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Neuro 7® Overview

NEURO 7Ò OVERVIEW & ACCESSORIES
please contact us if you would like to receive the illustrated hard-copy of this document
 


The Neuro 7
Ò is a precision, hand-held instrument which includes the tools medical practitioners need to perform a basic neurological exam.   All unnecessary weight has been trimmed from the Neuro 7Ò to make it an instrument of the 21st Century.   With all tools retracted, the Neuro 7Ò may be clipped into one's shirt or white-coat pocket.
 
The Neuro 7Ò has the following tools:


Reflex Hammers

The reflex hammers are an integral part of the Neuro 7Ò with rubber seated on the edges near the end of the Neuro 7Ò.   The entire instrument, with all tools retracted, is used as the handle for the hammers.   The Taylor-type hammer has been used for decades by practitioners world-wide. 

Deep tendon reflexes (DTR) are automatic (involuntary) responses to a stimulus (hammer strike) that stretches a muscle and tendon.   A deep tendon reflex involves the spinal nerve segment, and when intact indicates normal function of cutaneous innervation, motor supply and cortical input to the corresponding spinal segment.  

Reflexes must be tested bilaterally as well as on both the upper and lower limbs.   Reflexes are considered normal, even if diminished, if they are symmetric.   All textbooks use a 0 - 4 scale to grade DTRs.   The least amount of force to elicit a reflex arc should be used, the Neuro 7 hammers being particularly well-suited for this.   The most common spinal nerve roots tested are biceps (C5,6), brachioradialis (C6), triceps (C7), patellar (L4), and Achilles (S4).  

A multitude of pathological disease states result in hyporelfexia or hyperreflexia, including clonus (sustained jerking).   Hyperreflexia is associated with upper motor neuron lesions and is seen, e.g., in hyperthyroidism and pre-eclampsia.   Hyporeflexia is associated with abnormalities in upper and lower motor neuron lesions, abnormalities in muscles and mechanical factors such as joint disease.
   

Two-point Discriminator
The two-point discriminator is an entirely new instrument with its tines spreading apart from 2 to 20 mm which correlate precisely with the numbers imprinted by the thumb push.   A neurologically intact person should be able to distinguish one or two points being touched on various parts of the body.   For example, one should be able to tell the examiner if one or two points is being touched on the finger tips when the tines are 4 mm. apart, on the cheek when 6-7 mm apart, on the palm when 10 mm. apart and on the foot when 20 mm apart.  

The two-point discrimination test is the most commonly used test to assess sensory outcome following peripheral nerve repair, though the test is not at all standardized, something a practitioner using the Neuro 7's two point discriminator will be able to do.   Also, after surgical decompression of a peripheral nerve (as decompression of the carpal tunnel at the wrist), two-point discrimination may be used to assess restoration and improvement of nerve function.  

Likewise, with a potentially traumatic peripheral nerve injury, two-point discrimination testing will help the examiner determine dysfunction and the need for specific care, including referral to a specialist for nerve repair when feasible.   Two-point discrimination is useful in determining postoperative improvement following surgical intervention for mandibular and mid-face fractures.   It is also useful in assessing peripheral nerve damage and improvement or deterioration for frostbite and burn injuries of the extremities.
    


Light Source
The light source is a single focused LED light (with a momentary switch) for examining pupillary light reflex, pharynx and external ears.    The myriad of disease states, traumatic brain injuries, toxicologic and electrolyte abnormalities causing changes in the pupillary response can be discussed as needed.    As an example, a patient overdosing on narcotics (except Darvon) will have pinpoint pupils that respond poorly to a bright light.   About 20% of the population has anisocoria (unequal pupils), but a significant disparity in the size of the pupils in a trauma patient is indicative of a herniating brainstem through the foramen magnum of the skull, a condition requiring immediate surgical decompression by a neurosurgeon.
 

Brush
As part of the sensory exam, the brush is used for testing light touch sensation by brushing it gently over a small area of skin.  The brush may be used, for example, to test a patient's ability to discern light touch on the face in each of the three divisions of the fifth cranial nerve (ophthalmic, maxillary and mandibular).

One must remember that light touch, pain and temperature are part of the cutaneous sensory exam (spinothalamic), while position sense, vibratory sense, and touch localization are part of the proprioceptive exam (dorsal column).   Consistent technique is necessary while performing any part of a sensory exam, which requires the patient's cooperation and reliability (i.e. subjective).   

The protruded brush will extend far enough out from the Neuro 7Ò body such that the edges of the instrument body don’t interfere with its use.
    

Wartenberg Wheel
This small, rotating wheel with its sharp points is used for sensory testing.   To help determine the level of a partial or complete spinal cord disruption from trauma or disease, one rolls the wheel over the skin of the torso from an area of anesthesia or hypesthesia to an area of good sensation.   One must keep in mind that it is difficult to determine the precise level of sensory loss (also motor loss), and that one may only ascertain that a lesion is above the highest level affected.  

