27. The nervous system 2 PROFESSIONAL ENGLISH IN USE FOR MEDICINE

PROFESSIONAL ENGLISH IN USE FOR MEDICINE

27. The nervous system 2

A	The motor system Examination of the motor system should include assessment of the following: A muscle bulk (amount of muscle tissue). Look for signs of wasting (muscle atrophy) B muscle tone (amount of tension in a muscle when it is relaxed). Tone can be increased (spasticity), or decreased (flaccidity) C muscle power (strength) D coordination (the ability to use several muscles at the same time to perform complex actions) E gait (the manner of walking) F reflexes (see B below) G involuntary movements, for example a tie or a tremor. Here is an extract from a case report about a patient with a tremor Case 80 On examination, her face showed a little or no expression. There was a tremor affecting mainly her right hand. She had generally increased muscle tone. Power, reflexes, coordination and sensation were within normal limits. Examination of her gait showed that she was slow start walking and had difficulty stopping and turning.
B	Tendon reflexes Examination of the nervous system normally includes testing the tendon reflexes, for example the knee jerks, with a tendon hammer (also known as a reflex hammer). The reflexes may be absent (0), diminished (-), normal (+) or brisk (+++). The plantar reflexes are also checked. The normal plantar response is a downgoing (↓) movement (plantar flexion) of the big toe. An upgoing (↑) toe (extensor or Babinski response) is abnormal.
C	Coma Coma is unconsciousness with a reduced response to external stimuli. Doctors say: The patient is in a coma The patient is comatose The Glasgow Coma Scale (GCS) score is calculated as follows:

EXERCISES

27.1	Complete the table with words from A and B above.
27.2	A doctor is giving instructions to a patient during examination of the motor system. Identify what the doctor is assessing in each case. look at A opposite to help you. 1 I’d like you to relax. I’m just going to move your arm up and down. 2 Can I see your hands? 3 Now, I’m going to straighten your arm out. Try to stop me. 4 Can you touch my finger with yours and then touch your nose? Good. Now do it again with your eyes closed.
27.3	Complete the sentences. Look at A, B and C above and at the table 27.1 above to help you. 1 A _______ hand droops limply to form a right angle with the wrist. 2 _______ reflexes are reflexes that are stronger than normal.
27.4	A patient is brought to A&E in coma. When her name is spoken, she opens her eyes but she does not answer questions, or obey instructions. What her GCS score?

Answer key