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central nervous system examination

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central nervous system examination

  1. 1. Examination Examination of cEntral nErvous systEm Dr. Shalu Jain MD Scholar Pt. Khushilal Sharma Govt. Auto. Ayurveda College And Institute, Bhopal (M.P.) Examination Examination cEntral nErvous systEm Jain MD Scholar College And Institute, Bhopal (M.P.)
  2. 2. INTRODUCTION  The purpose of CNS examination is to determine the presence or absence of disease in the nervous system . system .  These are involve in examining the neurological & physical status of the patient as part of the total physical assessment .  History taking  General examination  General examination  Systemic examination ( CNS ) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) The purpose of CNS examination is to determine the presence or absence of disease in the nervous These are involve in examining the neurological & physical status of the patient as part of the Systemic examination ( CNS ) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  3. 3. Aspects of CNS Examination....  Higher Functions  Higher Functions  Cranial Nerves  Sensory System  Motor System  Reflexes  Reflexes Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Aspects of CNS Examination.... Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  4. 4. HIGHER FUNCTIONS HIGHER FUNCTIONS 1. Consciousness 1. Consciousness 2. Orientation 3. Intelligences 4. Memory 5. Language and speech 5. Language and speech Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) HIGHER FUNCTIONS HIGHER FUNCTIONS Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  5. 5. CONSCIOUSNESS  Consciousness is a state of awareness of one’s self and one’s environment. one’s environment. Level of consciousness:-  Sleep  Catatonia  Akinetic mutism  Drowsiness  Semicoma  Stupor  coma Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Consciousness is a state of awareness of one’s self and Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  6. 6. ASSESSMENT OF LEVEL OF ASSESSMENT OF LEVEL OF CONSCIOUSNESS CONSCIOUSNESS Glasgow Coma Scale Abbreviated Coma Scale Glasgow Coma Scale (GCS) GCS is useful in assessing level of consciousness in a patient with head injury. Best Total sore - 15 Mild injury - 13 -15 Abbreviated Coma Scale (AVPU) A alert V responds to vocal stimuli P respond to pain U unresponsive Mild injury - 13 -15 Moderate injury 9 – 12 Severe injury 8 Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) ASSESSMENT OF LEVEL OF ASSESSMENT OF LEVEL OF Abbreviated Coma Scale Abbreviated Coma Scale (AVPU) alert responds to vocal stimuli respond to pain unresponsive Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  7. 7. ORIENTATION Questions are put to the patients to test his orientation to orientation to  Time  Place  Person TIME PLACE Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Questions are put to the patients to test his PERSON Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  8. 8. Memory It is the power to retain and recall past experience. It can be tested by mini mental state examination (MMSE) It can be tested by mini mental state examination (MMSE) Components of memory  Reception  Registration a. Immediate or short term memory  Registration  Retention  Recall b. Recent memory c. Long term or secondary or remote memory Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) It is the power to retain and recall past experience. It can be tested by mini mental state examination (MMSE) It can be tested by mini mental state examination (MMSE) Immediate or short term memory Types of memory Recent memory Long term or secondary or remote memory Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  9. 9. Examination of Cranial nerves Cranial nerves are a set of twelve nerves that has a different function for sense or movement 1. 3 11 Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Examination of Cranial nerves that originate in the brain. Each movement. 2 8 4 6 8 12 Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  10. 10. Olfactory nerve  Function: Smell Optic nerve  Function: eye to brain  Examination: Block one nostril. Get patient to smell strong distinctive smell (coffee, lemon, cinnamon).  Normal: If patient can identify smell with both nostrils – olfactory nerve intact.  Examination: Acuity: Read 2. Visual (for each 3. Pupillary  Normal: both pupillary light reflex  Palsy/Lesion: Unilateral loss of smell – lesion Generally from trauma, meningitis. light reflex  Palsy one or both Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Optic nerve Function: Visual transmission – brain Examination: 1. Visual Read snellen chart. Visual fields – finger wiggle each eye) Pupillary light reflex Normal: Consensual response to pupillary light and swinging reflex reflex Palsy: visual acuity is reduced in one or both eyes Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  11. 11. Oculomotor Nerve  Function: eye movement. Trochlear  Function: Oblique  Examination: . Look for ptosis, eye position and nystagmus, inspect pupil for PERRLA  Examination Look for nystagmus PERRLA Normal: Consensual pupil responses No diplopia or nystagmus Palsy: Ptosis PERRLA  Palsy Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Trochlear nerve Function: Innervates Superior Oblique Examination: Examination: Look for ptosis, eye position and nystagmus, inspect pupil for PERRLA PERRLA Palsy: Intorsion Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  12. 