Motor Testing

7/18/2019 Motor Testing

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THE NEUROLOGIC EXAMINATIONMOTOR SYSTEM EXAMINATIONMOTOR SYSTEM EXAMINATION


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Motor System Examination, including Cerebellar tests

Insection! "ody osition

In#oluntary mo#ements

Muscle bul$

Muscle Tone Manual Motor Testing Coordination and %ait


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Examination of the motor system

1. Inse!tion an" #a$ation

A. Tremors% Parkinsonian / Metabolic / Cerebellar / Essential

Rubral / Physiologic tremor, Tremor of Hepaticencephalopathy

&. 'ystonia

C. In(o$)ntary mo(ements% Chorea, Tardive dyskenisia,

thetosis, Pseudoathetosis, Choreoathetosis, !allism

'. C$on)s * Myo!$on)sE. +asm% muscle cramps, oculogyric crisis, hemifacial

cramps, palatal myoclonus or nystagmus,

blepharospasm, hiccup

,. +ei-)res

. M)s!$e +ymmetryLeft to Ri/ht

#roxima$ (s. 'ista$

Atrohy "particular attention to the hands, shoulders, and thighs#

0. Gait


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Examination of the motor system

Muscle Tone

As the atient to re$ax.

,$ex an" exten" the atient2s fin/ers3 4rist3 an" e$5o4.

,$ex an" exten" atient2s an$e an" nee.There is norma$$y a sma$$3 !ontin)o)s resistan!e to assi(e

mo(ement.

O5ser(e for "e!rease" 6f$a!!i"7 or in!rease" 6ri/i"*sasti!7

tone.


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Testing of motor and sensory function re$uires a basic understanding of

normal anatomy and physiology.

In 5rief% 8o$)ntary mo(ement 5e/ins 4ith an im)$se /enerate" 5y !e$$ 5o"ies

$o!ate" in the 5rain. +i/na$s tra(e$ from these !e$$s "o4n their rese!ti(e axons3 formin/ the

Corticosinal (a.k.a. Pyramidal)tract.

At the $e(e$ of the 5rain stem3 this motor ath4ay !rosses o(er to theoosite si"e of the 5o"y an" !ontin)e "o4n4ar" on that si"e of the

sina$ !or". The ner(es 4hi!h !omrise this motor ath4ay are

!o$$e!ti(e$y referre" to as &er Motor Neurons '&MNs() At a se!ifi! oint in the sina$ !or" the axon synases 4ith a n"

ner(e3 referre" to as a *o+er Motor Neuron '*MN()The re!ise$o!ation of the synase "een"s )on 4here the $o4er motor ne)ron is

"estine" to tra(e$. If3 for exam$e3 the LMN terminates in the han"3 the

synase o!!)rs in the !er(i!a$ sine "i%e% neck area#%Ho4e(er3 if it9s

hea"e" for the foot3 the synase o!!)rs in the $)m5ar sine "i%e% lo&er

back#%


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The &MNsare art of the Central Ner#ous System 'CNS(,4hi!h is

!omose" of ne)rons 4hose !e$$ 5o"ies are $o!ate" in the 5rain or sina$

!or". The *MNsare art of the eri-eral Ner#ous System 'NS(,ma"e

) of motor an" sensory ne)rons 4ith !e$$ 5o"ies $o!ate" o)tsi"e of the

5rain an" sina$ !or". The axons of the #N+ tra(e$ to an" from the

erihery3 !onne!tin/ the or/ans of a!tion 6e./. m)s!$es3 sensory

re!etors7 4ith the CN+. Ner(es 4hi!h !arry im)$ses a4ay from the CN+ are referre" to

E..erents"i%e% motor#4hi$e those that 5rin/ si/na$s 5a! are !a$$e"

A..erents"i%e% sensory#% Axons that exit an" enter the sine at any /i(en $e(e$ /enera$$y

!onne!t to the same "ista$ anatomi! area. These 5)n"$es of axons3

referre" to as sina$ ner(e roots3 !ontain 5oth afferent an" efferent

ner(es. The roots exit*enter the sina$ !or" thro)/h ne)roforamina in the

sine3 aire" oenin/s that a$$o4 for their assa/e o)t of the 5ony

rote!tion ro(i"e" 5y the (erte5ra$ !o$)mn.


