Week 12: Neurological Testing

Test point for C2 dermatome

Mastoid process

Test point for C3 dermatome

Supraclavicular Fossa

Test point for C4 dermatome

AC joint/Upper Trap

Test point for C5 dermatome

Lateral deltoid/Anterolateral arm

Test point for C6 dermatome

Lateral base of thumb

Test point for C7 dermatome

Posterior 3rd digit

Test point for C8 dermatome

Lateral 5th digit

Test point for L1 dermatome

Inguinal line

Test point for L2 dermatome

Upper thigh below inguinal line

Test point for L3 dermatome

Distal thigh above knee

Test point for L4 dermatome

Medial malleolus

Test point for L5 dermatome

Dorsum of foot

Test point for S1 dermatome

Lateral border of foot

Test point for S2 dermatome

Achilles tendon

Test point for S2-5 dermatome

Saddle area

Which sensory receptors are responsible for superficial sensations

Exteroceptors

Exteroceptors receive stimuli from

the external environment via the skin and subcutaneous tissue

Exteroceptors are responsible for perceptions of sensations of

• Pain

• Temperature

• Light touch

• Pressure

Which sensory receptors are responsible for deep sensations

Proprioceptors

Proprioceptors receive stimuli from

• muscles

• ligaments

• joints

• fascia

Proprioceptors are responsible for

• position sense

• awareness of joints at rest

• movement awareness (kinesthesia)

• vibration

What are combined cortical sensations

the combination of both the superficial and depp sensory mechanisms

Combined Cortical Sensations require information from

both exteroceptors and proprioceptive receptors as well as intact function of cortical sensory association areas

Combined Cortical sensations include

• Stereognosis

• Two point discrimination

• Baragonosis

• Graphesthesia

Stocking Glove Distribution

Peripheral Neuropathy

Cannot feel sensation in the hands and feet but are able to feel the arms and legs

Stocking Glove Distribution may be from what disease

Diabetes

Testing pain perception is also referred to as

sharp/dull discrimination

Testing pain perception indicates

function of protective sensation

Testing proprioceptive awareness examines

joint position sense AND awareness of joints at rest

When testing proprioception of a extremity/joint

it is moved through a ROM and HELD in a static position

When testing proprioceptive awareness, the pt will respond with

“up” or “down”

Where should your fingers be placed when testing proprioception and kinesthesia

along the sides of the joint

When testing proprioception, the pt is asked to describe the position verbally

AFTER the change in movement has stopped

Testing for kinesthesia awareness examines

joint position sense AND the awareness of joints at rest

When testing kinesthesia of a extremity/joint

it is moved passively through a relatively small ROM

When testing kinesthesia the pt responds with

• “Up”

• “Down”

• “In”

• “Out”

When testing kinesthesia the pt verbally describes the direction when

DURING the motion - typically as soon as they feel which direction their extremity/join tis moving

Reflex

an involuntary, predictable, and specific response to a stimulus, which is dependent on an intact reflex arc

DTR

Deep Tendon Reflex

A DTR results from

stimulation of the stretch-sensitive IA afferents

DTR grading scale

• 0

• 1+

• 2+

• 3+

• 4+

DTR grade 0

Absent, no response

DTR grade 1+

Slight reflex, but depressed, low normal

DTR grade 2+

Normal, typical reflex

DTR grade 3+

Brisk reflex, possibly but not necessarily abnormal

DTR grade 4+

Very brisk reflex, abnormal, clonus

DTRs are increased in

Upper Motor Neuron (UMN) syndromes (e.g. stroke)

DTRs are decreased in

Lower Motor Neuron (LMN) syndromes (e.g. peripheral neuropathy, nerve root compression)

B/c each DTR arises from specific spinal segments

an absent reflex can be used to identify the level of a spinal lesion (e.g. radiculopathy)

WHy is it important to test reflexes bilaterally

so you can determine if the response is “normal” for the pt

Biceps Deep Tendon Reflex

C5 - 6

Biceps Deep Tendon Reflex response

Slight contraction of elbow flexors

Brachioradialis Deep Tendon Reflex

C6 - 7

Brachioradialis Deep Tendon Reflex response

Slight contraction of elbow flexors, slight wrist entension or radial deviation

Triceps Deep Tendon Reflex

C7

Triceps Deep Tendon Reflex response

Slight contraction of elbow extensors

Patellar Deep Tendon Reflex

L3 - 4

Patellar Deep Tendon Reflex

Slight contraction of knee extensors

Achilles Deep Tendon Reflex

S1 - 2

Achilles Deep Tendon Reflex response

Slight contraction of plantar flexors

DTRs you hit directly on tendon

• Triceps

• Patellar

• Achilles

DTRs you hit on your thumb

• Biceps

• Brachioradialis

Capital Flexion myotome

C1

Capital Extension myotome

C2

Cervical lateral flexion myotome

C3

Shoulder elevation myotome

C4

Shoulder abduction myotome

C5

Elbow flexion myotome

C6

Elbow extension myotome

C7

Thumb extension myotome

C8

Finger abduction myotome

T1

Hip flexion myotome

L2

Knee extension myotome

L3

Ankle dorsiflexion myotome

L4

Great toe extension myotome

L5

Ankle eversion myotome

S1

Ankle plantarflexion myotome

S2

Motion to test C1 myotome

Capital flexion

Motion to test C2 myotome

Capital Extension

Motion to test C3 myotome

Cervical lateral flexion

Motion to test C4 myotome

Shoulder elevation

Motion to test C5 myotome

Shoulder abduction

Motion to test C6 myotome

Elbow flexion

Motion to test C7 myotome

Elbow extension

Motion to test C8 myotome

Thumb Extension

Motion to test T1 myotome

Finger abduction

Motion to test L2 myotome

Hip Flexion

Motion to test L3 myotome

Knee extension

Motion to test L4 myotome

Ankle dorsiflexion

Motion to test L5 myotome

Great toe extension

Motion to test S1 myotome

Ankle eversion

Motion to test S2 myotome

Ankle plantarflexion