Lower Limb Motor Examination Flashcards
6 parts of examination
What mneumonic can be used?
Inspection Tone Power Reflex Coordination Other tests
Inspection - what do you look for?
Mneumonic - SWIFT
Scarring Wasting Involuntary movements Fasciculations Tremor
How to assess tone in lower limbs? - 3
Leg roll
Leg lift
Ankle clonus (>5 is abnormal)
Power:
MRC scale 0-5: - define each stage
0 - no contraction
1 - flicker or trace of contraction
2 - active movement but not against gravity (e.g. horizontal on surface)
3 - active movement vs gravity
4 - active movement vs resistance but less than normal
5 - normal power
Power
What movements do you test for at the:
- Hips
- Knee
- Ankle
- Toe
Hips flexion
Hip extension
Knee flexion
Knee extension
Ankle dorsiflexion
Ankle plantarflexion
Toe extension
Power
What descriptors would you use to describe the power?
Mild, moderate, severe - could also use MDC
Bilateral or unilateral
Symmetrical or asymmetrical
Proximal
Distal
Global - all the muscles in a limb are affected equally
Pyramidial - originating from UMN lesion
Deep tendon reflexes
What reflexes do we look for?
What is the babinski reflex and what does it indicate?
Knee jerk
Ankle jerk
Babinski reflex
Extension of great toe and spread of other toes - UMN lesion
Think toes go UP so has to be UPPER motor neurone
Reflexes
How would distract the patient to help elicit it?
What could you say if you don’t elicit any reflexes?
Distract them - clench teeth while you are doing it/interlock their hands and pull them apart
Reflexes absent even with distraction
Coordination
How is this tested for?
What does an inability to do this mean?
Heel to shin test
Motor strength
Proprioception
Cerebellar disorder
Gait - what to assess?
Posture Arm swing Stride length Base Speed Symmetry Balance Abnormal movements
Ataxic gait:
- what is it commonly referred to as?
- base?
- one other feature
- what won’t they be able to do?
- what do patients with sensory ataxia do?
- what happens if there is a cerebellar lesion causing this?
Drunk gait
Broad based - feet are far apart
Unsteady
Tandem gait - walk with toes of the back foot touch the heel of the front foot at each step.
Look at feet intently to compensate for proprioceptive loss - may also stomp due to lack of sensation
May veer to one side
Parkinsonian gait:
- steps
- posture
- arm swing
- how do they turn?
- what else may be present?
- they may also festinate. What does this mean?
small shuffling
stooped
reduced (unilateral at first)
several steps taken to turn
Tremor
Festinate - accelerating as they walk
High stepping gait:
- cause
- what will they not be able to do?
- what is it a sign of?
Foot drop - weakness of ankle dorsiflexion
Won’t be able to walk on their heels
LMN lesion - cause equine syndrome
Waddling gait:
-what does it indicate?
Proximal lower limb weakness - myopathy
Hemiplegic gait:
- What does the pathological leg do?
- What is this called?
- what is it often seen after?
One leg held stiffly and swings round in arch with each stride
Circumduction
Stroke
