How to test your nerves at home. Neurological examination. Do you always have something to do, or is this a problem?

T tests are designed to assess the patient’s attention, his orientation in time and space, memory, adequate self-esteem, judgment and ability to perceive information. general. The patient may be offered number series with a request to mark a certain number (test of attention). They ask you to give your name, location, day of the week and date. Fixation memory and immediate recall are assessed by determining the ability to repeat a series of numbers while maintaining their sequence. Short-term (working) memory is assessed by the ability to reproduce a number of concepts after certain periods of time (for example, 5 minutes and 15 minutes). Memory for more distant events is assessed by the ability to present a convincing chronological history of one's own illness or biography. Reproduction by the subject of the main historical events and dates or major current events can help in assessing the stock of general knowledge. Language testing includes assessment of spontaneous speech, naming, repetition, reading, writing, and comprehension. Additional tests are also important - assessing the ability to draw and copy, the ability to perform arithmetic operations, interpret proverbs or logic problems, determine the right and left side, name and identify parts of the body.

Cranial nerve examination

I cranial nerve

Close the patient's nostrils one by one and apply mild irritants (soap, toothpaste, coffee, lemon extract) to see if it can distinguish between odors and identify them correctly.

II cranial nerve

Test your corrected and uncorrected visual acuity using the Snellen visual acuity chart (at distance) and the Jaeger optotype (in front of your eyes). Construct a visual field map by roughly identifying the boundaries of the visual fields in each quadrant for each eye. The best way to do this: sit facing the patient at a distance of 60-90 cm, ask him to close his eye with his palm, without pressing on the eyeball. The other eye should be open and fixed on the bridge of the examiner's nose. Small item white(eg, an applicator wrapped in cotton) is moved from the periphery to the center of the visual field until the patient can see it. The patient's visual field map is compared with a reference. Approximate perimetry and campimetry make it possible to establish the boundaries of small visual field defects. The fundus is examined with an ophthalmoscope, and the color, size, as well as the degree of edema (swelling) and elevation of the nipple should be described. optic nerve. It is necessary to check the size and compliance with the norm of the retinal vessels, the presence of a “crossover phenomenon” that occurs due to depression of the artery at the site of its intersection with the dilated vein, the presence of hemorrhages, exudates, aneurysms, etc. Determine the presence of pathological pigmentation and other lesions on the retina, including the macula.

Ill, IV and VI cranial nerves

Describe the size, normality and shape of the pupils, their reaction to light (direct and friendly), and the convergence of the eyes. Note the presence or absence of ptosis upper eyelid on one or both sides, delay of the eyelid during movement or retraction of the eyelid. Ask the subject to watch your finger move horizontally and then horizontally. vertical planes to the right and left, when the eye is first in a state of full adduction, and then in full abduction. Check for traffic restrictions eyeballs in any direction, as well as the presence of regular rhythmic involuntary eye twitching (nystagmus). You can conduct a test for rapid voluntary movements of the eyeballs (saccades), as well as tracking (for example, with the researcher’s finger).

V cranial nerve

Palpate the masticatory and temporal muscles (the patient must clench his teeth), perform tests for opening the jaw, moving it forward, and lateral movement against resistance. Check the sensitivity of the facial skin and corneal reflexes by lightly touching the cornea with a piece of cotton wool.

VII cranial nerve

Pay attention to facial asymmetry at rest and during movement (spontaneous movements; emotionally driven movements, for example, when laughing). The subject is asked to raise his eyebrows, wrinkle his forehead, close his eyes, smile,

frown, puff out your cheeks, whistle, purse your lips, check the contraction of the chin muscles. Special attention notice the difference in the strength of contraction of the upper and lower facial muscles. Taste sensations on the anterior two-thirds of the tongue may be changed due to damage to segment VII cranial nerve, located proximal to the chorda tympani. Taste testing for sweet (sugar), salt, sour (lemon) and bitter (quinine) is carried out with an applicator wrapped in cotton, moistened with an appropriate solution. The applicator is touched to the lateral edge of the patient's protruding tongue approximately in the middle.

