ADVANCE NEUROLOGICAL TESTS FOR PHYSIOTHERAPIST

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  1. Finger to nose test:-   In this test we ask the patient to touch his finger to his nose or can touch the physiotherapist finger while the patient performing this action .doctor should check any  tremor or patients is not able to touch his nose .this sign shows abnormality in cerebeller dysfunction. .

      finger to nose

     2.  Heel-shin test:-  For Heel to shin test patient should be in lying positions and doctor ask him to place one heel to the other side of  knee and run the heel toward the ankle with the line of shaft of tibia and tell him to repeat 2-3 times.if the patient is not able to control his leg or not able to place his heel to shaft of tibia that sign shows cerebeller dysfunction.Patients may demonstrate intention tremor,an inability to keep the heel on the shin or uncoordinated movements.

           heel to shin

    3.  Joint position sense: Test the most distal joint of the limb,i.e distal phalanx of the index finger or interphalangeal joint of the hallux.With the patient’s eye open.demonstrate the movements.To test,get the patients to close their eyes.hold the joint to be tested at the sides between two finger and move it up and down.Ask the patient to identify the direction of movements,ensuring that you are not moving more proximal joints or brushing against the neighbouring toes or fingers.If there is impairment,test more proximal joints.

          Upper-Limb-Proprioception-examination-2

Indicates: altered touch sensation.

4. Light touch:- Use a wisp of cotton wool.with the patients eyes open,demonstrates what you are doing to do.To test get the patient to close their eyes.Stroke the patient’s skin with the cotton wool at random points,asking them to indicate every time they feel the touch.

Indicates: Altered pain sensation.

5. Planter response(Babinski):- Apply  To check Babinski sign doctor use a sharp pen and apply pressure to along the lateral aspect of foot ,if the thumb goes in flexion thats show normal sign but the thumb goes in extension thats show positive Babinski sign. Positive Babinski sign show abnormality in Upper motor neurone lesion.

babinski

Indicates: upper motor neurone lesion.

6. Rapidly alternating movements:- Ask the patient to hold out one hand palm up and then alternately slap it with the plam and then dorsal aspect of the fingers of the other hand.Where there is a loss of rhythm and fluency it is referred to as dysdiadochokinesia.For the lower limbs get the patient to tab first one foot on the floor and then the other.

Indicates: possible cerebellar dysfunction.

7. Romberg’s test:- Tell the patient to stand on the plan floor with his feet together in open eye then tell the patient to mention same positions in close eye ,check is their any excessive sway or loss of balances (ensuring that you can support them if they fall). Romberg`s test indicates the proprioceptive or vestibular deficit if they fall when he close their eyes.

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8. Two-point discrimination:-Requires a two-point discriminator,a device similar to a pair of blunted compasses.With the patient’s eyes open,demonstrate what you are going to do.Get the patient to close their eyes.Alternately touch the patient with either one prong or two.Reduce the distance between the prongs untill the patient can no longer discriminate between being touched by one prong or two prongs.Varies according to skin thickness but normal young patients can distinguish a separation of approximately 5 mm in the index fibger and approximately 4cm in the legs.compare left to right.

indicates: impaired sensory function.

9. Vibration sense:- Use a 128Hz tuning fork.Ask the patient to close their eyes.Place the tuning fork on a bony prominence or on the fingertip or toes.The patient should report feeling the vibration and not simply the contact of the tuning fork.If in doubt,apply tunning fork and then stop it vibration suddenly by pinching it between your finger and see if the patient can correctly identify when it stops vibrating.

Indicates: altered vibration sense.

NEUROLOGICAL TESTS.

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