motor system and coordination

8/14/2019 Motor System and Coordination

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The Neurological Examination

Dante P. Bornales, MD, MHPEd

Fellow of the Philippine Neurological Association

Part II Motor System Examination and Coordination


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The Neurological Examination

Always include the following in the

Motor System examination:

General Inspection of the Motor System

Muscle tone

Muscle Strength Manual Muscle Testing

Coordination

Your task: recall UMN and LMN lesions and signs


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Inspection

When inspecting, look for:

6. Wasting/Atrophy

- a reduction of the muscle bulk in certain muscles compared with

other muscle groups

- wasted muscles are frequently weak


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Observe!

muscle atrophy

of the thenar muscle

of the left hand

Always compare the

symmetry of muscles!


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Inspection


2. Body position/s

3. Scars

- may indicate previous injury/ies or surgery, which may have affected

a nerve or the muscle itself


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Inspection


4. Fasciculations

- seen as rippling or twitching of muscles at rest

5. Involuntary movements

- look for jerks, tremors, dystonia, other dyskinesias

- describe the abnormal movements


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Whenever possible,

always check for the patients gait

1. ask the patient to walk in his usual fashion, with arms on the

side

2. observe for patients posture, the pattern of the arm andleg movements, and the control of the trunk

3. if normal, ask:

heel-toe walk

stand on his toes and heels without support

hop! (most patients with significant weaknesscannot hop)


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Muscle Tone

Tone how floppy or stiff a limb feels

Some patients may have difficulty relaxing during the exam, which

can artificially increase stiffness in their limbs. Always do your

utmost effort to put them at ease!


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Testing for muscle tone


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Testing for muscle strength


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Full strength (cannot overcome the

movement)

5

Moves against resistance but not to full

strength

4

Moves against gravity but not against

resistance

3

Moves, gravity eliminated2

Flicker of muscle when pt. tries to move1

No movement0

MRC Scale for grading muscle strength


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Testing for shoulder adduction and abduction


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Testing for flexion (C5-C6 biceps) and extension ((C6-8)

at the elbow


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Testing for extension at the wrist (C6-8, radial nerve)


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Testing for extension and flexion at the wrist


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Testing for hand grip (C7-8, T1)


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Testing for finger abduction (C8-T1, ulnar nerve)


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Testing for opposition of the thumb ( C8, T1, median nerve)


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Testing for flexion at the hip L2-4, iliopsoas)


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Testing for extension at the hips (S1, gluteus maximus)


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Testing for adduction (L2-4, adductors) and abduction (L4-5, S1,

Gluteus maximus and medius) at the hips


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Testing for flexion at the knee (L4-5, S1-2, hamstrings


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Always remember to compare the symmetry of both sides


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Testing for extension at the knee (L2-4, quadriceps)


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Variation (sitting) in testing

for the hip flexion

Variation (sitting) in testing

for knee extension


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Variation in the position totest for knee flexion


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Testing for dorsiflexion (L4-5) and plantar flexion (S1)


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End of segment

motor system and coordination

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