THE NEUROLOGIC EXAM
A neurologic exam is an evaluation by a healthcare provider of a person’s nervous system. The nervous system includes the brain, the spinal cord and the nerves. In examining each of these areas the examiner will perform different tests and ask the patient to do different things. Things such as cognition/mental status, strength, sensation, reflexes, walking, balance and coordination will be evaluated. The neurologic exam typically starts while a person is sitting in a chair, the examiner will then ask the patient to stand, perform some tasks to assess balance and then evaluate walking. At times, it may be necessary depending on the condition to further evaluate the patient lying down. Tools such as a lights, reflex hammers, and tuning forks are used in many neurologic exams. The extent of the exam is determined by the patient’s history and what symptoms they currently have.
A neurologic exam is traditionally done in a specific order. Each of the following areas are assessed:
- Mental Status
- Cranial nerves – nerves to the face including eyes, ears, mouth and skin
- Motor (power) – muscle strength, muscle tone and reflexes
- Gait (Walking)
A careful and thorough neurologic exam is done when there is a concern for an underlying problem within the nervous system. When there is damage within the nervous system a patient can have problems with daily function, which can impact quality of life. Fine details are discovered through a neurologic exam that would not other wise be seen and help determines where the problem is coming from within the nervous system. This helps to maximize interventions and improve quality of life.
A neurologic exam is indicated when a patient experiences some of the following conditions – headaches, blurry vision, change in behavior, memory problems, fatigue, speech problems, weakness, tremor, problems with balance or coordination, numbness or tingling in the arms or legs or walking problems.
Dr. Deborah Boland, D.O., MSPT
Neurologist/Movement Disorder Specialist
Owner Be Mobile Neurology
FALLS AND FALL PREVENTION
“I’ve fallen, but I can’t get up!”
Now hopefully you haven’t been in that situation before, but did you know that individuals diagnosed with Parkinson’s disease have a higher incidence of falling at home. The reason for the higher incidence is due to the slow reaction responses; increased postural instability, loss of balance, and increased fear of falling. Actually, the higher the age and the severity of your Parkinson’s symptoms, the increased likelihood of you falling at home. Thankfully there are some things that you can do to reduce your chances of falling.
One of the ways of reducing your risk of falling at home is to make simple modifications within the home that are safer. For example:
- Use night lights along your path to the bathroom or others areas you may wonder at night
- Placing grab bars along the walls around the home where you walk and can easily grab onto if you feel insecure or off balance
- Having grab bars in a place near the toilet and entering or exiting the shower
- Bundling up all electrical and extension cords, and secure them near the wall away from walking traffic
- Remove loose tiles, rugs, or any item that might make you trip or fall
- Marking the bottom and top staircase steps with white non-slip paint to make them easy to identify
Another way of reducing your falls at home is by practicing balance exercises. These exercises can help improve your balance. Examples of balance exercises are:
- Standing with feet together
- Standing with one foot in front of the other
- Standing raising both your heels then toes up, alternating
- Standing on one leg
With these exercises, you maintain the position for a few seconds with your eyes open, while holding on to a solid, non-moving object. You can make these exercises harder by performing them without holding on or with your eyes closed, but make sure the solid surface is right in front of you, so you can grab on if you lose your balance. Never perform these exercises alone, have someone next to you, and have a solid surface to grab if you lose your balance.
If you are still having difficulty maintaining your balance or having difficulty walking, talk to your doctor to get a prescription to see a physical therapist. It is best to see a physical therapist that specializes in Parkinson’s disease, fall prevention, or neurology; these specialized practitioners are experts in safety and fall prevention. They can help you learn how to use different strategies to reduce your fall risk, walk with less difficulty and show you how to safely get up from the floor if a fall occurs.
Latosha Solomon Manning, PT, DPT
outpatient physical therapist; specialist in PD, Stroke, Vestibular, & neuromuscular conditions
Florida Hospital Tampa , 813-615-7253
DR BOLAND’S EXERCISE TIPS for PD
- Exercise likely helps with neuroplasticity in PD
- Exercise likely increases dopamine availability
- PD patients who exercise do better
- Any movement is better than no movement
- Pick what you like and will be consistent with
- Be safe
- Exercise within your own limitations
- Always get clearance from your physician prior to establishing an exercise program
- A well balanced exercise program includes – stretching, strengthening, cardiovascular and balance
- Have the program initially designed by a qualified professional such as– PT, OT, certified athletic trainer, etc