Examination of Motor Function & Deep Tendon Reflexes Flashcards
What are checked during inspection of the motor funciton & DTRs?
- Observe general acitivity, posture, stands, sits, walks, gestures
- Observe body build, contours & proportions
- Inspect muscle size contous & involuntary movements (rostrocaudal sequece)
- Posture & gait
- neurocutanoeous lesions
What neurocutaneous lesions are inspected in px?
Cafe au lait spots = neurocutaneous stigmata
During range of motion, what is assessed in the px’s joint?
Spasticiity
Rigidity
Hypotonia
Range of movements
What are the 4 strength principles?
Matching principle
Length-strength principle
Antigravity muscle principle
Engagement principle
what strength test principle uses selective movements to match arm & hand strength to gauge the strength accurately?
Matching principle
What strength testing principle uses muscles when acting from their shortes postiion & have no strength when acting from their longest position?
length-strength principle
What strength principle has muscles working in opposing agonist-antagonist pairs?
Antigravity muscle principle
What strength test principle has most the examiner engaging the px’s competitive spirit to get maximum effort?
Engagement principle
“I’m trying to test how strong you are, don’t let me win”
what muscle of the neck is not included in assessment of the neck?
Trapezius muscle = already assessed in CN
what are the actions assessed in tesitng shoulder girdle strength?
Arm elevation
Arm adduction downward
Arm adduction across the chest (Pectoralis m)
Scapular adduction
Scapular winging
after testing the free movements of the shoulder girdle, what should then be assessed?
strength of these movements
what is done to test for weakness of the upper arm?
- elbow flexion
- elbow extension
What are done to the forearm to assess its presence or absence of weakness?
Wrist flexion
Wrist extension
what are tests done to assess presence/absence of weakness?
Finger extension
Finger flexion
What are also assesed in the finger muscles?
- thenar & hypothenar eminences for size & asymmetry
- atrohy of interosseous muscles
when assessing the abdominal muscles, what part of the body should be carefully observed?
contraction of the abdominal muscles in the umbilicus
What tests are done in assessing back muscles?
Prone position then palpate Paraspinal muscles
What tests are done in assessing the hip girdle?
Hip flexion & extension, Thigh abduction & adduction
Sitting position -> lift thigh then try to push the knee down with butt of palm
Hold legs abducted and counter it by placing ur hands at the L sides of the knees –> px squeezes legs as u place ur hands in the middle of the knees to pull the knees apart
Prone position –> lift thigh off the table & try to push it down at the popliteal space
What are tested in the lower extremities (thigh, ankle, & toes)?
Thigh muscles = Knee extensor muscles, Hamstrings/Flexor muscles
Ankle & Toes = Dorsiflex, evert and invert the feet
In grading muscle strength, what should also be done aside from scoring?
report pattern of weakness => where is it localized?
What is the grading of muscles?
5 = normal strength
4 = full range against resistance to greater gravity
3 = mores part full range against gravity but NOT against ANY RESISTANCE
2 = moves PART ONLY WHEN POSITIONED TO ELIMINATE GRAVITY
1 = Only. A FLICKER OF CONTRACTION of muscle but cannot move joint
0 = complete paralysis
what are the 3 things assessed during percussion of muscles?
check for irritability, Myoedema, Myotonia
what indicates percussion irritability
appearance of FAINT DIMPLE at the percussion site (using a hammer @ the biceps belly)
what is elicited in percussion myoedema?
non-propagating mound appears at the percussion site
In what conditions can you see Myoedema upon percussion?
Debilitation
Malnutrition
Dysmetabolic state (ie hyperthryoidism & Uremia)
What is assessed in percussion myotonia?
if there is a BRIEF RXN & RELAXATION that is NOT VISIBLE –> sign of neuromuscular disorder
How do you elicit perussion Myotonia?
tight fist => hold for 10secs => flip fingers open as quickly as possible => (+ MYotonia): cannot open fingers rapidly & wrist involuntary flexes
What are the diff DTRs?
Jaw jerk
Triceps reflex
Brachioradiaiis reflex
Finger flexion reflex
Knee reflex
Ankle reflex
what nerve roots mediate biceps reflex?
C5-C6
What nerve roots emdiate triceps reflex?
C7-C8
What nerve roots mediate brachioradialis reflex?
C5-C6
What are the 2 methods used to elicit finger flexion reflex?
Tromner method
Hoffman method
What nerve roots mediate finger flexion reflex?
C7-T1
what nerve roots mediate knee reflex?
L2-L4
What nerve roots mediate ankle reflex?
L5-S2
What is the NINDS scale for DTR grading?
0 = areflexia
1 = hyporeflexia
2 = NORMAL
3 = Hyperreflexia
4 = Clonus present
What is mayo clinics reflex scale?
