Examination of Motor Function & Deep Tendon Reflexes Flashcards by TRISHA JOY BASILLE RODRIGUEZ

What are checked during inspection of the motor funciton & DTRs?

Observe general acitivity, posture, stands, sits, walks, gestures
Observe body build, contours & proportions
Inspect muscle size contous & involuntary movements (rostrocaudal sequece)
Posture & gait
neurocutanoeous lesions

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What neurocutaneous lesions are inspected in px?

Cafe au lait spots = neurocutaneous stigmata

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During range of motion, what is assessed in the px’s joint?

Spasticiity
Rigidity
Hypotonia
Range of movements

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What are the 4 strength principles?

Matching principle
Length-strength principle
Antigravity muscle principle
Engagement principle

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what strength test principle uses selective movements to match arm & hand strength to gauge the strength accurately?

Matching principle

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What strength testing principle uses muscles when acting from their shortes postiion & have no strength when acting from their longest position?

length-strength principle

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What strength principle has muscles working in opposing agonist-antagonist pairs?

Antigravity muscle principle

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What strength test principle has most the examiner engaging the px’s competitive spirit to get maximum effort?

Engagement principle
“I’m trying to test how strong you are, don’t let me win”

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what muscle of the neck is not included in assessment of the neck?

Trapezius muscle = already assessed in CN

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what are the actions assessed in tesitng shoulder girdle strength?

Arm elevation
Arm adduction downward
Arm adduction across the chest (Pectoralis m)
Scapular adduction
Scapular winging

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after testing the free movements of the shoulder girdle, what should then be assessed?

strength of these movements

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what is done to test for weakness of the upper arm?

elbow flexion
elbow extension

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What are done to the forearm to assess its presence or absence of weakness?

Wrist flexion
Wrist extension

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what are tests done to assess presence/absence of weakness?

Finger extension
Finger flexion

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What are also assesed in the finger muscles?

thenar & hypothenar eminences for size & asymmetry
atrohy of interosseous muscles

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when assessing the abdominal muscles, what part of the body should be carefully observed?

contraction of the abdominal muscles in the umbilicus

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What tests are done in assessing back muscles?

Prone position then palpate Paraspinal muscles

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What tests are done in assessing the hip girdle?

Hip flexion & extension, Thigh abduction & adduction

Sitting position -> lift thigh then try to push the knee down with butt of palm

Hold legs abducted and counter it by placing ur hands at the L sides of the knees –> px squeezes legs as u place ur hands in the middle of the knees to pull the knees apart

Prone position –> lift thigh off the table & try to push it down at the popliteal space

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What are tested in the lower extremities (thigh, ankle, & toes)?

Thigh muscles = Knee extensor muscles, Hamstrings/Flexor muscles

Ankle & Toes = Dorsiflex, evert and invert the feet

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In grading muscle strength, what should also be done aside from scoring?

report pattern of weakness => where is it localized?

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What is the grading of muscles?

5 = normal strength
4 = full range against resistance to greater gravity
3 = mores part full range against gravity but NOT against ANY RESISTANCE
2 = moves PART ONLY WHEN POSITIONED TO ELIMINATE GRAVITY
1 = Only. A FLICKER OF CONTRACTION of muscle but cannot move joint
0 = complete paralysis

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what are the 3 things assessed during percussion of muscles?

check for irritability, Myoedema, Myotonia

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what indicates percussion irritability

appearance of FAINT DIMPLE at the percussion site (using a hammer @ the biceps belly)

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what is elicited in percussion myoedema?

non-propagating mound appears at the percussion site

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In what conditions can you see Myoedema upon percussion?

Debilitation Malnutrition Dysmetabolic state (ie hyperthryoidism & Uremia)

What is assessed in percussion myotonia?

if there is a BRIEF RXN & RELAXATION that is NOT VISIBLE --> sign of neuromuscular disorder

How do you elicit perussion Myotonia?

tight fist => hold for 10secs => flip fingers open as quickly as possible => (+ MYotonia): cannot open fingers rapidly & wrist involuntary flexes

What are the diff DTRs?

Jaw jerk Triceps reflex Brachioradiaiis reflex Finger flexion reflex Knee reflex Ankle reflex

what nerve roots mediate biceps reflex?

C5-C6

What nerve roots emdiate triceps reflex?

C7-C8

What nerve roots mediate brachioradialis reflex?

C5-C6

What are the 2 methods used to elicit finger flexion reflex?

Tromner method Hoffman method

What nerve roots mediate finger flexion reflex?

C7-T1

what nerve roots mediate knee reflex?

L2-L4

What nerve roots mediate ankle reflex?

L5-S2

What is the NINDS scale for DTR grading?

0 = areflexia 1 = hyporeflexia 2 = NORMAL 3 = Hyperreflexia 4 = Clonus present

What is mayo clinics reflex scale?

