Motor Examinations & coordination

الموضوع مرتب بحيث يوضح في البداية ال normal لكل test على ال upper & lower extremities ومن ثم ال abnormal لكل منهما
لمن يرغب بتحميل جميع الفيديوهات سوف اقوم برفعها قريبا ان شاء الله وسوف ابلغكم عنها ايضا
:normal

FIRST : upper extremities

Inspection and Palpation ( Muscle bulk or state )
The muscles are inspected for bulk and fasciculations and, when indicated, palpated for tenderness, consistency and contractures




click here to watch video



Tone
Muscle tone is assessed by putting selected muscle groups through
passive range of motion. The most commonly used maneuvers for the upper
extremities are flexion and extension at the elbow and wrist
click here to watch video




Strength testing
Muscle strength is tested from the proximal to the distal part of the
extremity so that all segmental levels for the extremity are tested (for
the upper extremity that is C5 to T1 – see table). Muscle power is
graded on a scale of 0-5 (see table)




Strength Testing



C5 – Shoulder extension
C6 – Arm flexion
C7 – Arm extension
C8 – Wrist extensors
T1 – Hand grasp



Muscle Strength Grading



0 – No contraction
1 – Slight contraction, no movement
2 – Full range of motion without gravity
3 – Full range of motion with gravity
4 – Full range of motion , some resistance
5 – Full range of motion, full resistance




click here to watch video



Stretch or Deep Tendon Reflexes
A brisk tap to the muscle tendon using a reflex hammer produces a
stretch to the muscle that results in a reflex contraction of the
muscle. The muscles tested, segmental level, and grading of DTR's is
listed below.


Levels for DTR's



Biceps – C5-6
Brachioradialis – C5-6
Triceps – C7
Finger Flexors – C8




Grading DTR's



0 – Absent
1 – Decreased but present
2 – Normal
3 – Brisk and excessive
4 – With clonus





click here to watch video




Testing for pronator drift
The patient extends their arms in front of them with the palms up and
eyes closed. The examiner watches for any pronation and downward drift
of either arm. If there is pronator drift this indicates corticospinal
tract disease
click here to watch video





SECOND : Lower extremities
Inspection and Palpation
The muscles are inspected for bulk and fasciculations and, when indicated, palpated for tenderness, consistency and contractures




click here to watch video



Tone
Muscle tone is assessed by putting selected muscle groups through
passive range of motion. The most commonly used maneuvers for the lower
extremities are flexion and extension at the knee and ankle




click here to watch video




Strength testing
Muscle strength is tested from the proximal to the distal part of the
extremity so that all segmental levels for the extremity are tested (for
the lower extremity that is L2 to S1 – see table). Muscle power is
graded on a scale of 0-5 (see table)




Strength Testing



L2 – Hip flexion
L3 – Knee extension
L4 – Knee flexion
L5 – Ankle dorsiflexon
S1 – Ankle plantar flexion




Muscle Strength Grading



0 – No contraction
1 – Slight contraction, no movement
2 – Full range of motion without gravity
3 – Full range of motion with gravity
4 – Full range of motion, some resistance
5 – Full range of motion, full resistance




click here to watch video



Stretch or Deep Tendon Reflexes
A brisk tap to the muscle tendon using a reflex hammer produces a
stretch to the muscle that results in a reflex contraction of the
muscle. The muscles tested, segmental level, and grading of DTR's is
listed below.



Levels for DTR's



Patellar or Knee – L2-4
Ankle – S1-2



Grading DTR's



0 – Absent
1 – Decreased but present
2 – Normal
3 – Brisk and excessive
4 – With clonus




click here to watch video




Plantar Reflex
The plantar reflex is a superficial reflex obtained by stroking the skin
on the lateral edge of the sole of the foot, starting at the heel
advancing to the ball of the foot then continuing medially to the base
of the great toe. The normal response is flexion of all the toes. The
abnormal response is called a Babinski sign and consists of extension of
the great toe and fanning of the rest of the toes




click here to watch video





Abnormal

FIRST : upper extremities

[/size]Inspection & Palpation
In this patient there are fasciculations
(spontaneous contraction of a motor unit) noted in the deltoid muscle
as well as atrophy. There is also atrophy of the interosseous muscles of
the hands. These findings can be seen in motor neuron disease such as
amyotrophic lateral sclerosis