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As the efferent ne)rons tra(e$s erihera$$y3 !omonents from

"ifferent roots !ommin/$e an" 5ran!h3 fo$$o4in/ a hi/h$y ro/ramme"attern. U$timate$y3 !ontri5)tions from se(era$ roots may !om5ine to

form a name" erihera$ ner(e3 4hi!h then fo$$o4s a re!ise anatomi!

ro)te on its 4ay to inner(atin/ a se!ifi! m)s!$e.

The Ra"ia$ Ner(e3 for exam$e3 tra(e$s aro)n" the H)mer)s

!ontains !ontri5)tions from Cer(i!a$ Ner(e Roots :3 ; an" < an"

inner(ates m)s!$es that exten" the 4rist an" s)inate the forearm.

It may he$ to thin of a ner(e root as an e$e!tri!a$ !a5$e !omose"

of many "ifferent !o$ore" 4ires3 ea!h 4ire reresentin/ an axon. As

the !a5$e mo(es a4ay from the sina$ !or"3 4ires s$it off an" hea" to

"ifferent "estinations. #rior to rea!hin/ their tar/ets3 they !om5ine 4ith

4ires ori/inatin/ from other !a5$es. The /ro) of 4ires that )$timate$yen"s at a tar/et m)s!$e /ro) may therefore ha(e !ontri5)tions from

se(era$ "ifferent roots.


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SIGN UNM Lesion LMN Lesion

=eaness >es >es

Atrohy No ? >es

,as!i!)$ation No >es

Ref$exes In!rease" 'e!rease"

Tone In!rease" 'e!rease"

' Mild atrophy may develop due to disuse

Signs o. &er Motor Neuron '&MN( and *o+er

Motor Neuron '*MN( *esions


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Motor Testin/

The m)s!$e is the )nit of a!tion that !a)ses mo(ement.Norma$ motor f)n!tion "een"s on inta!t )er an"$o4er motor ne)rons3 sensory ath4ays an" in)t from an)m5er of other ne)ro$o/i!a$ systems. 'isor"ers ofmo(ement !an 5e !a)se" 5y ro5$ems at any oint4ithin this inter!onne!te" system.

Muscle !ulk and ppearance(

This assessment is some4hat s)5@e!ti(e an" )ite"een"ent on the a/e3 sex an" the a!ti(ity*fitness $e(e$

of the in"i(i")a$. A frai$ e$"er$y erson3 for exam$e3 4i$$ha(e $ess m)s!$e 5)$ then a B year o$" 5o"y 5)i$"er.=ith exerien!e3 yo) 4i$$ /et a sense of the norma$ran/e for /i(en a/e /ro)s3 fa!torin/ in their arti!)$ara!ti(ity $e(e$s an" o(era$$ states of hea$th.


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Motor Testin/

Things to look for:Usin/ yo)r eyes an" han"s3 !aref)$$y examine the ma@or

m)s!$e /ro)s of the )er an" $o4er extremities. #a$ation of the

m)s!$es 4i$$ /i(e yo) a sense of )n"er$yin/ mass. The $ar/est an"

most o4erf)$ /ro)s are those of the )a"ri!es an" hamstrin/s

of the )er $e/ 6i.e. front an" 5a! of the thi/hs7. The atientsho)$" 5e in a /o4n so that the areas of interest are exose".

M)s!$e /ro)s sho)$" aear symmetri!a$$y "e(e$oe" 4hen

!omare" 4ith their !o)nterarts on the other si"e of the 5o"y.

They sho)$" a$so 5e aroriate$y "e(e$oe"3 after main/a$$o4an!es for the atient9s a/e3 sex3 an" a!ti(ity $e(e$.


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Muscle Assymetry

=hi$e 5oth $e/s ha(e 4e$$ "e(e$oe" m)s!)$at)re3

the $eft has /reater 5)$.


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Motor Testin/

There sho)$" 5e no m)s!$e mo(ement 4hen the $im5 is at rest.

Rare "isor"ers "e%g% myotrophic )ateral *clerosis#res)$t in"eath of the $o4er motor ne)ron an" s)5se)ent "ener(ation of

the m)s!$e. This !a)ses t4it!hin/ of the fi5ers no4n as

fas!i!)$ations3 4hi!h !an 5e seen on /ross inse!tion of affe!te"

m)s!$es.

Tremors are a se!ifi! tye of !ontin)o)s3 in(o$)ntary m)s!$e

a!ti(ity that res)$ts in $im5 mo(ement. #arinson9s 'isease 6#'73

for exam$e3 !an !a)se a (ery !hara!teristi! restin/ tremor of the

han" "the head and other body parts can also be affected#that

"iminishes 4hen the atient (o$)ntari$y mo(es the affe!te" $im5.