VIII cranial nerve

Test the patient's ability to hear the sound of a tuning fork, the clicking of fingers, the ticking of a watch, or whispered speech. Hearing acuity is assessed at a certain distance and for each ear separately. Check the air and bone conduction sound (Rinne maneuver) and lateralization of the sound of a tuning fork applied to the middle of the patient’s forehead (Weber maneuver). Accurate quantitative testing of hearing acuity requires audiometry. Don't forget to check your eardrums.

IX and X cranial nerves

Inspect the palate and uvula. To do this, the patient is asked to pronounce the sound “e”. Determine whether the soft palate is drooping and whether the uvula is symmetrically located. Determine the position of the uvula and palatine arches at rest. In some people, sensitivity is detected in the tonsil area, back wall pharynx and tongue. Pharyngeal vomiting reflex check by touching the back wall of the pharynx on both sides with a blunt object (for example, a spatula). In some cases, an inspection may be necessary. vocal cords using a laryngoscope.

XI cranial nerve

Test the ability to lift the shoulders (trapezius) and turn the head to each side (sternocleidomastoid) against resistance (obstruction by the examiner).

XII cranial nerve

Check the size and tone of your tongue. It is necessary to note whether there is atrophy, whether the tongue deviates when protruding from the midline, or whether there is tremor, trembling or twitching of the tongue.

Motor activity study

Muscle strength is sequentially determined during basic movements in each joint (Table 160-1). The results of the active movement test should be recorded using a rating scale (for example, 0 - no movement; 1 - twitching or weak contraction in which there is no movement in the joint; 2 - there is movement in the joint, but it is impossible to overcome the weight of the limb; 3 - there is

Fig, 160-1. Distribution of skin sensitivity (left) and skin areas, innervated by individual nerves (right). Rear surface(names

top down).

Rice. 160-2. Distribution of cutaneous sensitivity (left) and skin zones innervated by individual nerves (right).

Table 1 60- 1 Muscles that carry out movements in joints

Table 160-1 Muscles that carry out movements in joints

movement with overcoming the weight of the limb, but it is impossible when resisting; 4 - movement in the joint is carried out with some resistance from the examiner; 5 - movement is carried out in full force; You can enter additional gradations within the scale by adding a (+) or (-) sign to the result. In addition, pay attention to the speed of movement, the ability to quick shift contraction of the muscle by its relaxation, the onset of fatigue with repetition of movements. It is necessary to check for loss of muscle volume and mass (atrophy), as well as involuntary pathological contractions of certain groups muscle fibers(fasciculation). Involuntary muscle contractions are determined at rest, while maintaining a certain body posture and active voluntary movement. Rhythmic involuntary muscle contractions are defined by the term tremor, while less regular muscle contractions fall under the concepts of choreoathetosis, large limb hyperkinesis, myoclonus and tics.

Reflexes

The following are the important muscle stretch reflexes commonly studied, as well as the segments spinal cord, in which they are presented reflex arcs: reflex from the biceps tendon C 56; reflex from the tendon of the triceps muscle of the shoulder C 67 8; carporadial reflex C 5 6; knee (patellar, quadriceps reflex, Westphal reflex, Erb reflex) L 234; Achilles (heel) reflex L 5, S r The following gradation scale is used: 0 - no reflex, 1 - weakened reflex, 2 - normal, 3 - enhanced reflex (hyperactive), 4 - enhanced reflex + clonus (repeated rhythmic muscle contractions when they increased stretch). The plantar (plantar) reflex is induced using the blunt end of any object, for example, the handle of a neurological hammer, a key. The reflex is examined by applying line irritation to the skin of the outer edge of the sole (from the heel to the base thumb feet). Babinski's pathological reflex is extension of the big toe. In some cases, this is accompanied by spreading the remaining toes and flexion at the ankle, knee and hip joints varying degrees expressiveness. (Normally, slight plantar flexion of the big toe.) Sometimes it is important to check the abdominal (abdominal) and anal reflexes, as well as additional muscle stretch reflexes.