12. Trigeminal nerve Function:  Sensory to the face by ophthalmic, maxillary, mandibular  Motor: Muscles of mastication  Examination: Point touch with cotton wool/ tissue, pain using a sharp point,  Corneal reflex: rapid blinking of the eye lids  Motor: Inspect. Palpate temporalis and masseters clenches the jaw, pterygoids – mouth open against resistance, jaw  Normal: even feeling of sensation, both eyelids reflex, able to clench jaw, no jaw jerk reflex, able to clench jaw, no jaw jerk  Palsy: wasting of temporalis or masseter, unable close mouth Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) lids from a sudden stimulus masseters as patient mouth open against resistance, jaw jerk eyelids respond to corneal unable to resist pressure to Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  13. 13. Facial nerve Function: Sensory - Taste (Anterior 2/3 of the of facial expression  Examination:  Sensory: Test Taste of distinctive flavours test of olfactory).  Motor: 1) raise both eyebrows 2) screw eyes muscular strength 3) smile 4) bare teeth (show teeth) 6) puff out cheeks  Palsy: Bell’s Palsy (central/peripheral) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) the tongue); Motor – Muscles flavours (similar to the smell eyes up, try to pull to test (show both upper and lower Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  14. 14. Vestibulocochlear nerve  Function: Hearing  Function: Hearing  Examination: 1) Whisper a number into patient’s time. Ask the patient to repeat the numbers  2) Rinne Test 3) WeberTest  Normal: 1. Correct number 2. Air conduction louder than bone 3. Hear the tuning fork in both ears equally  Palsy: in middle year disease bone conduction is better then air conduction Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) patient’s ears. One at a Normal: 1. Correct number 2. Air conduction louder than bone 3. Palsy: in middle year disease bone conduction is better then air Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  15. 15. Spinal  Function SCM and Function: Swallowing, Gag Reflex Glossopharyngeal , Vagus nerve  Examination: patient shrug (against  Normal: Symmetrical movements Reflex Examination: Gag response Palsy: Abnormal Cough on swallowing movements Able  Palsy: unable Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) SpinalAccessory Function: Innervation to SCM and Trapezius. Examination: Ask patient to turn head, shrug shoulders (against resistance). Normal: Symmetrical movements performed. movements performed. Able to resist pressure Palsy: Muscle wasting, unable to resist pressure Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  16. 16. Hypoglossal Nerve  Function: movement of tongue  Function: movement of tongue  Examination: Inspect for tongue fasciculations atrophy. Ask patient to poke out their tongue  Normal: No deviation of the tongue on protrusion  Palsy: Will deviate ipsilateral to the paralysis and contralateral to the lesion contralateral to the lesion Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) fasciculations, asymmetry or protrusion to the paralysis and Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  17. 17. Modalities of sensation to be tested :  Exteroceptive Senstion /Superficial sensation  Exteroceptive Senstion /Superficial sensation  Proprioceptive Sensations  Cortical sensations Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Modalities of sensation to be tested :- /Superficial sensation /Superficial sensation Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  18. 18. Exteroceptive Senstion /Superficial sensation Touch  Fine touch – tested by cotton Pain  Superficial pain:  Fine touch – tested by cotton wool  Crude touch – by blunt object Temperature Two test tubes one containing hot water and the other  Superficial pain: pin prick  Deep pain : the calves, containing hot water and the other crushed ice is taken and placed on all the parts of the body Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) /Superficial Superficial pain:- tested with a Superficial pain:- tested with a pin prick Deep pain :- tested by pressing the calves, tendo achilis or testis. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  19. 19. Proprioceptive sensation/ Deep sensation Position sense  A part of limb / arm is placed in Joint sense  Fixing  A part of limb / arm is placed in definite position and then he is asked to denote the position or place the other limb in similar position.  Fixing moved joint holding  Patient either Vibration Assessment of vibration sense by tuning fork(128 Hz) is applied on bony prominences . Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) sensation/ Deep Joint sense Fixing the joint, the finger/ toe is Fixing the joint, the finger/ toe is moved at terminal interphalangeal , either up or down by holding the sides of digits. Patient to tell the direction i.e. either up or down. by tuning fork(128 Hz) is College And institute, Bhopal (M.P)
