Neuro: motor & sensory Flashcards
what 4 topics are we thinking about in regard to the motor system in neuro?
body position
involuntary movements
characteristics of muscles (bulk, tone, strength)
coordination
3 types of involuntary movements
Tremors, Tics, or Fasciculations
- -Location, Quality, Rate, Rhythm, amplitude
- -Relation to Posture, Activity, Fatigue, Emotion, Other
what to do with suspected decreased or increased resistance muscle tone?
Suspect Decreased Resistance?
Hold forearm and shake hand – Is it moving freely or is it “floppy?”. Hypotonic or flaccid may point to abnormality in peripheral motor system
Suspect Increased Resistance?
Is there variation vs persistence ROM during flexion and/or extension?
–Spastic –may be rate-dependent and increase with rapid motion (central corticospinal abnormality)
–Rigid – resistance throughout motion, does not increase or decrease with rate
graded muscle scale
0: No muscular contraction detected
1: A barely detectable flicker or trace of contraction
2: Active movement of the body part with gravity eliminated
3: Active movement against gravity
4: Active movement against gravity and some resistance
5: Active movement against full resistance without evident fatigue. (Normal muscle strength)
CNs for elbow movement : flexion and extension
Flexion (C5, C6 – biceps)
Extension (C6, C7, C8 – triceps)
Pull and push against forearm (countertraction) to test strength of flexion/extension
CNs for wrist movement
Extension (C6, C7, C8 – radial nerve – extensor carpi radialis longus and brevus)
“Make a fist and resist me pulling down.”
CNs for grip
C7, C8, T1
“Squeeze my two fingers as hard as you can.”
Should have trouble removing fingers from hand
Do bilateral testing simultaneously to compare strength
CNs for finger abduction
C8, T1, Ulnar Nerve
Palm down with fingers spread
“Don’t let me move the position of your fingers.”
CNs for thumb opposition
C8, T1, Median Nerve
“Try to touch the tip of your little finger with your thumb, against my resistance.”
trunk exam for motor system function
Flexion, Extension, Lateral Bending of the Spine
Thoracic Expansion, Diaphragmatic Excursion during Respiration
CNs for hip movement- 4 parts
Flexion (L2, L3, L4 – iliopsoas)
Place hand on pt’s thigh – “Raise your leg against my hand”
Adduction (L2, L3, L4 – adductors)
Hands on bed between patient’s knees – “Bring both legs together.”
Abduction (L4, L5, S1 – gluteus medius and minimus)
Hands firmly on bed outside patient’s knees – “Spread both of your legs against my hands.”
Extension (S1 – gluteus maximus)
Pt pushes posterior thigh down against your hand
CNs for knee movement: flexion and extension
Extension (L2, L3, L4 – quadriceps)
Support knee in flexion – “Straighten your leg against my hand.”
Be careful because quad is strongest muscle in body!
Flexion (L4, L5, S1, S2 – hamstrings)
Knee flexed with foot resting on bed
“Keep your foot on the bed as I try to straighten your leg.”
CNs for foot movement
Dorsiflexion (L4, L5 – tibialis anterior)
“Pull your foot up against my hand.”
Plantar flexion (mainly S1 – gastrocnemius, soleus)
“Push your foot down against my hand.”
coordination requires what 4 areas to function?
Motor system (strength) Cerebellar system (rhythmic movement, steady posture) Vestibular system (balance, coordination of eye, head, and body movement) Sensory system (position sense)
what are we testing with rapid alternating movements?
coordination : hands (slapping on legs) and feet (tapping PAs hands with feet)
