MIDTERM - Physical Tests Flashcards
List of UMN and LMN tests
- UMN (Pronator Drift, Hoffmans, Clonus, Babinski, Tone Assessment)
- LMN (DTRs)
Pronator Drift
Instructions: Patient stands with both arms flexed at 90 and forearms supinated, eyes closed
Duration: 20-30 seconds
Positive: One arm starts to drift downward - indicates UMN disorder
Examples of anticipatory, reactive and dynamic balance
Anticipatory
- Functional reach test
- Catching
Reactive
- Nudge/push test
Dynamic balance tests
- Berg Balance Scale
- Tinetti Balance Gait
What is the primary nerve root and contributing roots for DTR?
- Biceps Brachialis: C5 (C6)
- Brachioradialis: C6 (C5)
- Triceps: C7 (C6)
- Quads: L4 (L2, L3)
- Achilles: S1 (S2)
How do you perform a tone assessment? - UE
- Place patient in a supine position
- Support upper arm with one hand and move the forearm
- Slowly move patient through elbow ROM and increase speed with each cycle
- **Spasticity will more often be felt moving out of flexion into extension
- If resistance is greater as speed increases, spasticity is present**
Tone Assessment - LE
- Place patient in a supine position
- Grasp plantar aspect of patient’s foot and the hand just distal to popliteal fossa
- Slowly move patient through knee and hip from extended to flexed
- Perform ROM several times and increase speed with each cycle
- **Spasticity will more often be felt moving out of extension into flexion
- If resistance is greater as speed increases, spasticity is present**
Clonus
- Instructions: Patient in supine position. Knee flexed and limb supported. Gently move the patient’s ankle from PF/DF several times and then rapidly DF the ankle and hold
- Positive: Feel and observe oscillation equal or great than 3
Babinski
- Instructions: Patient lies supine with skin below ankle exposed. Scrape bottom of foot from lateral calcaneous towards toes and then medially across metatarsals
- Normal: No response or first toe flexion
- Abnormal: 1st toe extension and splaying
Hoffman’s
- Grasp distal phalanx of the middle finger between thumb and index finger. Apply pressure to distal fingernail to induce flexion and then quickly slip your thumb off the patient’s finger
- Normal: No response
- Abnormal: Thumb flexes, adducts and other fingers flex.
How would you distract someone during DTR?
UE: Fingers grasp one another with eyes closed and pull
LE: Cross ankles and with eyes closed try to pull apart
When do you ask AOx4? What does it stand for?
- People with Balance, Coordination, Cognition
- Name, Age, Date/Time, Event
- IF only AOx2: Name and Date? (You can choose)
- Alert and Oriented
What is important to do when having the patient change positions?
Inquire if they are feeling dizzy after sitting/standing
Worried about orthostatic hypotension
What should you aquire before coordination testing?
ROM Screen
Strength Screen
What are some UE Coordination Tests?
- Rapid alternating Movements
- Finger Opposition
- Finger to Nose (Chin)
- Finger to Clincian Finger
What are some LE Coordination Tests?
- Toe Tapping
- Heel to shin
- Romberg (Feet together)
Rapid Alternating Movement (RAM)
Patient position: Arms ar sides, elbows flexed to 90 degrees
Test: patient moves both forearms repeated from supination to pronation
Duration: 10-15 seconds
Test Progression: Increase speed of movement
Abnormal test: Difficulty producing RAM (slow, irregular, clumsy
Inability to produce ram is a condition called…
dysdiadochokinesia
Finger Opposition
Patient Position: Arm at sides, elbows flexed to 90 degrees
Test: Thumb touches to the tip of each: ipsilateral finger in sequence
Duration: Several
Finger to Nose (chin)
Patient Position: Arms abducted to 90 degrees
Test: Eyes open, patient brings tip of index finger to nose (chin)
Duration: Several sequences
Test progression: Finger to clinicial finger
Abnormal: Slow, irregular, clumsy
Finger to Clinician Finger
Patient Position: Arms abducted to 90 degrees
Test: Sit in front of patient, ask patient to touch nose and then touch the tip of your finger
Duration: Several sequences
Test progression: move the target to several locations, increase speed of testing
Abnormal: Slow, Irregular, clumcy movement ot intention tremor
- Dysmetria or Past pointing
Dysmetria or Past pointing
Patient will overshoot your finger which may indicate cerebellar dysfunction
Toe Tapping
Patient position: Sitting with feet on floor
Test: Tap the bal of the foot on the floor repeatedly, do not raise the heel
Duration: Several sequences
Progression: Both feet at same time
Abnormal: Slow, irregular, clumsy movement
- If lacking DR ROM, can be performed in supine and patient taps clinicans hand
Heel to Shin
Patient Position: Supine
Test: Ask patient to place heel of one foot on the opposite knee and then run heel down the shin and back to knee
Duration: Several Sequences
Progression: Weight bearing tests
Abnormal: Slow, irregular, clumsy movement
Romberg (Feet Together)
Patient Position: Standing on the floor with feet touching and together
Test: Stand unsupported
Duration: 30 Seconds
Progression: Tandem Romberg (feet heel to toe), Eyes Closed, Balance Testing
Abnormal: Unable to maintain balance
ALWAYS NEED A GAIT BELT
Potential UMN Findings
- Dysdiadochokinesia
- Hyperreflexia
- Hyper/hypotonia
- +Clonus/Babinski
- Dysmetria
- Weakness
- Sensory & Balance Deficits
- CN Involvement
Potential LMN Findings
- Hyporeflexia
- Hypotonia
- Weakness
- Somatosensory Deficits
- Pain, tingling and numbness along nerve
- Negative UMN