  20. 20. Cortical Sensory Functions Localzation Test  Touch a part of patient body with his eyes closed  Ask him to open the eyes and Two Point Discrimination Test  Ability to distinguish the contact of two separate points applied simultaneously to the  Ask him to open the eyes and place his finger of that part applied simultaneously to the skin Tactile Extinction Test Tactile Extinction Test When two stimuli are applied simultaneously to two symmetrical portion of the body, the patient neglect the one on the opposite side the lesion,. Though individually he appriciates the stimulus on both side. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Cortical Sensory Functions Two Point Discrimination Test Ability to distinguish the contact of two separate points applied simultaneously to the applied simultaneously to the simultaneously the of the Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  21. 21. Cont. Graphasthesia  The ability to recognize a number or letter written in the Stereognosis  The suitable object after careful number or letter written in the palm with closed eyes.  This ability is lost in sensory cortex lesion suitable object after careful palpation.  This ability is lost in sensory cortex lesion Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Stereognosis The abilty to identify a suitable object after careful suitable object after careful palpation. This ability is lost in sensory cortex lesion Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  22. 22. Examination of Motor System Motor system is examined under following headings. These points are very useful in examine the points are very useful in examine the Hemiplegia  Nutrition  Tone  Power  Co-ordination  Co-ordination  Involuntary movements Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) System system is examined under following headings. These the patient of the patient of Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  23. 23. Nutrition  Nutrition is tested by measuring circumference of muscles, at bulk and comparing circumference of left and right  Circumference of muscle can be measured distance from bony prominence.  For upper limb (arm & forearm) -10 cm above and below the olecronon process.  For lower limb (thigh & calf region) -16 cm above  10 cm below the tibial tuberosity (knees) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) by measuring circumference of muscles, at bulk right side. measured by fixing the 10 cm above and below the 16 cm above patela Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  24. 24. Cont.  When circumference of both right and left indicates nutrition of these muscles is normal.  When it abnormal it may  Atrophy or wasting of muscle is seen in LMN myelitis  Hypertrophy of muscle is seen in UMN lesion Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) When circumference of both right and left sides is normal it normal. LMN lesion like polio lesion Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  25. 25. Tone  Its resistance offered by noramal muscle to passive movements.  It is greatest in those muscles that maintain the body in  It is greatest in those muscles that maintain the body in position.  Tone of the muscle is tested by 2 ways  By examining feel of the muscle  Tone can be seen by Resistance offered Movements.  Normal feel is Elastic.  Hypertonia is seen in UMN lesion  Hypotonia is seen in LMN lesion Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) muscle to passive It is greatest in those muscles that maintain the body in It is greatest in those muscles that maintain the body in ways offered to passive Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  26. 26. Power of Muscles The power of all muscles should be tested at each joint in both the upper and lower limb. MRC (Medical Research Council) Scale for strength is a commonly used scale for assessing muscle strength. used scale for assessing muscle strength.  Grade 0 - No movements at all.  Grade 1 - Only flickering movement are visible but no movements possible  Grade 2 - If movement is occurring horizontally but not against gravity.  Grade 3 - If subject is able to lift up leg or hand, gravity (compare the right and left side) gravity (compare the right and left side)  Grade 4 - Patient is able to move his extremities against resistance  Grade 5 - Patient is able to lift the extremities against the good resistance applied by the Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) The power of all muscles should be tested at each joint in both the for strength is a commonly visible but no movements If movement is occurring horizontally but not able to lift to lift up leg or hand, against his extremities extremities the doctor. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  27. 27. Cont.  Complete loss of power is called as  Complete loss of power is called as typical feature of LMN lesion like  Partial loss of power is called as "paresis" which typically seen in Hemiplegia or Paraplegia Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) as 'paralysis' which is as 'paralysis' which is lesion like polio myelitis "paresis" which is Paraplegia. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  28. 28. Co-ordination of Muscles  Co-ordination means the smooth recruitment interaction and co operation of separate muscle or group of muscles in order to operation of separate muscle or group of muscles in order to accomplish a definite motor act.  If it is imperfect it is called ataxia that means the motor action becomes difficult and impossible.  Causes of ataxia  cerebellar  Sensory  Labyrinthine  Labyrinthine  Central  How to test- all test of co-ordination performs first with eyes open and then with eyes close. