neuro exam motor

Question 1

observing the pt

Answer 1

dementred or confussed
depressed or mood inappropriately elevated?

Question 2

test higher function

Answer 2

Assess level of consciousness
Assess orientation
If abnormalities are suspected, test more fully – refer MSE (mental state examination)

Question 3

Examine the head and neck

Answer 3

Check the head and neck
Test for meningism
Check carotid pulses

Question 3

inspection

Answer 3

Gait
Musculature
Posture
Movement and the presence of abnormal movements

Question 4

evaluations of motor system

Answer 4

INSPECTION
TONE
REFLEXES
POWER

Question 5

gait inspection

Answer 5

Examine the gait in an ambulant patient
eg. hemiplegic circumductal (swinging single leg), ataxic, waddling - broad
Then position the patient comfortably supine on the couch

Question 6

posture inspection

Answer 6

head trunk limbs
global

Question 7

musaculature inspection

Answer 7

systemically examin bulk of muscle, fasciculations (twitching unpurposeful movement), compare sides, local or general atrophy

Question 8

movement inspection

Answer 8

Look for abnormal movements, assess spontaneous movements eg. movements are slow or reduced in Parkinson’s

Question 9

insprection swift

Answer 9

scar
wasting
invol mvnt
fasiculation
tremours

Question 10

thenar

Answer 10

thumb side
look for signs of early wasting

Question 11

abn posture of the head

Answer 11

tortus- twist
collis- column- neck
torticollis
latero- retro- antero- collis

Question 12

chorea

Answer 12

non repetitive abrupt and jerky
eg huntingtons chorea

Question 13

athetosis

Answer 13

sinous writhing distal, continuous
eg cp

Question 14

dystonia

Answer 14

invol abn posture
eg spasmodic torticollis

Question 15

tic

Answer 15

brief movement of untimed intervals
specific and predictable to the patient

Question 16

tremours

Answer 16

resting in parkinsons
fine with thyrotoxicosis
intentional in cp

Question 17

tone hyper vs hypo

Answer 17

hypertonia- upper motor neuron
hypotonia- lower motor neuron

Question 18

important principles for tone assessment

Answer 18

pt is relaxed
passive movement is necessary to assess the tone
the movement must be randomized in speed and direction
assess all joints
compare sides

Question 19

spacticity

Answer 19

lesion occurs in pyramidal tract
one muscle group invovled either ag or antag
hypertonia
streth senstive

Question 20

technique for reflex test

Answer 20

Fully expose the muscle
Limb must be fully relaxed
Joint must be in the mid range
Identify the tendon
Technique direct (as in knee jerk) or indirect (as in biceps jerk)
Strike the tendon firmly (technique must be practiced) and observe the response
Assess each reflex, compare with the opposite side and grade the reflex – see later slide
If the reflex is diminished, use reinforced techniques

Question 20

clonus

Answer 20

extreme hypertonicity
invol rythmic contr and rel

always assoc with upper motor neuron
always in extremity

Question 21

rigidity

Answer 21

occurs in basal gang lesions
both ag and antag
hypertonia
not stretch sensitive

Question 21

reflexes dfn

Answer 21

Involuntary stereotypical response involving a sensory (afferent) and motor (efferent) fibre.

Question 22

reflex grading

Answer 22

O ABSENT + PRESENT - NORMAL ++ PRESENT - NORMAL (brisk) +++ BRISK - ABNORMAL (exaggerated) ++++ CLONIC OR HYPER-REFLEXIC - ABNORMAL

Question 22

deep tendon level of innervation

Answer 22

Biceps C5/6 Triceps C7/8 Supinator C5/6 (= Brachioradialis) Knee L3/4 Ankle S1/S2

Question 23

ABDOMINAL REFLEX

Answer 23

(upper approx T8 -10, lower T10 -12): Test by lightly stroking the abdominal wall in all 4 quadrants towards the umbilicus. Reflex contractions are absent in UMN lesions above the segmental level.

Question 24

CREMASTERIC REFLEX

Answer 24

(L1-2) Stroke the inner thigh in a downward direction. Normal response is contraction of the cremaster muscle which pulls up the scrotum and testis on the side tested. May be absent in old men, in patients with orchitis, hydrocoele or varicocoele.

Question 24

PLANTAR REFLEX

Answer 24

PLANTAR REFLEX (L5/ S1/ S2) inwards towards the middle MTP Joint

Question 24

Normal vs Babinski Response

Answer 24

Normal is down-going or flexor response Babinski response is up-going or extensor (abnormal) response Occurs with UMN lesion or after a seizure (bilateral)

Question 25

muscle power

Answer 25

Take into account age / gender / build Compare sides Evaluate muscle groups systematically: Shoulder - abduction & adduction Elbow, wrist - extension & flexion Fingers - grip strength, finger strength Hip - flexion/ extension/ abduction & adduction Knee - extension & flexion Ankle - dorsi- and plantar flexion

Question 26

upper limb myotomes

Answer 26

Shoulder abduction C5/6 Shoulder adduction C6/7/8 Elbow flexion C5/6 Elbow extension C7/8 Wrist flexion C6/7 Wrist extension C7/8

Question 27

test for shoulder power

Answer 27

abd c5/6 add c5/6/7

Question 27

test for power at elbow

Answer 27

Flexion (C5/6) Extension (C7/8)

Question 28

power test at wrist

Answer 28

Flexion (C6/7) Extension (C7/8)

Question 28

interossei (fingies) power test

Answer 28

C8/T1

Question 29

testy power at knee

Answer 29

Flexion (L5/S1) Extension (L3/4)

Question 29

test power at hip

Answer 29

Flexion L2/3 Extension L5/S1/2 ADduction L2/3/4 ABduction L4/5/S1

Question 29

test power at ankle

Answer 29

Planter Flexion Dorsiflexion/toe extension

Question 30

Asymmetrical muscle weakness

Answer 30

is most often the result of a peripheral nerve, brachial plexus or root lesion, or an upper motor neurone lesion.

Question 30

power grading

Answer 30

5/5 NORMAL (No weakness against resistance) 4/5 Weakness against resistance 3/5 Overcomes gravity, not resistance 2/5 Muscle contracts, cannot overcome gravity 1/5 Flicker of movement 0/5 No movement

Question 31

clinical features of lmn lesions

Answer 31

Interrupts spinal reflex arc Muscle wasting marked Flaccidity/hypotonicity Reflexes diminished or absent Plantar flexor or absent Power diminished

Question 31

clinical features of umn lesion

Answer 31

Above anterior horn cell Muscle wasting absent or slight Spasticity/hypertonicity Reflexes increased Plantar extensor Power diminished