-2 = low response -1 = moderately low 0 = normal +1 = brisk +2 = very brisk

what are the causes of hyperreflexia?

interruption of UMN pathway (betw the cerebrum & LMN)

when do we see sustained and abortive clonus?

Sustained clonus = newborns & infants Abortive clonus = adults Sustained clonus in adults = ABNORMAL

how do you know is it is sustained clonus?

foot oscillates betw flexion and extension for as long as you maintain pressure

What are signs of Hypertonia & Hypotonia?

Hypertonia = Spasticity, rigidity, paratonia/Gegenhalten Hypotonia = flaccidity

what causes rigidity?

extrapyramidal lesion in the basal motor circuit

What is a phenomenon that occurs with the rigidity of Parkinsons disease?

Cogwheel phenomenon

What is the resistance that equals in degree & range every attempt of exminaer to move a part in any directoin?

Paratonia/Gegenhalten

what are the clinical differences of spasticity & rigidity?

Spasticity - Clasp-knife phenomenon - Quick jerk of the resting extermity - extensor toe sign - predominate in one set of muscles - EMG inactive Rigidity - lead pipe phenomenon w/ cogwheel and tremor at rest - slow movement of the px's resting extremity

what are clinical signs of hypotonia?

DEC resistance INC range of joint movements

what are the nerve roots of upper & lower quadrants of abdominal skin & muscle reflex?

Upper = T8-T9 Lower = T11-T12

What sign is checked for px suspecting of having thoracic spinal cord lesions?

Beevor sign

what nerve roots are affected in cremasteric reflex?

Afferent L1 Efferent L2

what is the normal response of cremasteric reflex?

Elevation of ipsilateral testicle

what is the normal response of Anal pucker reflex and nerve roots responsible for it?

Response: Pricking or scratching the perianal skin S4-S5

why is anal pucker & Bulbocavernosus-anal reflex done?

to see if there is incontinence/impotence in sacral or cauda equinal lesions, lumbosacral plexus

What is the normal response & nerve root of Bulbocavernosus/Clitoral-Anal reflex?

Response: pricking the glans penis S3-S4

what are the nerve roots assoc with Babinski reflex?

Afferent: S1 Efferent: L5-S1

what are the diff methods for eliciting the extensor toe sign?

Babinski Chaddock Schaeffer Oppenheim Gordon Bing Gonda, Stansky

for whom should we do the nerve root stretching test?

px with low back or leg pain

what are the 2 signs observed in nerve root stretching test?

Lasegue Sign: Straight-knee-leg raising test Kernig sign: Bent-knee leg raising test

In px suspecting of meningeal irritation, we also test for what?

Local rigidity and concomitant leg flexion

What are the diff involuntary movements?

Physiologic synkinesia Myoclonic jerks Physiologic tremor Emotional tremor

what is the bell phenomenon?

automatic rolling up of eyeballs when you close your eyes

what are the 2 classifications of tremors?

rest tremor action tremor

what are the 2 types of action tremor?

postural tremor - voluntary maintained posture kinetic tremor - voluntary movement, visually/non-visually guided

what are the 4 types of kinetic tremor?

simple kinetic tremor = voluntary movements not target directed just to and for wrist movements intentional tremor = target-directed movements that increases in amp as that part approaches the target task specific kinetic tremor = exacerbated by specific task isometric tremor = muscular contraction against a stationary object

what are the diff non-tremor hyperkinesia movement disorders?

Chorea Athetosis Dystonia Hemiballismus Tics Multiple tic syndrome of Gilles de la Tourette

what type of movement disorder is the fasts wherein with each movement, it is measure to be less than a sec?

chorea

what type of movement disorder has slow, writhing movements most severe in the appendicular muscles?

Athetosis

What type of movement disorder has long, sustained twisting movements most sever ein axial muscles?

Dystonia

What type of movement disorder is due to hemorrhagic lesion of the CL subthalmic nucleus in HTN px?

Hemiballismus

What are the 3 major features of Multiple tic syndrome?

change from time to time involuntary respiratory actions & vocalization personality traits differ

What are general/simple tests for motor dysfunction?

Writing Finger-tapping speed Tasks for daily living Archimedes spiral

Px with what motor dysfunction can have a hard time writing?

Ataxia dysgraphia-cerebellar disease Micrographia or rigidity pD Tremulous dysgraphia-essential tremor

In finger-tapping speed, what is the normal speed?

50 taps/10 secs Children & elderly - taps at slower rates

In Archimedes spiral , what are the indications of diff spirals drawn by px?

Spiral narrows, lines regular = RIGIDITY Lines irregularly weave in and out = ATAXIA Continuous wavering of lines = ESSENTIAL TREMOR

Examination of Motor Function & Deep Tendon Reflexes Flashcards

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