Motor Examination Flashcards
What are the signs of an UMN lesion?
Hemiplegia/hemiparesis, spastic hypertonia, hyperreflexia, clonus, Babinski sign.
What are the signs of an LMN lesion?
Paralysis/paresis, reduced tone/flaccidity, atrophy, hyporeflexia, fasciculations.
What is the difference between AROM and PROM?
AROM is active range of motion performed by the patient, PROM is passive range of motion tested by the examiner.
What does severe muscle atrophy indicate?
A lower motor neuron lesion.
What is hypertonia and its types?
Increased resistance to passive stretch, includes rigidity (basal ganglia) and spasticity (UMN).
What does mild muscle atrophy indicate?
An upper motor neuron lesion or disuse.
What is the purpose of a dynamometer in muscle strength testing?
To measure the force output of muscles objectively.
What is a quick screen for myotomes?
A bilateral upper extremity (U/E) quick screen.
What does hypertonia suggest if found during an examination?
It may indicate a lesion in the upper motor neurons or basal ganglia.
What does hypotonia suggest if found during an examination?
It may indicate a cerebellum or lower motor neuron lesion.
What is the difference between rigidity and spasticity?
- Rigidity involves increased resistance regardless of speed or direction (basal ganglia)
- Spasticity involves velocity-dependent resistance (UMN).
What is the clasp knife phenomenon?
A type of spasticity where there is a sudden decrease in resistance during rapid movement.
What is decorticate rigidity?
- Spasticity of antigravity muscles, causing flexion of the upper and extension lower extremities.
- Has a GCS motor response score of 3 and 10% of pts don’t gain functional independence
What is decerebrate rigidity?
- Spasticity of the antigravity (extensor) muscles of the entire body. Extension of upper extremity and lower extremity.
- Equates to 2 points for Best Motor Response on Glascow Coma Scale. 35-45% of people don’t gain funtional independence
What is the arm dropping test?
A test where the arm is dropped to observe for normal muscle tone or abnormalities.
What is the arm drop and pendulum test used to assess?
A test used to assess muscle tone by observing the swinging motion of a limb.
How is the pronator drift test performed?
Hold UE in supination with 90 degrees of shoulder flexion and elbow extension for 15-30 seconds, observe for pronation or dropping.
What indicates hypertonic limbs during passive motion testing?
Stiff and resistant to movement.
What indicates flaccid limbs during passive motion testing?
Heavy and unresponsive to movement.
What is the grading scale for deep tendon reflexes?
- 0 = absent
- 1+ = slight
- 2+ = normal
- 3+ = brisk
- 4+ = very brisk
What is the significance of testing for clonus?
To detect rhythmic involuntary contractions associated with reflexes.
What is a positive Babinski sign?
Great toe extension and toe splaying in response to stroking the sole.
What does severe atrophy indicate?
A lower motor neuron lesion.
What does mild atrophy indicate?
An upper motor neuron lesion or disuse.
What is the significance of the arm dropping test?
To assess muscle tone by observing the reaction of the arm when dropped.
What is the procedure for testing deep tendon reflexes at the biceps?
Test at C5-C6 nerve root level.
What is the procedure for testing deep tendon reflexes at the brachioradialis?
Test at C6-C7 nerve root level.
What is the procedure for testing deep tendon reflexes at the triceps?
Test at C6-C7-C8 nerve root level.
What is the procedure for testing deep tendon reflexes at the patella?
Test at L3-L4 nerve root level.
What is the procedure for testing deep tendon reflexes at the Achilles?
Test at S1-S2 nerve root level.
What is the purpose of goniometry?
To measure the range of motion in joints.
What is the modified Ashworth scale used for?
To measure spasticity in patients.
What is clonus and how is it tested?
A rhythmic involuntary contraction, tested by rapidly and forcefully moving the joint to end-range.
How is passive motion testing performed?
The therapist supports and moves the limb, assessing resistance and responsiveness.
What is the significance of muscle tone observation?
To differentiate between normal, hypertonic, and hypotonic muscle states.
What are the common locations for deep tendon reflex testing?
Biceps, brachioradialis, triceps, patella, Achilles.
How are reflexes graded on a scale of 0-4+?
0 = absent, 1+ = slight, 2+ = normal, 3+ = brisk, 4+ = very brisk.
What is a superficial reflex?
A reflex elicited by gentle stimulation of the skin.
What does increased resistance in passive motion indicate?
Hypertonia or spasticity.
What does decreased resistance in passive motion indicate?
Hypotonia or flaccidity.
What is the significance of varying speed in passive motion testing?
To determine the presence and extent of spasticity.
What does a positive clonus test indicate?
UMN lesion and associated spasticity.
What is the procedure for testing the plantar reflex?
Stroke along the lateral side of the sole, moving from heel to the ball of the foot, curving medially across the metatarsal heads.
What hypertonia is velocity dependent, with faster velocity you will have more resistance and with slower velocity you will have less resistance; also directional dependent?
spastic
What hypertonia has both sides being tighter and is not velocity or directional dependent?
rigidity
what is the rigidity with continued catch and release throughout ROM? (tremor superimposed on rigidity)
cogwheel
What is the rigidity that has an uniform increase in tone?
lead-pipe