Sensitivity study

In most cases, it is enough to examine the pain, tactile, muscle-joint and vibration sensitivity of each of the four limbs (Fig. 160-1 and 160-2). However, in some cases a more detailed study is required. Patients with brain damage may experience changes in “discriminatory sensitivity”, for example, the ability to distinguish between two stimuli when exposed to them simultaneously, to accurately determine the location of the stimulus, to distinguish between injections applied simultaneously at close range (two-point discrimination), to identify objects using the sense of touch. (stereognosis), assess the heaviness of an object, its texture, recognize signs and letters written on the skin (graphesthesia).

Coordination and gait

Motor Coordination Tests: Ability to Touch the Tip index finger to the examiner's finger (finger-toe test), the ability to move the heel of one foot along the shin of the other leg from knee joint down (heel-knee test). For some patients, additional tests are useful: drawing objects in the air with a finger, accurately matching the index finger with the thumb (or with any other) finger. In all cases, the patient's ability to stand with his toes and heels pointed should be checked. eyes closed(Romberg pose), walk in a straight line, placing one foot in front of the other (tandem gait), turn.

It is impossible to avoid the stresses of life. This means that we must not run from them, but learn to cope with them, react calmly, adequately assess exciting situations and be able to resist their destructive consequences. Can you do this, are your nerves okay? Let's check?

First of all, you need to find out how irritable and nervous you are, to find out the threshold of your self-control. After all, on stressful situations people react not just differently, but also differently at certain periods of life. By passing the stress tolerance test, you will be able to assess how you will react to a difficult situation that may occur in the very near future. You will be able to assess its destructive scale and understand in which direction to work - to strengthen endurance and resist stress. But do not forget that stress can be caused by increased stress.

Stress resistance test

Answer the test questions and calculate the number of points.

1. What will you do if the TV breaks down during the most interesting part of a show or movie?

• 1. I’ll throw a remote control at him in my heart, it won’t get worse anyway (3)
• 2. I’ll try to fix the problem myself (2)
• 3. I’ll go look for the repairman’s phone number (1)

2. Can you list the titles of three books that you plan to read in the near future?

• 1. find it difficult to answer (1)
• 2. no (3)
• 3. yes (2)

4. Do you like to go out into nature?

• 1. I prefer to admire nature in pictures (3)
• 2. yes, I take advantage of every opportunity to get out at least to a park nearby (1)
• 3. yes, but on the condition that this does not imply special effort or difficulties (2)

4. Do you have a hobby?

• 1. no, I don’t like wasting time on nonsense (3)
• 2. yes (1)
• 3. I prefer to relax at home or go out and have fun somewhere (2)

5. What do you do in your free time?

• 1. enjoying amazing idleness! (2)
• 2. what I wanted for a long time, but did not have the opportunity to do, things got in the way (1)
• 3. I feel discomfort because there is nothing to do, I can’t find a place (3)

6. How will you react that the expected important call on your only day off is already delayed by half an hour?

• 1. I’ll do something while I’m waiting so I don’t waste time (1)
• 2. I’ll be angry at such human disorganization (3)
• 3. I’ll sit in front of the TV, I can’t wait, I’ll have so much fun (2)

7. Your favorite games are:

• 1. chess, checkers, backgammon and other board games (2)
• 2. cards, lottery, slot machines (3)
• 3. none of the above (1)

8. Do you always have something to do, or is this a problem?

• 1. I have a lot of different interests, so the difficulty is the choice itself (1)
• 2. I hate idleness: it’s better to work more (2)
• 3. I do what I want, it doesn’t concern anyone (3)

9. What will be your reaction if a stranger is rude to you (in public transport, in line, etc.)?

• 1. I will answer the boor in the same style (3)
• 2. with difficulty, but I can restrain myself (2)
• 3. I will ignore, turn around and forget (1)

10. What will you do if you were shortchanged a little at the cash register?

• 1. I will deal with the incompetent cashier, I will defend my own interests (2)
• 2. insistently but politely demand the boss (3)
• 3. well, just think, it happens to everyone, the cashier is also a person - I’ll give up and leave (1)

Calculate the results of the stress resistance test and find out the result:

10-14 points. Congratulations, your nerves are in perfect order. You are quite capable of controlling your own emotions, it is difficult to unbalance you, and you are not afraid of occasional stress. In any case, this week, because the result obtained can be both evidence of your absolute resistance to stress and a consequence of a good mood at the moment. And there is time to find out, they can tell you a lot about you.