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Muscles ordination means the smooth recruitment interaction and co- operation of separate muscle or group of muscles in order to operation of separate muscle or group of muscles in order to If it is imperfect it is called ataxia that means the motor action ordination performs first with eyes open Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  29. 29. Co-ordination Tests Romberg’s test Finger nose test Tandem walking Knee heel test Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Finger nose test Postural holding Postural holding Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  30. 30. Cont.  If patient walks correctly with open eyes, but looses balance with  If patient walks correctly with open eyes, but looses balance with closed eyes - It indicates damage lies in dorsal column tract (which is called as sensory ataxia)  If patient is not able to walk with open or closed cerebellum (it is cerebellar or Motor ataxia) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) If patient walks correctly with open eyes, but looses balance with If patient walks correctly with open eyes, but looses balance with It indicates damage lies in dorsal column tract (which to walk with open or closed eyes damage is in ataxia) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  31. 31. Involuntary Movements  An involuntary movements occur when you move your body in an uncontrollable and intended way. uncontrollable and intended way.  These movements can be anything :-  Tremors  Chorea  Athetosis  Hemibellismus  Dystonia  Dystonia  Fasciculation  fibrillation Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Movements An involuntary movements occur when you move your body in an Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  32. 32. Tremors These are unintentional rhythmic muscle contraction movement. It is most common in all involuntary movements and can affect the hands, arms, head , face, voice, trunk and leg. • Fine Tremors – In Thyrotoxicosis, Tachycardia, weight loss, Intolerance to heat atmosphere ,Feeling excessive heat all the time. • Pin rolling tremors at rest In Parkinsonism • Action • Action diseases Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) These are unintentional rhythmic muscle contraction movement. It is most common in all involuntary movements and can affect the hands, arms, head , face, voice, trunk and leg. Pin rolling tremors at rest – In Parkinsonism Action tremor - In cerebellar Action tremor - In cerebellar diseases Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  33. 33. Reflexes  It is an involuntary and nearly instantaneous movement in response  It is an involuntary and nearly instantaneous movement in response to stimuli  In Superficial Reflexes - receptors are in skin or  In Deep Reflexes -receptors are in muscles  By convention the deep tendon reflexes are graded as follows:  0 = No Response (Absent)  1+ =Hypoactive  1+ =Hypoactive  2+ = A Brisk Response (Normal)  3+ = Hyperactive Without Clonus  4+ = Hyperactive Without Clonus Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) It is an involuntary and nearly instantaneous movement in response It is an involuntary and nearly instantaneous movement in response skin or mucous membrane muscles or tendons By convention the deep tendon reflexes are graded as follows: Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  34. 34. Superficial Reflexes Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  35. 35. Plantar Reflex  The normal plantar  The normal plantar reflex consists of flexion of the great toe or no response.  With dysfunction of the corticospinal tract, there is a positive Babinski sign, which consists of dorsiflexion of the great toe with an associated fanning of the other toes. fanning of the other toes. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  36. 36. Deep Tendon Reflexes Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  37. 37. Cont. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  38. 38. Gait  Circumduction gait –paralysis Gait is a person’s pattern of walking. Walking involves muscles that the body is propalled forward in arhythm There are numerous possibilities that may cause  Circumduction gait –paralysis  Diplegic gait /scissor gait – cerebral palsy  Neuroplegic gait- peroneal nerve palsy  Fascinating gait – parkinsonism  Cerebellar gait/ ataxic gait Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) involves balance and co-ordination of arhythm is called stride. an abnormal gait. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  39. 39. Sign of Meningeal Irritation Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Irritation Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  40. 40. Summary & Conclusion Central Nervous System Examination Higher Function Cranial Nerves Motor System Consciousness Orientation Memory Nutrition Tone Power Co-ordination Involuntary Movement Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Central Nervous System Examination Motor System Sensory System Reflexes ordination Touch Pain Temperature Jointsense Superficial Deep Jointsense Position Sense Vibration Tactile L Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)
  41. 41. Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P) Dr. Shalu jain @ Pt. Khushilal Sharma Govt. Auto. Ayurveda College And institute, Bhopal (M.P)

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