 30 | ||
| Acute inflammatory demyelinating polyneuropathy (AIDP) | 30 | ||
| Acute motor axonal neuropathy (AMAN) | 30 | ||
| Chronic inflammatory demyelinating polyneuropathy (CIDP) | 31 | ||
| Epidemiology | 31 | ||
| Prevalence | 31 | ||
| Age | 31 | ||
| Gender | 31 | ||
| Aetiology | 31 | ||
| Pathology | 31 | ||
| Demyelination | 31 | ||
| Axonal loss | 32 | ||
| Outcome and prognosis | 32 | ||
| Signs and symptoms | 32 | ||
| Motor | 33 | ||
| Sensory | 33 | ||
| Autonomic dysfunction | 33 | ||
| Secondary complications | 33 | ||
| References and Further Reading | 34 | ||
| 2 Functional Neuroanatomy | 35 | ||
| Introduction | 35 | ||
| 6 Introduction to excitable tissue | 37 | ||
| Basic anatomy | 37 | ||
| Neurons | 37 | ||
| Function of a neuron | 39 | ||
| Resting potential | 39 | ||
| Graded potential | 39 | ||
| Action potential | 39 | ||
| Summation | 40 | ||
| Conduction along a neuron | 40 | ||
| Synaptic transmission | 40 | ||
| References and Further Reading | 41 | ||
| 7 The cerebral cortex | 42 | ||
| Basic anatomy | 42 | ||
| Hemispheres | 42 | ||
| Grey/white matter | 42 | ||
| The internal capsule | 43 | ||
| Connections | 43 | ||
| Cells of the cerebral cortex | 45 | ||
| Neurons | 45 | ||
| Glial cells | 45 | ||
| Function of the cerebral cortex | 45 | ||
| Overview | 45 | ||
| Sensory | 46 | ||
| Motor | 47 | ||
| Anatomical areas and their function linked to assessment | 47 | ||
| References and Further Reading | 54 | ||
| 8 Meninges, ventricular system and blood supply | 55 | ||
| Meninges | 55 | ||
| Basic anatomy | 55 | ||
| Dura mater | 55 | ||
| Arachnoid mater | 56 | ||
| Pia mater | 57 | ||
| Function of the meninges | 57 | ||
| The ventricular system | 57 | ||
| Basic anatomy | 57 | ||
| Ventricles | 57 | ||
| Cerebrospinal fluid | 57 | ||
| Function of the ventricular system | 57 | ||
| Circulatory systems of the brain | 58 | ||
| Arterial supply | 58 | ||
| Basic anatomy | 58 | ||
| Anterior circulation | 58 | ||
| Posterior circulation | 58 | ||
| The circle of Willis | 60 | ||
| Function of the arterial supply | 60 | ||
| The vertebral arteries | 60 | ||
| The basilar artery | 60 | ||
| The anterior cerebral arteries | 60 | ||
| The middle cerebral arteries | 61 | ||
| The posterior cerebral arteries | 61 | ||
| The blood–brain barrier | 61 | ||
| Venous drainage | 61 | ||
| Basic anatomy | 61 | ||
| Superficial | 61 | ||
| Deep | 62 | ||
| Function of venous drainage | 62 | ||
| References and Further Reading | 62 | ||
| 9 Thalamus and limbic system | 63 | ||
| Basic anatomy OF THE THALAMUS | 63 | ||
| Function of the thalamus | 64 | ||
| Function of the thalamic nuclei | 65 | ||
| The anterior part | 65 | ||
| The medial part | 65 | ||
| The lateral part/dorsal tier | 65 | ||
| The lateral part/ventral tier | 65 | ||
| Intralaminar nuclei | 66 | ||
| Paramedian nuclei | 66 | ||
| Geniculate nuclei | 66 | ||
| The limbic system | 66 | ||
| Basic anatomy and function of the expression of emotional behaviour | 66 | ||
| Involuntary movement | 67 | ||
| Visceral motor response | 67 | ||
| Sympathetic nervous system | 67 | ||
| Parasympathetic nervous system (including the enteric division) | 68 | ||
| Posture | 68 | ||
| Voluntary movement | 68 | ||
| Facial expression | 68 | ||
| Posture and distal movement | 68 | ||
| Basic anatomy and function OF the control of emotional behaviour | 68 | ||
| Hypothalamus | 69 | ||
| Cingulate gyrus | 69 | ||
| Amygdala | 69 | ||
| Medial and orbital pre-frontal lobe | 69 | ||
| Mamillary body | 69 | ||
| Hippocampus | 69 | ||
| Parahippocampus | 70 | ||
| References and Further Reading | 70 | ||
| 10 Brain stem, cranial nerves, visual system, vestibular system, reticular system | 71 | ||
| Brain stem | 72 | ||
| Basic anatomy | 72 | ||
| Mid-brain | 72 | ||
| Pons | 72 | ||
| Medulla oblongata | 72 | ||
| Function of the brain stem | 73 | ||
| Cranial nerves | 73 | ||
| Basic anatomy | 73 | ||
| Motor nuclei | 73 | ||