15-25 points. You try to be calm in any situation, but your resistance to stress is unstable and occurs with varying degrees of success. By holding back your emotions and not allowing yourself to get nervous unnecessarily, you break down from time to time. Even an unfortunate accident can make you worry and conflict, and stress resistance depends on to a greater extent depending on your mood. Try to relax and change activities more often. It may be necessary to make changes to your job or lifestyle. Such results may indicate that you are overtired or too difficult circumstances for your mental balance.

26-30 points. For you, life is a battlefield where there are serious battles. However, front-line soldiers must rest sometimes. Perhaps your body is very strong, but it is hardly “iron”. You urgently need to learn to ignore outside attacks, not take everything to heart or at your own expense, and distance yourself from life’s dramas. And we will tell you how to calm your nerves and maintain a sober attitude towards the surrounding reality.

The human nervous system is a rather complex structure that permeates the body and allows for its normal functioning, since with its help we react to any external and internal influences. At the moment there is already evidence that nerve endings present even in various organs immune system, and the main function of this system is to receive, as well as store and process any information received.

It is likely that you yourself have noticed that occasionally you become too irritable, hot-tempered, and also get tired quickly. All this ultimately has an extremely negative impact on your work. nervous system, and also affects health. Everyone knows the expression “any disease occurs due to nerves.” That is why it is important to understand the current state of your nerves, the degree of your balance and be able not to worry unnecessarily, since often this feeling is simply greatly exaggerated. If you want to spend as little stress on yourself as possible, just try to do more things that bring you positive emotions. Take the test and find out how healthy your nervous system is.

Take an online test for the state of the nervous system

1. Can you be called a calm and self-possessed person?

• a) No
• b) I don't know
• c) Sometimes you can
• d) It is possible

1. 2. Would you go to study for a certain period of time in order to more successfully continue your professional activities? Does it give you great pleasure to work carefully, but slowly?

   • a) No
   • b) I don't know
   • c) Sometimes
   • d) Yes

2. 3. Do you often have reasons for irritation and resentment?

   • a) Yes
   • b) Sometimes
   • c) I don’t know
   • d) No

3. 4. Do you tend to become impatient when forced to wait?

   • a) Yes
   • b) Sometimes
   • c) I don’t know
   • d) No

4. 5. Do you enjoy hard physical work?

   • a) No
   • b) Sometimes
   • c) I don’t know
   • d) No

5. 6. Do people around you often bother you?

   • a) Often
   • b) Sometimes
   • c) Very rarely
   • d) Never

6. 7. Did you imagine that you would be doing such a thing? Have your comrades often been unfair and rude to you?

   • a) Very often
   • b) Often
   • c) Rarely
   • d) Very rarely

7. 8. Are you easily distracted from work or reading literature?

   • a) Easy
   • b) In different ways
   • c) I try not to get distracted
   • d) I don’t get distracted

8. 9. Do you easily part with old friends in order to make new friends?

   • a) Easy
   • b) In different ways
   • c) With difficulty
   • d) With a lot of work

9. 10. Can you be called a diligent and patient person?

   • a) No, you can’t
   • b) I don't know
   • c) Sometimes you can
   • d) Yes, you can

• Your nervous system is unbalanced. It looks like you should seriously start treating your nerves, and also reduce as much as possible the presence of factors that drive you crazy, be it your job or an unsuccessful relationship. Do not delay solving your problem, because nerves are very important.

  The test showed that you have a nervous imbalance. You should spend more time on peace and relaxation, and reduce the amount of irritants in your life. Remember that the most important thing in life is you. Don't let people negative factors spoil your precious nerves.

  Unfortunately, the state of your nervous system is uncertain. We advise you to retake the test. You have too many contradictory and mutually exclusive answers. You might want to think about some of them better.

  There is balance. Despite minor troubles and worries, your nerves are in order. You know how to relax and pull yourself together in time. Your nerves are strong enough to allow you to be in a good mood and be productive.

  Wow! You have what is called “nerves of steel.” It is very difficult for problems and troubles to make you angry. People around you may feel calmer and more confident with you. Good mood And deep sleep, for sure, are your life companions. You are very lucky!