Lower limb assessment

Question 1

Describe gait assessment

Answer 1

• Speed
• Symmetry
• Stance
• Stability
• Arm swing (reduced is a sign of parkinsons)
• Steps
• Turning (balance)
• Heel toe (tandem)
• Tip toe

Question 2

List gait abnormalities

Answer 2

• Ataxic (cerebellar and sensory - wide stance)
• Parkinsonian
• High stepping
• Waddling
• Hemiparetic (semicircle on one side)
• Spastic parapparesis

Question 3

Describe rombergs test

Answer 3

• Test balance. Positive = sensory ataxia. Negative = cerebellar
• Ask patient to stand with feet together and stand close to them in case they need support
• Ask to rest hand by their side and close their eyes. See if their balance gets worse

Question 4

Describe tone assesment

Answer 4

• Check both sides
• Rotate thighs
• Lift knees behind kneecap. In increased tone heel comes off the leg
• Lift leg and dorsiflex and plantarflex ankle

Question 5

Is clonus upper or lower motor neurone?

Answer 5

Upper motor neuron

Question 6

Describe assessment of power

Answer 6

• Hip flexion and extension
• Abduction adn adduction
• Knee flexion and extension
• Ankle dorsiflexion
• Ankle plantar flexion
• Big toe extension and flexion

Question 7

Describe reflexes

Answer 7

• Knee jerk L3/4
• Ankle jerk (L5/S1, hit abducted and knee bent, ankle dorsiflexed)
• Plantar (S1 - blunt end of neurotip from heel along outer edge of foot)

Question 8

List what would be found in upper motor neurone lesion

Answer 8

• No fasciculations or wasting
• increased tone reduced power
• Hyperreflexia
• Babinski sign

Question 9

List signs of lower motor neuron lesion

Answer 9

• Fasciculations and wasting
• Decreased tone
• Hyporeflexia
• No babinski sign

Question 10

How is sensation assessed

Answer 10

• Normal on sternum, cotton wool and pin prick
• L2 lateral thigh
• L3 knee
• L4 medial leg
• L5 big toe
• S1 lateral foot
• S2 posterior thigh

Question 11

How is proprioception assessed?

Answer 11

• Moving toe joint

- If abnormal, move up the leg (ankle, knee, hip)

Question 12

How is coordination examined?

Answer 12

• Heel shin test
• Place heel on opposite knee and bring down to ankle. Repeat
• Could be wrong due to cerebellar problem or muscle weakness

Question 13

How is vibration assessed?

Answer 13

• Tuning fork for vibration

- Start on IP big toe joint, move up the leg if abnormal

Question 14

What is erythema nordosis a sign of?

Answer 14

• IBD