&eni/n Essentia$ Tremor3 on the other han"3 ersists thro)/ho)t

mo(ement an" is not asso!iate" 4ith any other ne)ro$o/i!a$

fin"in/s3 easi$y "istin/)ishin/ it from #'.


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Motor Testin/

The ma@or m)s!$e /ro)s to 5e a$ate" in!$)"e%

5i!es3 tri!es3 "e$toi"s3 )a"ri!es an" hamstrin/s.

#a$ation sho)$" not e$i!it ain. Interestin/$y3 myositis "a

rare condition characteri+ed by idiopathic muscleinflammation#!a)ses the atient to exerien!e 4eaness

5)t not ain.


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If there is asymmetry3 note if it fo$$o4s a arti!)$ar attern.

Remem5er that some a$$o4an!e m)st 5e ma"e for han"e"ness"i%e% right v left hand dominance#%

'oes the asymmetry fo$$o4 a arti!)$ar ner(e "istri5)tion3s)//estin/ a erihera$ motor ne)ron in@)ry ,or exam$e3m)s!$es 4hi!h $ose their LMN inner(ation 5e!ome (ery atrohi!.

Is the 5)$ in the )er an" $o4er extremities simi$ar +ina$!or" transe!tion at the Thora!i! $e(e$ 4i$$ !a)se )er extremitym)s!$e 5)$ to 5e norma$ or e(en in!rease" ")e to in!rease""een"en!e on arms for a!ti(ity3 mo5i$ity3 et!. Ho4e(er3 them)s!$es of the $o4er extremity 4i$$ atrohy ")e to $oss of

inner(ation an" s)5se)ent "is)se.

Is there another ro!ess 6s)//este" 5y history or otherase!ts of the exam7 that has res)$te" in $imite" mo(ement of aarti!)$ar $im5 ,or exam$e3 a 5roen $e/ that has re!ent$y5een $i5erate" from a !ast 4i$$ aear mare"$y atrohi!.

Motor Testin/


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/i..use Muscle 0asting!

Note $oss m)s!$e 5)$ in $eft han" ")e to erihera$ "ener(ation.

In arti!)$ar3 !omare $eft an" ri/ht thenar eminen!es.


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MOTOR TE+TING% Tone

=hen a m)s!$e /ro) is re$axe"3 the examiner sho)$" 5e a5$e to

easi$y mani)$ate the @oint thro)/h its norma$ ran/e of motion. Thismo(ement sho)$" fee$ f$)i". A n)m5er of "isease states may a$ter this

sensation. ,or the s!reenin/ examination3 it is reasona5$e to $imit this

assessment to on$y the ma@or @oints3 in!$)"in/% 4rist3 e$5o43 sho)$"er3 his

an" nees.

Techni$ue( As the atient to re$ax the @oint that is to 5e teste". Caref)$$y mo(e the $im5 thro)/h its norma$ ran/e of motion3 5ein/ !aref)$

not to mane)(er it in any 4ay that is )n!omforta5$e or /enerates ain. &e

a4are that many atients3 arti!)$ar$y the e$"er$y3 often ha(e other me"i!a$

!on"itions that $imit @oint mo(ement. 'e/enerati(e @oint "isease of the

nee3 for exam$e3 mi/ht !a)se $imite" ran/e of motion3 tho)/h tone

sho)$" sti$$ 5e norma$. If the atient has re!ent$y in@)re" the area or are in ain3 "o not erform

this ase!t of the exam.


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MOTOR TE+TING% Tone

Things to look for(

Norma$ m)s!$e /enerates some resistan!e to mo(ement 4hen

a $im5 is mo(e" assi(e$y 5y an examiner.

In!rease" tone 6hyertoni!ity7 res)$ts from m)s!$e !ontra!tion.

At the extreme en" is sasti!ity3 4hi!h o!!)rs 4hen the )ermotor ne)ron no $on/er f)n!tions. In this settin/3 the affe!te" $im5

is he$" in a f$exe" osition an" the examiner may 5e )na5$e to

mo(e the @oint. This is seen most !ommon$y fo$$o4in/ a stroe3

4hi!h res)$ts in the "eath of the )er motor ne)ron !e$$ 5o"y in

the 5rain.

