Motor exam, reflexes, coordination, sensory

observation, inspection, palpation, m tone test, functional test, strength test

6 parts of motor exam

twitch, tremor, involuntary movements, posture

motor exam: observation

involuntary movements and tremors

lesions of basal ganglia or cerebellum and w/ toxic or metabolic disorders

wasting, hypertrophy, fasciculations

inspect several indi ms for

intrinsic hand ms, shoulder girdle, thigh

best ms to look at for fasciculations in LMN disorders are

myositis

if suspect ___, palpate ms to see if tender

pseudohypertrophy

when palpating for m dystrophies, ms may have rubber texture due to

m tone

tested by: PROM for any resistance or rigidity

weakness, atrophy, fasciculations, hyporeflexia

signs of LMN lesion

weakness, hyperreflexia, increased tone

signs of UMN lesion

drift test

test: pt hold up both arms or legs simultaneously at certain point

functional testing

test: rapid finger/hand/foot tapping, rapid hand pro/supination

ataxia

disorders in coordination/balance due to cerebellum lesion

apraxia

abnorm motor conceptualization, planning, and execution

chorea

continuous involuntary movements varying as fluid or jerky

1 (trace), 2 (norm), 3 (brisk)

norm deep t reflex grades

0 (absent)

deep t reflex grade for LMN lesion

4 (nonsustained clonus), 5 (sustained clonus)

deep t reflex grade for UMN lesion

UMN

positive babinski’s or hoffmann’s signs indicated lesion of

thumb flex and adduct

hoffmann’s sign is + if (heightened reflex)

frontal release signs, glabellar response, palmomental reflex, posture

reflexes tested for frontal lobe damage

glabellar response

tap repeatedly btwn eyes; norm should blink few times but eventually stop

myerson’s sign

continued blinking on each tap during glabellar response; seen in neurodegenerative movement disorders like parkinson’s

palmomental reflex

scrape hypothenar eminence causing ipsilat contract of mentalis ms of chin

appendicular ataxia

affects extremity movements; lesion of cerebellar hemispheres and association pathways

truncal ataxia

affects prox ms, especially involved in gait stability

truncal ataxia

caused by midline damage to cerebellar vermis and associated pathways

rapid alternating movements, finger-nose-finger, heel-shin, overshoot

tests for appendicular coordination

appendicular coordination

fine movements of hands and feet

rhomberg

test for trunk coordination

pain and temp

spinothalamic tract signals (anterolat system)

vibration, proprioception, 2-point discrimination

dorsal/post column system signals

spinothalamic tract

tract that decussates immediately in SC via ant white commissure

dorsal column system

tract that decussates in medulla (synapse in nucleus gracilis or nucleus cuneatus)

fasciculus gracilis

lower body mechanoreceptors (dorsal column system) info travel thru

fasciculus cuneatus

upper body mechanoreceptors (dorsal column system) info travel thru

cortical sensation

higher-order aspects of sensation; lesion in contralat sensory cortex

graphesthesia

pt close eyes, trace letters/#s onto palm or finger tip

stereognosis

pt closes eyes, id various objects by touch