| Sensory nuclei | 73 | ||
| Mixed nuclei | 75 | ||
| Assessment of the cranial nerves | 75 | ||
| Visual system | 76 | ||
| Basic anatomy | 76 | ||
| The visual pathway | 76 | ||
| Function of the visual system | 76 | ||
| Binocular vision | 76 | ||
| Central or foveal vision | 76 | ||
| Peripheral vision | 76 | ||
| Visual acuity | 76 | ||
| Fixing (S3.27) | 78 | ||
| Scanning (S3.27) | 78 | ||
| Visual fields (S3.27) | 78 | ||
| Visual perception | 78 | ||
| Vision and movement | 78 | ||
| Vestibular system | 79 | ||
| Basic anatomy | 79 | ||
| Input to the vestibular system | 79 | ||
| Vestibule | 79 | ||
| Semicircular canals | 80 | ||
| Output from the vestibular system | 82 | ||
| Function of the vestibular system | 82 | ||
| Vestibule | 82 | ||
| Semicircular canals | 83 | ||
| Assessment of the vestibular system | 83 | ||
| Reticular system | 84 | ||
| Basic anatomy | 84 | ||
| Afferent connections | 84 | ||
| Efferent connections | 84 | ||
| Function of the reticular formation | 84 | ||
| Cardiovascular and respiratory control | 84 | ||
| Modulation of muscle tone | 85 | ||
| Pain modulation | 85 | ||
| Regulation of the sleep/wake cycle | 85 | ||
| References and Further Reading | 86 | ||
| 11 Basal ganglia | 87 | ||
| Basic anatomy | 87 | ||
| Function of the basal ganglia | 87 | ||
| Function of the BG in motor control | 89 | ||
| The big picture | 89 | ||
| The detail | 89 | ||
| At rest | 89 | ||
| During movement | 90 | ||
| Function in motor learning | 90 | ||
| References and Further Reading | 90 | ||
| 12 Cerebellum | 92 | ||
| Basic anatomy | 92 | ||
| The deep cerebellar nuclei | 92 | ||
| The functional loops | 93 | ||
| The cerebrocerebellum | 93 | ||
| The vestibulocerebellum | 93 | ||
| The spinocerebellum | 93 | ||
| The olivocerebellum | 93 | ||
| Peduncles | 93 | ||
| Afferent connections | 93 | ||
| Efferent connections | 94 | ||
| The intrinsic circuitry within the cerebellum | 95 | ||
| Function of the cerebellum | 97 | ||
| Cerebrocerebellum | 97 | ||
| Vestibulocerebellum | 97 | ||
| Spinocerebellum | 97 | ||
| The detail | 98 | ||
| References and Further Reading | 98 | ||
| 13 The spinal cord and spinal reflexes | 100 | ||
| Basic anatomy and function of the spinal cord | 100 | ||
| Gross anatomy | 100 | ||
| Grey and white matter | 100 | ||
| Central pattern generators (CPG) | 101 | ||
| Spinal nerves | 102 | ||
| Cauda equinus | 102 | ||
| Lower motor neuron/final common pathway and upper motor neuron | 102 | ||
| The lower motor neuron/final common pathway | 103 | ||
| Spinal root or spinal nerve | 103 | ||
| Peripheral nerve | 103 | ||
| The upper motor neuron | 104 | ||
| Basic anatomy and function of spinal reflexes | 104 | ||
| Stretch reflex | 104 | ||
| Phasic stretch reflex | 105 | ||
| 3 Clinical Assessment | 115 | ||
| Introduction | 115 | ||
| Body structures and functions | 116 | ||
| Activities | 116 | ||
| Participation | 117 | ||
| Contextual factors | 117 | ||
| Environmental factors (extrinsic influences) | 117 | ||
| Personal factors (intrinsic influences) | 117 | ||
| Evidence-based practice in assessment | 117 | ||
| Subjective assessment | 118 | ||
| Summary | 118 | ||
| What is a subjective assessment? | 119 | ||
| Why should I do a subjective assessment? | 119 | ||
| How do I do a subjective assessment? | 120 | ||
| Where do I start? | 120 | ||
| Informed consent | 120 | ||
| Data collection | 120 | ||
| Objective assessment | 121 | ||
| Summary | 121 | ||
| What is an objective assessment? | 122 | ||
| Why do I need to do an objective assessment? | 122 | ||
| How do I do an objective assessment? | 122 | ||
| Where do I start? | 122 | ||
| Risk assessment | 123 | ||
| Informed consent | 123 | ||
| Data collection | 123 | ||
| Recording | 124 | ||
| Impression | 124 | ||
| Limitations | 125 | ||
| Creating a problem list | 125 | ||
| Body structure and function | 125 | ||
| Activities | 125 | ||
| Participation | 126 | ||