-2 = low response
-1 = moderately low
0 = normal
+1 = brisk
+2 = very brisk
what are the causes of hyperreflexia?
interruption of UMN pathway (betw the cerebrum & LMN)
when do we see sustained and abortive clonus?
Sustained clonus = newborns & infants
Abortive clonus = adults
Sustained clonus in adults = ABNORMAL
how do you know is it is sustained clonus?
foot oscillates betw flexion and extension for as long as you maintain pressure
What are signs of Hypertonia & Hypotonia?
Hypertonia = Spasticity, rigidity, paratonia/Gegenhalten
Hypotonia = flaccidity
what causes rigidity?
extrapyramidal lesion in the basal motor circuit
What is a phenomenon that occurs with the rigidity of Parkinsons disease?
Cogwheel phenomenon
What is the resistance that equals in degree & range every attempt of exminaer to move a part in any directoin?
Paratonia/Gegenhalten
what are the clinical differences of spasticity & rigidity?
Spasticity
- Clasp-knife phenomenon
- Quick jerk of the resting extermity
- extensor toe sign
- predominate in one set of muscles
- EMG inactive
Rigidity
- lead pipe phenomenon w/ cogwheel and tremor at rest
- slow movement of the px’s resting extremity
what are clinical signs of hypotonia?
DEC resistance
INC range of joint movements
what are the nerve roots of upper & lower quadrants of abdominal skin & muscle reflex?
Upper = T8-T9
Lower = T11-T12
What sign is checked for px suspecting of having thoracic spinal cord lesions?
Beevor sign
what nerve roots are affected in cremasteric reflex?
Afferent L1
Efferent L2
what is the normal response of cremasteric reflex?
Elevation of ipsilateral testicle
what is the normal response of Anal pucker reflex and nerve roots responsible for it?
Response: Pricking or scratching the perianal skin
S4-S5
why is anal pucker & Bulbocavernosus-anal reflex done?
to see if there is incontinence/impotence in sacral or cauda equinal lesions, lumbosacral plexus
What is the normal response & nerve root of Bulbocavernosus/Clitoral-Anal reflex?
Response: pricking the glans penis
S3-S4
what are the nerve roots assoc with Babinski reflex?
Afferent: S1
Efferent: L5-S1
what are the diff methods for eliciting the extensor toe sign?
Babinski
Chaddock
Schaeffer
Oppenheim
Gordon
Bing
Gonda, Stansky
for whom should we do the nerve root stretching test?
px with low back or leg pain
what are the 2 signs observed in nerve root stretching test?
Lasegue Sign: Straight-knee-leg raising test
Kernig sign: Bent-knee leg raising test
In px suspecting of meningeal irritation, we also test for what?
Local rigidity and concomitant leg flexion
What are the diff involuntary movements?
Physiologic synkinesia
Myoclonic jerks
Physiologic tremor
Emotional tremor
what is the bell phenomenon?
automatic rolling up of eyeballs when you close your eyes
what are the 2 classifications of tremors?
rest tremor
action tremor
what are the 2 types of action tremor?
postural tremor - voluntary maintained posture
kinetic tremor - voluntary movement, visually/non-visually guided
what are the 4 types of kinetic tremor?
simple kinetic tremor = voluntary movements not target directed just to and for wrist movements
intentional tremor = target-directed movements that increases in amp as that part approaches the target
task specific kinetic tremor = exacerbated by specific task
isometric tremor = muscular contraction against a stationary object
what are the diff non-tremor hyperkinesia movement disorders?
Chorea
Athetosis
Dystonia
Hemiballismus
Tics
Multiple tic syndrome of Gilles de la Tourette
what type of movement disorder is the fasts wherein with each movement, it is measure to be less than a sec?
chorea
what type of movement disorder has slow, writhing movements most severe in the appendicular muscles?
Athetosis
What type of movement disorder has long, sustained twisting movements most sever ein axial muscles?
Dystonia
What type of movement disorder is due to hemorrhagic lesion of the CL subthalmic nucleus in HTN px?
Hemiballismus
What are the 3 major features of Multiple tic syndrome?
change from time to time
involuntary respiratory actions & vocalization
personality traits differ
What are general/simple tests for motor dysfunction?
Writing
Finger-tapping speed
Tasks for daily living
Archimedes spiral
Px with what motor dysfunction can have a hard time writing?
Ataxia dysgraphia-cerebellar disease
Micrographia or rigidity pD
Tremulous dysgraphia-essential tremor
In finger-tapping speed, what is the normal speed?
50 taps/10 secs
Children & elderly
- taps at slower rates
In Archimedes spiral , what are the indications of diff spirals drawn by px?
Spiral narrows, lines regular = RIGIDITY
Lines irregularly weave in and out = ATAXIA
Continuous wavering of lines = ESSENTIAL TREMOR
