Motor examination is a part of the neurological examination discussed in the following 7 headings:
Consists of the following headings:
Nutrition/Bulk
Upper limb
Above olecranon process and below 10 cm, mark it and measure the circumference
Lower Limb
The superior border of the patella: 18 cm above / 10 cm below the tibial tuberosity
In children measure the bulkiest part on the normal side and in the same distance from the bony point measure on the abnormal side
If bulk Is <3 cm differences: It is acceptable
If bulk is > 3 cm differences: Are significant (Atrophy: LMN diseases)
Tone
Inspection
Certain Convexity: Increase tone
Flabby: Decrease tone
Palpation
Distract the concentration of the patient
Passive extension and flexion of the wrist, elbow, and ankle joint
In the lower limb
Log-roll method
See the movements of the foot
Like log move in a block: Increase tone
Sag movement: Decrease tone
Lifting Method
A rise in block: Increase tone
Crawl in-ground: Increase tone
Raise the hand and let it
Fall freefall: Decrease tone
Fall slowly: Increase tone
Power
Power’s Grading
0= Total paralysis
1= Flickering by giving pain
2= Only lateral movement, by eliminating gravity
3= Movements against gravity
4= Moving against gravity and resistance
5=Normal power
Reflex
Reflex assessment is a part of the motor examination and grading must be done after its examination
Grading of reflexes
0=Absent
1= Ankle reflex(+)
2= Knee reflex(++)
3=Very brisk (+++)
4=Clonus
DEEP TENDON REFLEXES
Ankle reflex:
COUNSELL Patient what you are going to do
Hip: Slight flex and external rotation
Knee: Flexed
Ankle: everted (slight) and flexion
Proper exposure
If the reflex is absent ==> then do Jendrassiks maneuvers(diverts inhibitors fibers towards upper limb) ==>if again absent then ABSENT
Knee reflex
See quadriceps femoris contraction
Bicep reflex
flex hand in body –>expose biceps muscles
Tricep Reflex
Supinator
Response –>flexon of hand (not supination)
SUPERFICIAL TENDON REFLEXES
Planter: In neutral position (fixation in malleolus) up to 2nd toe
Normal: Flexion of great toe followed by flexion of other toes
Babinski reflex:
Extension of great toe followed by extension and fanning of other toes, followed by flexion of the ankle, contraction of the iliotibial tract, and flexion of the knee and hip
Abdominal reflex:
Outward to Inward
Cremasteric reflex:
from lateral to medial
If Power is > 3=> check for coordination
Coordination
Eyes open and eyes closed
- Finger Nose test
- Finger-finger nose test
- Diasdiadokinesia (both ULs)
- Heel to knee test
Gait
9 meters: Walking, Turning, and Hand position
Abnormal Movements
Check and note for any abnormal movements. Examples:
Tremors
Chorea
Athetosis
Hemibalismus
Myoclonus
Fasciculation
Ticks
