Health Assessment

5. Neurologic System　　　　　English Version

a. Cognitive function

認知能力を調べます。

• 服装、行動の観察
• 自身、場所、日付がわかるか
• 長期記憶（昔のことを尋ねる）と短期記憶(朝食など)
• 感情の状態(特に心配、落ち込むことなどがないか尋ねる)

b. Cerebellar function

１．調和運動

• 腰掛けた状態で、大腿の上で掌をすばやく左右同時にひっくり返す
• 腕を伸ばし、目を閉じ、人差し指で交互に鼻に触れる
• 手のそれぞれの指先で親指に触れる
• かかとをもう一方の足の膝下につけ、下まで下ろし、また膝まで挙げる

２．バランス

• Romberg　ｔｅｓｔ：　目を閉じた状態で５秒以上立位を保つことができる
• 目を閉じて片足で立つことができる
• つま先にもう片方のかかとをつけ、歩く
• 片足でジャンプできる

c. Sensation

• 音叉を両手、両足につけ、振動をかんじるか
• 目を閉じさせ、手足の指を動かし、どの指がどう(上下)動かされたか言える
• 目を閉じ、綿球がどこに触れたか言える
• 目を閉じ、鋭いものとそうでないものを区別できる（舌デプレッサーを割り、割り口を鋭いもの、普段用いる先端をそうでないものとして使用)
• 立体認知：　目を閉じ、手に置かれたものを何か言える(クリップ、コインなど)
• 筆跡覚：　目を閉じ、手に書かれた数字、文字を言える(ペン先などでなぞる)
• ２点識別：　目を閉じさせ、２本の棒を１本、または２本で手足にあて、１本か２本か言い当てることができる

d. Reflexes

• 二頭筋：　肘の腱を指で押さえ、指の上をハンマーでたたく　→　肘が少し屈曲する
• 三頭筋：　肘を内側から押さえ、三頭筋の腱をハンマーでたたく　→　肘が少し伸展する
• 膝蓋腱：　下腿を直角にたらし、膝蓋腱をハンマーでたたく　→　硬いが伸展する
• アキレス腱反射：　アキレス腱をハンマーでたたく　→　足先が底屈する
• 足底反射：　足の裏を下から外側、指の下、母指の下をハンマーの柄で刺激する　→　爪先の足底屈曲を起こす

English Version

a. Cognitive function

• Appropriately dressed for the weather?
• Well-groomed?
• Oriented to time, place, and person?
• Recent memory : ex. What did you have for the brealfast today?
• Remote memory : ex. When did you get married?
• Emotional Status

b. Cerebellar function

1. Coordination

• Alternately tap thighs with hands. Timing should be equal bilaterally.
• Stretch arms out and alternately touch the nose. Rythmic, and no missing.
• Touch each finger to the thumb. Rythmic and rapid.
• Place the heel just below the opposite knee on the tibia and run the heel down the shin to the toe and up again.

2. Balance

• Romberg test: Stand with feet together with eyes closed.
• Stand on one foot with eyes closed.
• Heel to toe walk.
• Hop on one foot.

c. Sensations

• Vibrating tuning folk on bone (both wrists and both ankles)
• Position sense of fingers and toes
• Light touch with cotton
• Sharp and dull
• Stereognosis
• Graphesthesia
• Two-point discrimination

d. Reflexes

• Biceps : Let client relaxed arm fall onto Ns's arm. Hold the arm with elbow flexed at a 90 angle, and place Ns's thumb over the biceps tendon. Atrike Ns's thumb instead of striking the tndon directly. The expected response is the contraction of the biceps muscle that causes visible flexion of the elbow.
• Triceps : Let client relaxed arm fall onto Ns's arm with elbow flexed at a 90 angle. Strike te triceps tendon just above th elbow. The expected response is the contraction of the triceps muscle that causes visible extension of the elbow.
• Patellar : Flex client's knee at a 90 angle, with the lower leg hanging freely. Strike the patellar tendon just below the patella. The expected response is the contraction of the quadriceps muscle that causes extension of the lower leg.
• Achilles : Flex client's knee and dorsiflex the ankle at 90. Hold Ns's hand against the bottom of the client's foot and strike the Achilles tendon. The expected response is the contraction of the gastronemius muscle, causing plantar flexion of the foot.
• Plantar (Babinski) : Stroke the lateral aspect of the sole of the foot from heel to ball with a moderately sharp object, curving medially across the ball of the foot. There should be flexion of the great toe with fanning of the other toes.