Tone and Myotome Tests

Question 1

Muscle tone for upper and lower extremities

Answer 1

Upper extremity tone

• Graps the elbow and take the hand at the same time. Pronate and supinate the forearm and then roll the hand at the wrist.
• Compare both sides

Fast elbow Test

• Support elbow in flexed position and hold hand. Extend elbow quickly and observe resistance.

Lower Extremity Test

• Supine and legs extended, sudeenly lift leg up at knee and the heel should drag up against the bes as normal.
• Contact thigh and roll the leg inward and outward, noting lag of the foot relative to upper leg. Increased resistance if the leg moves as one

Question 2

Test for clonus and Modified Ashworth Scale test and scoring

Answer 2

Test for Clonus

• Pt relaxed with elbow slightly flexedm palm on plam contact and thurst the wrist inot extension and note any repeatative jerking against hand

Lower limb

• Supine and hold foot and forcfly apply dorsiflexion of ankle and look for clonus

Modified Ashworth Scale test

• Assess spasticity in people with spinal cord injury. Test the resistance of muscles to a passive range of motion about a single joint.
• Flex or extend a joint over a period saying one thousand and one.
• grade 0-5

Question 3

Ashworth Test Grading

Answer 3

0. No increase in muscle tone (should be no resistance to the movement)
1. Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension

1 plus . Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM

2. More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
3. Considerable increase in muscle tone, passive movement difficult
4. Affected part(s) rigid in flexion or extension

Hypetonia can be devided into spascity and ridgity

Spascity due to UMN

Rigidity indicates basel ganglia disease

Question 4

Functional Tests

Drift Test and Fine Movements

Answer 4

Drift Test

• Hold arms up horizontal, palms up and eyes closed
• Shake head in “no” direction, note any drifts
• Cerebella disease - upwarss drift
• Loss of proprioception - searching for movement of fingers
• UMN weakeness - pronation fo wrist, finger flexion slowly

Fine Movements - rapiud hand movements shows weakness, tone abnormalmalies, tremours and coordination problems.

• Tap thumb and finger together left and right
• Pretend to screw in light bulb
• Tap hand rapidly on thigh,right and left
• Tap toe on ground left and right

Question 5

Myotomal testing of C1- T1 and MRC scoring

Answer 5

Pt is sitting and test one side then the other. Grade after testing both sides

• C1-C2: Neck Flexion
• C3: Lateral Neck
• C4: Shoulder Elevation
• C5: Shoulder Abduction
• C6: Elbow Flexion full supination
• C6: Wrist Extension
• C7: Elbow Extension
• C7: Wrist Flexion and finger extension
• C8: Finger Flexion
• T1: Finger Abduction

Question 6

Myotomal testing for L1 – S2 and MRC scoring

Answer 6

Sitting:

L1-L2: Hip Flexion

L2-L3: Hip adduction

L4-L5: Hip abduction

L3: Knee Extension

L4: Foot Inversion

L4-L5: Ankle Dorsiflexion

L5: Big Toe extension

S1: Foot Eversion

Lying Prone:

L5/S1: Hip Extension

L5/S1: Knee Flexion

S1: Foot Plantar Flexion

S2; Toe Flexors