Lower Motor Exam

Question 1

Introduction of lower motor neuron

Answer 1

INTRODUCTION:
• Greet the examiner.
• Greet the patient.
• Introduce yourself and establish rapport.
• Confirm patient’s identity.
• Briefly explain what the examination is about.
• Obtain consent.
• Ask for a chaperone.

To the examiner:
I would like to:
• screen my patient for privacy.
• adequately expose my patient (properly expose the leg).
• position my patient (e.g. with the body supine, the arms at the sides
and the palms facing upwards).
• sanitize or wash my hands with running water and soap.

Question 2

Inspection is

Answer 2

INSPECTION:
• Inspect the lower limb from side to foot of the bed.
• Points to note:
• Any deformities?
• Any muscle wasting?
• Presence of fasciculations?
• Any hair loss, scarification marks, etc.?
Ask patient to walk (observe gait)

Answer 3

*Elicit Fasciculation
*Muscle Bulk:

Question 4

Tone

Answer 4

This is the movement across joints (rotation, flexion, extension). Hip (Ball and Socket joint)
Knee (hinge joint)
Ankle (hinge joint)

Question 5

Power

Answer 5

Power:
This is assessed across muscle groups (adduction, abduction, flexion, extension, etc.).
Grade 0: No contraction or muscle movement.
Grade 1: Flicker of contraction, but no movement at the joint.
Grade 2: Movement at the joint with gravity eliminated.
Grade 3: Movement against gravity, but not against added resistance. Grade 4: Movement against external resistance with less strength than usual.
Grade 5: Normal strength or power.