Neuro - Lower limb

Question 1

How do you assess gait?

Answer 1

1. Cross arms, stand up without using hands
2. While walking assess speed, symmetry, balance, arm swing
3. Assess tandem gait
4. Assess tip-toe walk (power test of plantar flexion)
5. Assess heel walk (power test of dorsiflexion)

Question 2

How do you assess Romberg’s test?

Answer 2

Tests proprioception - close eyes and stand still
Positive test = loss of balance
Suggests ataxia (sensory)

Question 3

How do you assess tone?

Answer 3

1. Leg roll
2. Leg lift
3. Ankle clonus (roll and swiftly dorsiflex, UMN lesion, severe liver failure)

Question 4

How do you assess power?

Answer 4

Hip flexion tests L1/2 (“stop me from pushing leg down”)
Hip extension tests L5/S1 (pulling up)
Hip adduction tests L2/3 (squeeze legs together)
Hip abduction tests L4/5 (push legs apart)
Knee flexion tests S1 (kick heel towards bum)
Knee extension tests L3/4 (straighten leg)

Question 5

How do you assess power in the feet?

Answer 5

1. Ankle dorsiflexion tests L4
2. Ankle plantar flexion tests S1/2
3. Big toe extension tests extensor hallucis longus (“stop me from pushing toe down”)
4. Ankle inversion tests L4 (push foot in against hand)
5. Ankle eversion tests L5/S1 (push foot out against hand)

Question 6

How do you test reflexes?

Answer 6

1. Knee jerk (L3/4)
2. Ankle jerk (L5/S1)
3. Plantar reflex (S1, use neuro tip)

Question 7

How do you test sensation?

Answer 7

Assess L2-S1 on both sides
Cotton wool = light touch
Neuro tip = fine touch
If sensation is reduced peripherally, assess from distal point and move proximally (stocking sensory loss)

Question 8

How do you test vibration?

Answer 8

Tuning fork
Place on distal bony prominence
Ask patient when vibration stops

Question 9

How do you test proprioception?

Answer 9

Move big toe up and down

Ask patient which direction it is pointing

Question 10

How do you test coordination?

Answer 10

1. Heel to shin test
   Repeat
   Abnormal due to lower limb weakness, cerebellar disorder
2. Tap feet to hands repeatedly