Examination: Neurological (Lower Limb Motor)

Question 1

Neurological Lower Limb Motor

Step 1:

Answer 1

Prepare the patient
•	Introduce yourself and the exam
•	Ask them to remove their pants (shorts are ok)
•	Check the patient is comfortable
•	Prepare bed (flat)

Question 2

Neurological Lower Limb Motor

Step 2:

Answer 2

Hand Hygeine

Question 3

Neurological Lower Limb Motor

Step 3:

Answer 3

Gait
• Fluidity of movement
• The way the foot strikes the floor
• Asymmetry

Question 4

Neurological Lower Limb Motor

Step 4:

Answer 4

General Inspection
•	Scars or Deformities
•	Muscle Bulk
•	Fasciculations
•	Inspect lower back also

Question 5

Neurological Lower Limb Motor

Step 5:

Answer 5

Tone
• Ask patient to allow you to take their weight/ make their legs go floppy
• Knee and Ankle
• Look for clonus

Question 6

Neurological Lower Limb Motor

Step 6:

Answer 6

Power
•	Hip flexion (L2,L3)
•	Hip extension (L4,L5,S1)
•	Hip abduction (L4,L5, S1)
•	Hip adduction (L2,L3,L4)
•	Knee flexion (L5, S1)
•	Knee extension (L2,L3,L4)
•	Ankle dorsiflexion (L4,L5)
•	Ankle plantarflexion (S1,S2)
•	Inversion of the foot (L4, L5)
•	Eversion of the foot (L5,S1)
•	Great toe extension (L4, L5, S1)

Question 7

Neurological Lower Limb Motor

Step 7:

Answer 7

Reflexes
• Knee Jerk (L2,L3,L4)
• Ankle Jerk (S1, S2)
• Plantar reflex – look for Babinski sign (L5,S1,S2)

Question 8

Neurological Lower Limb Motor

Step 8:

Answer 8

Coordination

• Heel-shin test

Question 9

Neurological Lower Limb Motor

Step 9:

Answer 9

Conclude
• Inform the patient that the examination is complete
• Thank the patient

Question 10

What are you looking for when examining the patient’s gait?

Answer 10

• Fluidity of movement
• The way the foot strikes the floor
• Asymmetry

Question 11

What features are you looking for in the general inspection

Answer 11

• Scars or Deformities
• Muscle Bulk
• Fasciculations

Question 12

What word describes incomplete loss of strength to the legs?

Answer 12

Paraparesis

Question 13

What word describes complete loss of strength to one limb?

Answer 13

Monoplegia