| Creating smart patient-centred goals | 126 | ||
| Example: short-term goal | 126 | ||
| Example: long-term goal | 126 | ||
| References and Further Reading | 126 | ||
| 16 Subjective assessment | 128 | ||
| Personal information | 129 | ||
| Present complaint (PC) | 129 | ||
| History of present complaint (HPC) | 129 | ||
| Date of onset of the signs/symptoms | 129 | ||
| Progression of the condition | 130 | ||
| Investigations and results | 130 | ||
| Medical management | 131 | ||
| Medical observations | 131 | ||
| Other management | 131 | ||
| Previous therapy | 131 | ||
| Pain | 131 | ||
| Past medical history (PMH) | 132 | ||
| Co-morbidities | 132 | ||
| Previous surgery | 132 | ||
| Technology dependency | 132 | ||
| Special equipment | 132 | ||
| Risk factors | 132 | ||
| Previous neurological conditions | 132 | ||
| Drug history (DH) | 132 | ||
| Social history (SH) | 133 | ||
| The setting | 133 | ||
| The level of function of the patient | 133 | ||
| Activities of daily living (ADL) | 134 | ||
| Personal ADL (PADL) | 134 | ||
| Washing | 134 | ||
| Dressing | 134 | ||
| Feeding/drinking | 135 | ||
| Toileting | 135 | ||
| Domestic ADL (DADL) | 135 | ||
| Cooking | 135 | ||
| Cleaning | 135 | ||
| Shopping | 135 | ||
| Mobility | 136 | ||
| General mobility | 136 | ||
| Walking indoors | 136 | ||
| Walking outdoors | 136 | ||
| Stairs and steps | 136 | ||
| Falls | 136 | ||
| Other | 137 | ||
| Environment | 137 | ||
| Psychosocial | 137 | ||
| Personal factors | 138 | ||
| Life style | 138 | ||
| Support | 138 | ||
| Family situation | 138 | ||
| Planning the objective assessment | 138 | ||
| Reference | 139 | ||
| 17 Objective assessment (general observation) | 140 | ||
| Vision | 140 | ||
| Hearing | 140 | ||
| Communication | 140 | ||
| Cognition and perception | 141 | ||
| General appearance | 141 | ||
| Behaviour | 141 | ||
| Exercise tolerance | 141 | ||
| 18 Objective assessment (functional assessment) | 142 | ||
| Observation of how the patient moves | 142 | ||
| Patient | 142 | ||
| Therapist | 142 | ||
| Functional ability | 143 | ||
| The quality of performance/movement analysis | 143 | ||
| Normal requirements of the task | 143 | ||
| Patient observation | 144 | ||
| Analysis | 146 | ||
| References | 146 | ||
| 19 Gait | 148 | ||
| What is gait? | 148 | ||
| Stance phase (Fig. 19.1) | 150 | ||
| Swing phase (Fig. 19.2) | 150 | ||
| Why do I need to assess gait? | 150 | ||
| How do I do gait analysis? | 151 | ||
| Observation | 151 | ||
| Patient | 151 | ||
| Therapist | 151 | ||
| Recording | 152 | ||
| Example | 152 | ||
| Analysis | 153 | ||
| Outcome measures | 154 | ||
| Research | 154 | ||
| Clinical | 154 | ||
| References and Further Reading | 154 | ||
| 20 Postural alignment | 155 | ||
| What is postural alignment? | 155 | ||
| Why do I need to assess postural alignment? | 156 | ||
| How do I assess postural alignment? | 157 | ||
| Observation | 157 | ||
| Patient | 157 | ||
| Therapist | 157 | ||
| Recording | 159 | ||
| Example | 159 | ||
| Analysis | 162 | ||
| Example | 162 | ||
| Outcome measures | 163 | ||
| Research | 163 | ||
| Clinical | 163 | ||
| References and Further Reading | 163 | ||
| 21 Muscle tone | 164 | ||
| What is normal muscle tone? | 164 | ||
| Non-neural factors | 165 | ||
| Neural factors | 165 | ||
| What is abnormal muscle tone? | 166 | ||
| Hypotonia | 167 | ||
| Definition | 167 | ||
| Pathophysiology of hypotonia | 167 | ||
| Hypertonia | 168 | ||
| Rigidity defined | 168 | ||
| Pathophysiology of rigidity | 168 | ||
| Neural factors | 168 | ||
| Non-neural | 169 | ||
| Hypertonia (related to spasticity) defined | 169 | ||
| Pathophysiology of hypertonia (related to spasticity) | 170 | ||
| Neural factors | 170 | ||
| Non-neural | 171 | ||
| Why do I need to assess muscle tone? | 171 | ||
| How do I assess muscle tone? | 172 | ||
| Observation | 172 | ||
| Patient | 172 | ||
| Therapist | 172 | ||
| Palpation | 173 | ||
| Index | 323 |