Neuro - Lower Limb Flashcards
How to we introduce the examination?
- Wash hands
- Your ID
- Patient ID
- Explanation
- Consent
- Ask about Pain
What do we do before starting the lower limb examination?
End of bed assessment - AVPU and enviroment
List the catagories tested.
- Observation
- Tone
- Power
- Coordination
- Reflexes
- Sensations
What are we observing?
SWIFT
- Scars
- Wasting
- Involuntary movements
- Fasciculations
- Tremors
How do we test tone?
Check again about pain
Hip rotation - roll both legs back and forth
Knee drop
“Loking for hyper/hypotonia”
Ankle clonus
Is sustained ankle clonus normal?
No
How do we test power?
- Hip - push leg up in air and down
- Knee - bend knee and pull/push
- Ankle - pull ankle towards them and away
- Toe - pull big toe towards them
- rate everything on MRC power scale (narmally 5)
How do we test coordination?
Heel-shin test
“Take this ankle and place it on the other knee *point* and run it down this leg, do this as fast as you can”
“Repeat on other side please”
What reflexes do we test?
Knee - L3/L4
Ankle - S1
If the ankle reflex is not obtained, what do you do next?
Place hand on sole of foot and hit it
if this doesn’t work try reinforcment - pulling hands
What is tested after reflexes?
Planter response - start at bottom of foot laterally and work up towards base of big toe
Flexion is normal
Extension is abnormal
What is tested in sensation?
Light touch
Pinprick
Vibration sense
Join positioning
Where is tested in light touch/pinpricking?
Medial lateral foot
Medial lateral shin
Medial, mid and lateral thigh
testing L2,3,4,5 and S1
How is vibration sense tested?
128 Hz tuning fork on the big toe joint
No need to go up if felt here
How is joint position tested?
Big toe up/down
test both sides of everthing remember and EXPLAIN what you are going to do by showing them
