Physical exams

Question 1

What is dysarthria and what does it indicate?

What are the signs of dysarthria? how are they elicited?

Answer 1

• A defect of articulation with language function intact (writing will be unaffected).
• There may be a cerebrallar lesion, an LMN lesion of the cranial nerves, an extrapyramidal lesion, or a problem with muscles in the mouth and jaws or their nerve supply.
  
  • listen for slurring and the rhythm of speech
  • test function of different structures by asking the patient to repeat:
    
    • ‘Yellow lorry’ or words wtih ‘D’, ‘L’, and ‘T’ (tongue function).
    • ‘Peter Piper pciked a pickle’ or words with ‘P’ and ‘B’ (lip function).
  • Cerebellar lesions: slow slurred, low volume with equal empahsis on all syllables (‘scanning’)
  • Facial weakness: speech is slurred
  • Extrapyramidal lesions: monotonous, low volume, and lacing in normal rhythm.

Question 2

Define dysphasia.

Answer 2

This is a defect of language, not just speech, so reading and writing may also be affected. There are four main types of dysphasia:

• Expressive dysphasia
• Receptive dysphasia
• Conductive dysphasia
• Nominal dysphasia
• Global dysphasia

Question 3

Describe expressive dysphasia.

Answer 3

Also called ‘anteriro’, ‘motor’, or ‘Broca’s’ dysphasia

• Lesion is Broca’s area (frontal lobe), involved in language production.
• Understanding remains intact
• Unable to answer questions appropriately
• Speech is non-fluent, broken with abnormal word ordering
• Unable to repeat sentences

Question 4

What screening tool do you use to detect locomotor abnormalities and functional disability in a patient?

Answer 4

GALS examination

• 3 important questions to ask:
  
  • Do you have any pain in your muscles, joints or back?
  • Are you able to dress yourself completely without any difficulty?
  • Are you able to walk up and down the stairs without difficulty?
• Gait:
  
  • Does the patient demonstrating a normal heel strike/ toes off gait ?
  • Is each step of normal height?
  • Is the gait smooth & symmetrical?
• Inspection:
  
  • Front: Shoulder bulk, elbow extension, quadriceps bulk, knee swelling/deformity, foot arches, mif-foot/ forefoot deformity.
  • Behind: Shoulder bulk, spinal alignment, gluteal muscle bulk, popliteal swellings, hind-foot abnormalities.
  • Side: Cervical lordosis, thoracic kyphosis, lumbar lordosis, assess degree of knee flexion/ hyperextension
• Spine:
  
  • Lumbar flexion: place 2 fingers on lumbar spine - as patients bends - fingers should move apart
  • Lateral flexion of cervical spine - “touch you ear to your shoulder”
  • TMJ joint - “move your jaw to side”
• Arm:
  
  • Ask patient to place hands behind head
  • Pronation
  • Swelling/deformity of wrists & hands
  • Supination
  • Palms
  • Power grip
  • Precision grip
  • Squeeze MCP joints
• Legs:
  
  • Hip passive flexion
  • Hip passive internal rotation
  • Patella tap - knee effusion
  • Soles - callus formation may suggest a gait abnormality
  • Squeeze MTJ’s -