Lower Neuro Exam Flashcards
what are the steps of a lower neurologist exam
introduction
gait
heel-to-toe tandem gait
Rombergs test
SWIFT (look)
Feel (tone - hip and ankle clonus)
Power (hip, knee ankle, big toe)
Reflexes (knee, ankle, plantar)
Sensation - light touch and neurotip (L2-S1)
Vibration (big toe interphalangeal)
Proprioception
Co-ordination
what is a waddling gait and what does it indicate?
broad stance, slapping of the feet
indicates myopathy
what is an ataxic gait and what does it indicate?
stumbling, uncoordinated walking.
can be cerebellar in pathology or sensory ataxia.
sensory ataxia is when the patient is looking at their feet.
alcohol induced, stroke, MS, diabetic neuropathy, Friedrichs ataxia, cerebral palsy
what is parkinsonian gait?
small shuffling steps, hunched posture frozen arm potential tremor
what is a hemiparetic gait?
circumflex ion of one leg whilst walking - indicates stroke, cerebral palsy, MS
what is spastic paraparesis gait?
dual circumfelxion of the hips whilst walking (inverted scissors)
- stroke, MS, cerebral palsy
what is a high-stepping gait and what does t indicate?
high lift in the steps taken unilateraly and foot drop
what is rombergs test?
ask patient to stand with feet close together and eyes closed to assess sway
+ve if sway and can’t correct = b12 deficiency, hypermobility, Parkinson’s disease & ageing
-ve if sway happens and is self-corrected = vestibular issue, neuronitis or menieres
What does SWIFT stand for?
scars
wasting = LMN lesion
Imbalance = rombergs
Fasiculations = LMN Lesion
Tremor = UMN lesion
what does the tone/power aspect mean?
- leg roll
- ankle clonus test
what is ankle clonus?
repetitive dorsi and plantarflexion of the foot, 5x tapping = ankle clonus (cerebral palsy/UMN lesion)
hip power?
push against thigh to stop from lifting
lift thigh to stop from pushing down
knee power?
stop from straightening
stop from bringing heel to bum
ankle power?
feet to the sky press again
feet to the floor/pedal lift up
big toe power?
point big toe up and oppose
reflexes?
knee, ankle and plantar (lateral to medial +ve = UMN)
HYPER = UMN
HYPO/ABSENT = LMN
always try to clench teeth if no reflex (reinforcement)
sensation light touch
L2-S1
medial anterior thigh
medial knee
medial calf
big toe
little toe
with cotton wool
neuro tipi sensation?
sharp or blunt same L2-S1
vibration sense?
128hz tuning fork on sternum then interphalnageal joint of big toe and move up joints if that doesn’t work
can they feel it? tell me when it stops
proprioception?
stables joint up and down?
co-ordination?
heel of right foot to knee of left leg and run down to left foot and repeat as fast and as many times as possible
why use a heel-to-toe or tandem gait?
find more nuances easier to identify subtle ataxia
what is spasticity?
pyramidal tract lesions (stroke) - faster you move a limb more stiff it gets
what is rigidity?
extrapyramidal tract lesions (Parkinson) -always rigid no matter what
