3) Performing a Lower Extremity Neurological Exam Flashcards
1
Q
Neuropathic ulcers and neuropathic joints develop because of
A
- Lack of pain perception
- Pain is a protective mechanism
2
Q
When inspecting the motor system, the following points should be assessed
A
- Resting posture (unusual rotation or posture of a joint)
- Is the patient symmetrical
- Muscle wasting or hypertrophy (focal or diffuse)
- Involuntary movements (tremor, tics, myoclonic jerks, chorea or athetosis)
- Muscle fasciculation (LMN disease)
- Subcutaneous twitches over a muscle belly at rest (tapping the belly may stimulate fasciculation)
3
Q
Sharp touch
A
- Disposable pin
- Sternal area to establish a baseline
- Follow the same progression as with light touch, comparing both lower limbs
- Ask the patient to report hypoaesthesia (feels blunter) or hyperesthesia (feels sharper)
4
Q
Temperature
A
- Compare the quality of temperature sensation on arms, face, trunk, hands, legs and feet
- Containers of warm and cool water may be used for more accurate assessment
- Ask the patient to distinguish between warm and cool on different areas of the skin with their eyes closed
5
Q
Proprioception
A
- Test at IPJ of the big toe
- Hold the proximal phalanx with one thumb and finger and hold the medial and lateral sides of the distal phalanx with the other
- Move the distal phalanx up and down
- Ask the patient to tell you the direction of movement each time
- Test on both feet
- If there is an abnormality, move backwards to the MPJ and so on until joint position sense is normal
6
Q
Vibration sense
A
- 128 Hz tuning fork
- Place it on the sternum to start with so that the patient can feel the sensation
- Then place it on the big toe
- No vibration? move backwards to the bony malleolus of the ankle, the tibial shaft and tuberosity and the anterior iliac crest
7
Q
2-point discrimination
A
- Calipers or areshaped paperclip
- Alternate randomly between touching the patient with one point or with two points on the area being tested (finger, arm, leg, toe)
- The patient is asked to report whether one or two points was felt
- NOT usually performed on the soles of the feet because the distinguishing distance is usually much greater than that on the fingers
8
Q
If there is a spinal cord lesion, there may not be equal diminution across all the sensory modalities
A
- Light touch, vibration and joint position sense may remain intact while sharp touch and temperature are lost
- This is because the lateral spinothalamic pathways may be damaged while the dorsal columns remain intact
9
Q
Tone
A
- The resistance felt when a joint is moved passively through its normal range of movement
10
Q
Hypertonia vs. hypotonia
A
- Hypertonia is found in upper motor neuron lesions
- Hypotonia is found in lower motor neuron lesions and cerebellar disorders
11
Q
Clonus
A
- Rhythmic and involuntary muscle contraction that can be provoked by stretching a group of muscles
12
Q
Testing tone
A
- Ask the patient to let their legs ‘go floppy’
- Internally and externally rotate the ‘floppy’ leg
- Assess for any increased or reduced tone
- Then lift the knee off the bed with one of your hands
- Note whether the ankle raises off the bed as well, signifying increased tone
13
Q
Testing for ankle clonus
A
- Flex the patient’s knee, resting the ankle on the bed
- Dorsiflex the foot quickly and keep the pressure applied
- You will be able to see the foot moving up and down if clonus is present
14
Q
When assessing power, you must test the following
A
- Hip flexion, extension, adduction and abduction
- Knee flexion and extension
- Foot dorsiflexion, plantar flexion, eversion and inversion
- Toe plantar flexion and dorsiflexion
15
Q
Deep tendon reflexes can be
A
- Hyperactive (+++)
- Normal (++)
- Sluggish (+)
- Absent (-)
- (±) is used when the reflex is only present on reinforcement
