Station #1
Patellar and Achilles Reflexes
Patellar Reflex
Have one partner sit on the lab table with their legs dangling. Locate the patellar tendon inferior to the patella. Use the reflex hammer (wider side) to tap the patellar tendon. Allow the hammer to bounce back promptly. (Hint – the action is in the wrist). Note the response that is exhibited. Repeat this process for both knees. Repeat on the other partner(s). Answer the questions on your answer sheet.
Questions:
1. What is a reflex?
2. Is the patellar reflex considered a somatic or autonomic reflex? Why?
3. When assessing a patient, you find the patellar reflex to be abnormal (hyperactive, diminished or absent). What parts of the nervous system might be affected?
Achilles Reflex
Have one partner sit on the lab table with one leg crossed over the other. Hold the foot of the crossed leg in a slight dorsiflexed position. Locate the Achilles tendon on the posterior side of the foot. Use the reflex hammer (wider side) to tap the Achilles tendon (remember the techniques from above). Note the response that is exhibited. Repeat this process for both feet. Repeat on the other partner(s). Answer the questions on your answer sheet.
Questions:
1. Why is testing of reflexes a valuable clinical tool?
2. While assessing your patient, you find the Achilles reflex to be abnormal. What parts of the nervous system might be affected?
Station #2
Biceps and Triceps Reflexes
Biceps Reflex
Have one person sit in a chair. Support the person’s forearm on your forearm. The person’s arm should be slightly flexed, but relaxed. Place your thumb on the person’s biceps tendon (just proximal to the elbow). Use the reflex hammer (narrow side) to tap your thumb. Allow the hammer to bounce back promptly. (Hint – the action is in the wrist). Note the response that is exhibited. Repeat this process for both arms. Repeat with the other partner(s). Answer the following questions on your answer sheet.
Questions:
1. What is the normal response for this reflex?
2. This reflex is in response to the contraction of what muscle group?
3. What spinal nerves carry the sensory and motor information to allow this reflex to
occur?
Triceps Reflex
Have one person sit in a chair. Hold the distal portion of the person’s upper arm and let the forearm dangle towards the floor. Tell the person to let their arm “just go limp”. Tap the triceps tendon directly proximal to the elbow with the reflex hammer (narrow side). Note the response that is exhibited. Repeat this process for both arms. Repeat with the other partner(s). Answer the following questions on your answer sheet.
Questions:
1. What is the normal response for this reflex?
2. This reflex is in response to the contraction of what muscle group?
3. What spinal nerves carry the sensory and motor information to allow this reflex to occur?
Station #3
Babinski’s Reflex
Have one person sit in the chair and remove one of their shoes. Support the person’s leg with your hand on the posterior side of their ankle. Use the back (metal end) of the reflex hammer trace a ‘J’ from the heel along the lateral side of the foot and across the ball of the foot to the big toe. Note the response that is exhibited. Repeat this test for the other partner(s). Answer the questions on the answer sheet.
Questions:
1. In an infant, what would be the normal response?
2. In a child or adult, what would be the normal response?
3. What is this change in response attributed to?
4. In an infant should the babinski’s reflex be positive or negative?
5. In an adult should the babinski’s reflex be positive or negative?
6. What could a positive babinski’s in an adult be indicative of?
Station #4
Conduction Routes – Descending Tracts
Rapid Alternating Movements
Have one person sit on the lab table and place their hand, palms down, on their knees. Ask the person to pat their knees with both hands, lift up, turn hands over and pat their knees with the backs of their hands. Then ask the person to continue this, but with an increased speed.
Next ask the person to tough their thumb to each finger on the same hand starting with the index finger and then reverse direction. Ask the person to continue this, but with an increased speed.
Repeat these exercises with the other partner(s).
Questions:
1. Descending tracts carry what type of information?
2. Is this information carried away from or towards the CNS?
3. Bundles of neurons in the CNS are referred to as:
4. Which tract conducts impulses that control voluntary movements of small muscle groups on opposite side of the body?
5. Which tract conducts impulses that control voluntary movements of small muscles groups on the same side of the body?
Tandem Walking
Ask the person to walk a straight line in a heel-to-toe fashion. Observe the person’s balance. Repeat for the other partner(s).
Questions:
6. Which tract conducts impulses that control coordination of posture and balance?
7. Which part of the brain functions to control posture and balance?
Station #5
Conduction Routes – Ascending Tracts
Pain, Touch & Pressure
Locate the tongue depressor and the mechanical pencil at your lab table. Have one person sit on the lab table and close their eyes. Lightly apply pressure from the tongue depressor and the mechanical pencil to the person’s body in a random, unpredictable order. Have the person say “dull” or “sharp” depending on the sensation felt. Compare the responses on the opposite/symmetrical surface area.
Locate the cotton ball on your lab table. Have the person close their eyes. Brush the cotton ball over the skin in a random order of sites and at irregular intervals. Be sure to include the arms, forehead, hands, legs and feet. Ask the person to say “now” when touch is felt. Compare symmetric surface areas.
Repeat these exercises for the other partner(s). Then answer the questions.
Questions:
1. Ascending tracts carry which type of information?
2. Is this information carried away from or towards the CNS?
3. Which two tracts which carry sensory information pertaining to touch, pain and pressure?
Vibration
Locate the tuning fork on your lab table. Have the person sit in the chair. Strike the tuning fork with the palm of your hand and hold the base on a bony prominence of a finger. Ask the person to tell you when the vibrations start and stop. Repeat this process and move up the bony prominences of the arm (wrist and elbow). Compare the left and right sides. Repeat this exercise with the other partner(s).