The dermatome map (a dermatome is a band of skin innervated by a sensory spinal nerve) need not be memorized, but every practitioner should know a few key dermatomes such as C3-5 (back of neck), C6 (thumb & index finger), C8 (ring and little finger),  T4 (nipple line), T10 (umbilicus), L1 (inguinal), L4 (knee), L5 (dorsal/plantar foot & dorsal ankle), S2-5 (perineal) and S5 (perianal) 

The wheel is also used, especially by rural practitioners, as a screening test to help identify peripheral neuropathy in the feet, though the monofilament (see below) is more commonly used for this.   Because of the sharp points, the wheel should be disposable as on the Neuro 7Ò. 
           


Sharp/Dull Tool
A basic sensory exam includes having the patient distinguish a sharp (pinprick or sharp point) sensation from a dull sensation.   Pain (sharp point), as well as light touch and vibration (128 Hz tuning fork) should be tested proximally and distally on the extremities.   Note again that pain (as well as light touch and temperature) is a component of a cutaneous sensory exam.   The patient's eyes should be closed during a sensory exam for the practitioner to be able to identify any sensory loss or significant pattern, including dermatomal deficits, including hypesthesia, hyperesthesia or inability to sense pain at all.
    

Edge for Plantar Stimulation
The top edge of the pocket-clip was specifically designed for the practitioner to perform plantar stimulation, i.e. Babinski reflex.   This edge is rubbed briskly on the lateral edge of the foot, a normal response being plantar flexion of all toes, an abnormal response (positive Babinski reflex) being the dorsal flexion of the great toe, indicative of some form of disruption or dysfunction of the long corticospinal tract.   Physicians will use any hard edge to perform this reflex. 


Monofilament
A 10-gram monofilament, 4.5 cm. long, may be inserted in a tapered hole on the end of the pocket clip and then disposed of after single use.   The monofilament is used to detect peripheral neuropathy, most commonly in the diabetic patient.    The filament is pressed perpendicularly against the sole of the foot in 9-10 locations and 1 location on the dorsal aspect, to the point the filament bends.   If the patient cannot feel this in 4-5 locations, this patient is at risk for ulceration and possible future amputation.   The monofilament test is very predictive and is considered a protective sensation.    The monofilament test is considered more sensitive than using a 128 Hz tuning fork on the diabetic foot. 
 


Pupillary Dilation Chart, Ruler, Gross Angle Measurement
These are simple add-ons to the Neuro 7Ò which may be used by the practitioner during any patient evaluation.
  

Precautions
The Neuro 7Ò was designed by medical professionals for medical professionals so every precaution was taken to adhere to national blood borne pathogens standards for healthcare professionals (OSHA website). In order to comply with BBP standards Neuro 7® addresses this area in two different ways.

First, each of the retractable instruments are made out of stainless steel so that after each patient encounter it may be easily disinfected with a simple alcohol prep or other cleaning agent that is effective against blood borne pathogens (such as HIV or Hepatitis B/C). Neuro 7
Ò is also designed with a replaceable plastic Wartenberg (pinwheel) Wheel that can be disposed of after each patient use.

Secondly, it is recognized that many medical institutions have adopted BBP policies that require all sharp instruments be disposable, so the Neuro 7® design team developed a Disposables Combo Pack that is comprised of sharp plastic disposable tips for the Sharp/Dull instrument and a plastic disposable pinwheels and disposable monofilments. Each of these can be replaced in a matter of seconds after every patient interaction to protect against cross contamination. The Disposables Combo Pack comes complete with 20 plastic disposable pinwheels and 50 plastic disposable protective Sharp/Dull tips and one vial of 50 Monofilaments.


Neuro 7
Ò Product #JR701 includes the following:
 

  • 1 - Neuro 7Ò instrument
  • 2 - Extra Disposable Pinwheels
  • 2 - Extra Disposable Sharp Tips
  • 1 - Instruction Sheet - Describes the use of the Neuro 7Ò.
  • 10 – replacement monofilaments

  
Medical Professionals who purchase a Neuro 7Ò can acquire accessories through our sales rep or at our eStore - www.azream.us


#JR702
Disposables Combo Pack - the pack contains 20 disposable pinwheels, 50 disposable sharp tips and a Vial of 50 Monofilament lines. 
 
#JR703 Belt Holster – 1 count 
 
#JR704 Disposable sharp tips – 50 count
  
#JR705 Disposable pinwheels – 20 count
  
#JR706 Vial of 10g replacement monofilament – 50 count

#JR707
Replacement Battery (A-23)

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