Tone
There is increased tone in the right upper extremity that is rate
dependent with the clasp-knife phenomena noted when the arm is flexed.
[center]This is spasticity from an upper motor neuron lesion





click here to watch video




Strength testing
With an UMN lesion the fine, fractionated movements of the fingers and
hand are lost. Distal extremity weakness is greater than proximal
weakness. With greater effort to move the paretic hand, there is
overflow activation of proximal muscles and even of the contralateral
hand, which produces mirror or synkinetic movements




click here to watch video





Stretch or Deep Tendon Reflexes
It is always important to compare right vs. left. The first patient
shown has hyperreflexia or 3+ DTR's of the right biceps, triceps and
brachioradialis. The second patient has hyperreflexia of the right
finger flexors. Hyperreflexia is one of the signs of a UMN lesion




click here to watch video




Testing for pronator drift
With an UMN lesion there is pronation and downward drift of the
outstretched supinated arm. This is because the pronators overpower the
weaker supinators. Another name for this sign is a pronator Babinski




click here to watch video





SECOND : Lower extremities

Inspection & Palpation
There
is hypertrophy of this patient's left leg. Closer inspection of that
extremity shows hyperpigmented skin lesions suggesting segmental
neurofibromatosis. A thorough skin search can provide important clues to
diagnosis especially in the neurocutaneous syndromes




click here to watch video




Tone
There is spasticity on passive range of motion of the patient's right
ankle with decrease range of motion and clonus which is caused by
repetitive contraction of the stretched gastrocnemius muscle. Range of
motion at the knee would also demonstrate spasticity. These findings are
part of the UMN syndrome




click here to watch video




Strength testing
Testing of the muscle strength in this patient shows 1/5 weakness of
dorsiflexion, plantar flexion, inversion and eversion of the right ankle
with normal proximal strength




click here to watch video



Stretch or Deep Tendon Reflexes
There is hyperreflexia of the right knee jerk (3+) with a rightsided
crossed adductor response (the crossed adductor contraction occurred
because of the increased right leg tone which resulted in reflex
contraction of the adductor magnus with the very slight stretch of this
muscle caused by tapping the opposite knee). There is also hyperreflexia
with clonus (4+ DTR) of the right ankle. The second patient
demonstrates a 4+ ankle jerk on the left with sustained clonus.
Hyperreflexia is one of the signs of the UMN syndrome




click here to watch video



Plantar Reflex
The patient has a Babinski sign on the right with an up going great toe
and dorsiflexion and fanning of the other toes. This is an important
indication of UMN disease




click here to watch video







Coordination Exam(Cerebellar
Functions)










normal




Hand Rapid Alternating Movements


Finger
tapping, wrist rotation and front-to-back hand patting. Watch for the
rapidity and rhythmical performance of the movements noting any
right-left disparity





click here to watch video







Finger-to-nose
The
patient moves her pointer finger from her nose to the examiner's finger
as the examiner moves his finger to new positions and tests accuracy at
the furtherest outreach of the arm




click here to watch video







Heel-to-shin
The
patient places her heel on the opposite knee then runs the heel down
the shin to the ankle and back to the knee in a smooth coordinated
fashion



click here to watch video







Abnormal

Tremor
A
cerebellar intention tremor (1st scene in this movie) arises mainly
from limb girdle muscles and is maximal at the most demanding phase of
the active movement. This must be distinguished from a postural tremor
(fine distal 8-13 Hz)(2nd scene) or resting tremor (coarse distal 5-6 Hz
pill-rolling type of tremor)(3rd scene)



click here to watch video







Hand Rapid Alternating Movements
Movements
are slow and irregular with imprecise timing. Inability to perform
repetitive movements in a rapid rhythmic fashion is called dysdiadochokinesia




click here to watch video





Finger-to-nose
Under (hypometria) and over (hypermetria) shooting of a target (dysmetria) and the decomposition of movement
(the breakdown of the movement into its parts with impaired timing and
integration of muscle activity) are seen with appendicular ataxia




click here to watch video







Heel-to-shin
The
patient with ataxia of the lower extremity will have difficulty placing
the heel on the knee with a side-to-side irregular over- and
undershooting as the heel is advanced down the shin. Dysmetria on
heel-to-shin can be seen in midline ataxia syndromes as well as
cerebellar hemisphere disease so there is overlap between the two types
of ataxias for this finding



click here to watch video

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