Stereognosis
Locate the brown paper sack containing several objects on your lab table (leave these covered!). Have the person close their eyes. Reach into the back and hand the person one of the objects. Ask the person to identify the object. Repeat this process for all of the objects. Recover the objects when finished.
Two-Point Discrimination
Locate the two pens on your lab table. Have one person close their eyes. Lightly touch the person on their arm with both pencils about 3-4 inches apart. Ask the person if they feel 1 or 2 points of pressure. Move the pencils closer together and ask again. Continue this until only 1 point of pressure if felt. Allow the person to open their eyes to see the distance between the two points.
Repeat this exercise on the person face if they are willing. Then repeat the entire exercise with the other partner(s). Answer the questions below on your answer sheet.
Questions:
4. Which ascending tracts were tested in the above three exercises?
5. In the two-point discrimination test, hypothesize why 1 point of pressure was felt sooner on the arm versus the face?
Station #6
Cranial Nerves
Exercise #1
Have one person sit in the chair and look straight ahead. Place your right hand on their left cheek and ask them to rotate their head against your resistance. Repeat this for the other side. Next place your hands on their shoulders and ask them to shrug their shoulders against your resistance. Movements should feel equally strong on both sides. Repeat this exercise with the other partner(s).
Questions:
1. Which cranial nerve is being tested in this exercise (name and number)?
2. What is the functional classification of this cranial nerve?
Exercise #2
Have the person stick out their tongue. Assess if the tongue protrudes midline and is not deviated to either side. Next have the person say “light, tight, dynamite”. Assess for articulation of the letters L, T and D). Repeat this exercise with the other partner(s).
Questions:
3. Which cranial nerve is being tested in this exercise (name and number)?
4. What is the functional classification of this cranial nerve?
Station #7
Cranial Nerves
Questions:
1. What is the name of cranial nerve IX?
2. What is the functional classification of cranial nerve IX?
3. List the functions of CN IX.
4. What is the name of cranial nerve X?
5. What is the functional classification of CN X?
6. List the functions of CN X?
7. Describe a method by which you would test to see if Cranial nerve IX is intact.
8. Describe a method by which you would test to see if Cranial nerve X is intact.
Station #8
Cranial Nerves
Weber Test
Have the person sit in the chair and face forward. Locate the tuning fork on your lab table and activate it by striking the tines softly on the back of your hand. Place the vibrating tuning fork in the midline of the person’s skull. Ask the person if the tone sounds the same in both ears or better in one ear. The normal result is that the person hears the tone by bone conduction through the skull and it is heard equally in both ears. Repeat this test with the other partner(s).
Weber Test
Rinne Test
Rinne Test
The test compares air conduction (AC) sound with bone conduction (BC) sound. Have the person sit in the chair and face forward. Activate the tuning fork and place the stem on the person’s mastoid process. Ask the person to signal when the sounds stops. Quickly invert the tuning fork so that the vibrating end is near the ear canal. The person should hear the sound again. The normal result is that the sound is heard twice as long through air conduction as by bone conduction. This result would be call a + Rinne test (AC>BC). Repeat this exercise in the other ear and then with the other partner(s).
Romberg Test
Have the person stand up with feet together and arms at their sides. Once in a stable position, ask the person to close their eyes and hold the position. Wait about 20 second and observe the person’s movements. Normal result is a person maintaining balance without visual orientation, but slight swaying may occur.
Questions:
1. Which cranial nerve is being tested in these exercises (name and number)?
2. What is the functional classification of this cranial nerve?
3. What is the function of this cranial nerve?
Station #9
Cranial Nerves
Exercise #1
Have the person sit in the chair and face forward. Ask the person to clench their teeth and assess the muscles of mastication (“chewing muscles” of the cheeks). Muscles should feel equally strong on both sides. Next try to separate the jaws by pushing down on the chin. Normally, you should not be able to separate the jaw.
Next, locate the cotton ball on the lab table. Have the person remain sitting and close their eyes. Touch the cotton ball to the person’s forehead, cheek and chin. Ask the person to say “now” when the touch is felt. Repeat this on the other side of the face.
Repeat with the other partner(s) then answer the following questions.
Questions:
1. Which cranial nerve is being tested in the above exercises (name and number)?
2. What is the functional classification of this cranial nerve?
3. What are the functions?
Exercise #2
Have the person sit in the chair and face forward. Ask the person to smile, frown, raise eyebrows, close eyes tightly and puff cheeks. Note mobility and facial symmetry of the facial movement as the person responses to your requests. Next, press on the person’s puffed cheeks. Air should escape from equally from both sides. Repeat this exercise with the other partner(s). Answer the following questions.
Questions:
4. Which cranial nerve is being tested in the above exercise (name & number)?
5. What is the functional classification of this cranial nerve?
6. What other function does this cranial nerve exhibit that was not tested?
Station #10
Cranial Nerves
Exercise #1
Locate the pen light at your lab table. Have the person sit in the chair and face forward. Turn on the pen light and shine the light in the person’s eyes from the periphery. DO NOT shine the light directly in the person’s eyes. Note the response in the person’s pupil size. Repeat in both eyes. Repeat this exercise with the other partner(s).
Questions:
1. What cranial nerve is being tested in the above exercise (name & number)?
2. What is the functional classification of this cranial nerve?
3. What happened to the person’s pupil size in response to the light stimulus?
Exercise #2:
Have the person sit in the chair and face forward. Hold up one finger and ask the person to follow the movements of your finger with their eyes, but without moving their head. Your movements of your finger should follow the six cardinal positions (see below). Repeat this exercise with the other partner(s).
Questions:
4. Which cranial nerves are being tested in the above exercise (name & number)?