Lower neuro exam Flashcards
What’s the first thing you do?
Heel-toe gait
Speed Symmetry Stance Stability Arm swing (reduced in parkinsons) Step size e.g. shuffle gait, parkinsons Turning
List some gait abnormalities
Sensory ataxia Cerebellar ataxia Parkinsonian gait High stepping gait waddling gait Hemiparetic gait Spastic paraperesis
Explain what happens in a positive romberg’s test
proprioception
Vestibular function
Vision
Distinguish between cerebellar vs sensory ataxia
Cerebellar ataxia - Pt unsteady with eyes open
Sensory ataxia - pt unsteady with eyes closed
What would happened if there’s increased tone in the legs?
Increased tone - heel would come off bed too when feeling legs??
How do you look for ankle clonus?
Hold foot lightly and stretch gastrocnemius and see if there’s a clonus (more than 5 beats)
If pt is struggling, what do you do to eliminate gravity?
Ask pt to
If pt is struggling, what do you do to eliminate gravity?
Ask pt to lie on side
What are the points of reflex?
Knee
Ankle
Foot (babinki’s)
Positive Babinki’s sign?
Big toe extends whereas other toes flex
Fasiculations and wasting would suggest
LMN problem
Sensation
Cotton wool
Vibration
Proprioception
Move big toe whilst asking pt to close eyes
If pt answers proprioception questions incorrectly, what do you do?
Move up to the knee and bend the knee whilst pt is lying flat, then ask the pt to bend up or down
How do you test for coordination in the lower limbs?
Heel shin test
ask patient to run the heel of their foot down from the opposite knee to heel, and when they get to the bottom, pick it up and do it again
