Vision is obscured, use identifiable smell under one nostril at a time; Only tested when patient c/o difficulty smelling not associated with congestion
CN II (optic)
Test visual acuity, visual fields, use ophthalmoscope to visualize ocular fundus
CN III, IV, VI (oculomotor, trochlear, abducens)
Check for ptosis, PERRLA, EOMs (ask about diplopia), Nystagumus
CN V (trigeminal)
Test motor and sensory function - muscles of mastication, corneal/blink reflex, check all 3divisions of nerve (ophthalmic, maxillary, mandibular) for light touch & sharp vs dull sensation, muscle strength
CN VII (facial)
Test facial mobility and symmetry (smile, frown, raise eyebrows, puff out cheeks), If indicated check sense of taste with sugar, salt, lemon juice (not routine testing)
CN VIII (acoustic/vestibulocochlear)
Test ability to hear normal conversation, whisper test, Weber (tuning fork on top of head, where is sound from) & Rinne (turning fork near ear, when does sound stop) tests, Visualize TM & cone of light with otoscope
CN IX, X (glossopharyngeal, vagus)
Test motor function of palate & uvula, gag reflex, swallow ability; Sensory function not generally tested (CN 9 controls taste on posterior 1/3 of tongue)
CN XI (spinal accessory)
Examine sternomastoid and trapezius muscles for size & strength (turn head, shrug shoulders against resistance)
CN XII (hypoglossal)
Inspect tongue for wasting or tremors; Have client stick out tongue and say light, tight, dynamite
on a scale of 0-5/5: 0 = no contraction, 1 = muscle flicker, but no movement, 2 = movement possible, but not against gravity, 3 = movement possible against gravity, but not against resistance, 4 = movement possible against some resistance, 5 = normal strength
How is muscle tone assessed?
move extremities through PROM
How is balance assessed?
using gait, tandem walking, Romberg, knee bend/hop in place one leg at a time, rapid alternating movements, finger to nose/finger to finger, heel to shin
How are deep tendon reflexes (DTRs) rated?
on a 4 point scale: 0 = no response, 1 = hypoactive, 2 = normal, 3 = more than normal, 4 = hyperactive
What reflexes are elicited during an exam?
biceps, triceps, brachioradialis, quadriceps (knee jerk), Achilles (ankle jerk), and test for clonus by briskly dorsiflexing the foot
Light touch, Pain & Temperature, Vibration, Position sense (kinesthesia), Tactile discrimination (stereognosis, graphesthesia, two-point discrimination, extinction, point location)
What is sensoristasis?
optimal state of sensory arousal (not overloaded, not deprived)
What is often the response to sensory deprivation?
person becomes more aware of remaining stimulus and perceives it in a disoriented manner
What is often the response to sensory overload?
person is unable to process the amount/intensity of stimuli (3 factors contribute – internal stimuli, external stimuli, inability to disregard stimuli selectively)
What are sensory deficits?
impaired reception, perception (or both) of one or more of the senses (e.g. blindness, deafness)
What is social deprivation?
withdrawal from contact to avoid embarrassment or dependence on others (reports of lack of meaningful communication with others,absence of opportunities to discuss fears or concerns that facilitate coping mechanisms)
What is cultural deprivation?
lack of culturally assistive, supportive, or facilitative acts
Interventions for clients with sensory deprivation
encourage use of glasses, hearing aides; communicate frequently, maintain meaningful interactions; provide art, media, clocks, textured objects, social interaction, crosswords/games
Interventions for clients with sensory overload
minimize unnecessary light, noise, and distraction; provide dark glasses/earplugs; control pain; provide orienting cues; private room, limit visitors; speak in low tones, give new info gradually
Supporting visual function
announce your presence, stay in field of vision, speak in warm, pleasant tones, explain before touching, explain sounds in environment, indicated when conversation has ended and you are leaving the room
Supporting auditory function
convey presence before initiating conversation, decrease background noise, talk at moderate rate/normal tone, do not over-articulate, make sure person can see you easily, change subject at slower rate
Promoting orientation to TPP
provide consistent caregiver, address person by name, introduce yourself, identify time/place, place calendar/clock in room, encourage family to visit, schedule activities, provide adequate sleep
What is the goal of a Coma Stimulation Program?
to prevent environmental sensory deprivation which may slow recovery and development of CNS function and further depress impaired brain functioning
What is the goal of a TBI MinStim Program?
to prevent sensory overload by keeping stimulation within parameters that allow for the possible slower cognitive functions associated with TBI