HIGHER MENTAL FUNCTION

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HIGHER MENTAL FUNCTION

Examination of the higher mental function constitutes an integral part of the clinical evaluation of cortical function. However, a detailed assessment is time consuming and not routine performed. For all practical purposes, one needs to have a simple instrument for screening cognitive dysfunction. It is extremely unlikely that higher mental function assessment is assessed in the MRCPCH exam. In the section below, we have given modified mental assessment questions, which is suitable for children above four years and concentrates on five areas of cognitive functions i.e., orientation, attention-concentration, registration, recall and language. (Acronym – ROARS)

o Registration

• Can you identify three objects by name?

o Orientation (person, place and time)

• What is your name?

• Are you a boy or a girl?

• Where do you live?

• Where are you at present?

• How old are you?

• What time is it?

o Attention-concentration

• Can you count from 1, 2, 3…?

• Can count backwards from 20 to 1?

o Recall (Immediate)

• Show them three common objects and ask them to recollect them

o Speech (Language)

• Look at fluency and articulation of normal speech

• Name parts of the Body

• Simple command “take the toy from my hand and put it on the table”

• Repeat simple sentence (with a verb and a noun)

• Reading – “can you reads your name”

• Writing – “Write down your name”

• Copy a simple design

MOTOR EXAMINATION OF THE UPPER LIMB

• Inspection

o Posture - Note the resting posture. Look for abnormal flexion, unusual rotation or clawing of the hand. Always compare with the other side for symmetry. In a child with hemiplegia, the upper limb is flexed at shoulder and elbow with adduction and pronation of the a...

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...defects or sensory impairment). In order to assess the functional capacity of upper extremity and performance, the following tests can be done

o Give an object and see how he receives it

o Ask to write in paper or draw a figure

o Ask about ‘combing the hair’

• Back Examination

o Motor examination of the upper limb is only complete after performing the examination of the upper back.

o Inspection – Look for muscle wasting, winging of scapula and surgical scars.

o Power (in addition to muscles of the shoulder girdle – refer above)

 Serratus anterior (C5, C6, C7): ‘Stand in front of the wall and push it with your hands’. Look at the back for winging of the lower scapula.

 Infraspinatus (C5, C6): ‘with the arms at the sides, bend both elbows to 90º, and rotate the arms outwards (externally rotate)’, while you provide the resistance against external rotation.

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