,$a!!i"ness is the !om$ete a5sen!e of tone. This o!!)rs 4hen

the $o4er motor ne)ron is !)t off from the m)s!$es that it norma$$y

inner(ates.


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'isor"ers that "o not "ire!t$y affe!t the m)s!$es3 )er or $o4er

motor ne)rons !an sti$$ a$ter tone.

#erhas the most !ommon of these is #arinson9s 'isease 6#'7.

This is a "isor"er of the Extra #yrami"a$ +ystem 6E#+7. The

E#+ norma$$y !ontri5)tes to initiation an" smoothness ofmo(ement. #' !a)ses in!rease" tone3 /eneratin/ a rat!hetD$ie

sensation "kno&n as cog &heeling#4hen the affe!te" $im5s are

assi(e$y mo(e" 5y the examiner.

MOTOR TE+TING% Tone


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MOTOR TE+TING% Strength

As 4ith m)s!$e 5)$3 stren/th testin/ m)st tae into a!!o)nt the

a/e3 sex an" fitness $e(e$ of the atient. ,or exam$e3 a frai$3

e$"er$y3 5e" 5o)n" atient may ha(e m)s!$e 4eaness ")e to

se(ere "e!on"itionin/ an" not to intrinsi! ne)ro$o/i!a$ "isease.

Interretation m)st a$so !onsi"er the exe!te" stren/th of them)s!$e /ro) 5ein/ teste". The )a"ri!es /ro)3 for exam$e3

sho)$" 5e m)!h more o4erf)$ then the &i!es.


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%rading o. Muscle Strengt-

rade -escription

*B No m)s!$e mo(ement

1*B +$i/ht !ontra!ti$ity 5)t no @oint motion

*B Mo(ement at the @oint3 5)t not a/ainst /ra(ity

0*B Mo(ement a/ainst /ra(ity3 5)t not a/ainst a""e"resistan!e

F*B Mo(ement a/ainst resistan!e3 5)t $ess thannorma$

B*B Norma$ stren/th


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*pecifics of *trength Testing . Maor Muscle roups( In thes!reenin/ examination3 it is reasona5$e to !he! on$y the ma@orm)s!$es*m)s!$e /ro)s. More "etai$e" testin/ !an 5e erforme"in the settin/ of "is!rete*)nex$aine" 4eaness. The names ofthe ma@or m)s!$es*m)s!$e /ro)s a$on/ 4ith the sina$ roots an"erihera$ ner(es that ro(i"e their inner(ation are ro(i"e"

5e$o4. Ner(e roots ro(i"in/ the /reatest !ontri5)tion are rinte"in 5o$". More extensi(e "es!ritions of in"i(i")a$ m)s!$es an"their f)n!tions3 a$on/ 4ith their re!ise inner(ations !an 5e fo)n"in a Ne)ro$o/y referen!e text.

Intrinsi! m)s!$es of the han" 6C


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Intrinsic muscles o. t-e -and 'C 1, T 2( As the atient to srea" their fin/ers aart a/ainst resistan!e +)ee-e them to/ether3 4ith yo)r fin/ers $a!e" in 5et4een ea!h of

their "i/its 6a"")!tion7. Test ea!h han" searate$y.

The muscles &hich control adduction and abduction of the fingers are

called the 0nterossei, innervated by the 1lnar 2erve%


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3lexors o. t-e .ingers 'C 4, 1, T2( As the atient to mae a fist3 s)ee-in/ their han" aro)n" t4o of yo)r

fin/ers. If the /ri is norma$3 yo) 4i$$ not 5e a5$e to )$$ yo)r fin/ers o)t.

Test ea!h han" searate$y.

The 3le4or -igitorum Profundus controls finger fle4ion and is innervatedby the Median "radial 5# and 1lnar "medial 5# 2erves%


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0rist .lexion 'C 4, 1, T 2( Ha(e the atient try to f$ex their 4rist as yo) ro(i"e resistan!e. Test

ea!h han" searate$y.

The muscle groups &hich control fle4ion are innervated by the Median

and 1lnar 2erves%


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0rist extension 'C 5, 4, 1( Ha(e the atient try to exten" their 4rist as yo) ro(i"e resistan!e.

The Extensor Ra"ia$is m)s!$es !ontro$ extension an" are inner(ate" 5y the Ra"ia$

Ner(e. 'ama/e to the ra"ia$ ner(e res)$ts in 4rist "ro 6$oss of a5i$ity to exten"

the han" at the 4rist7. The ner(e !an 5e !omresse" a/ainst the h)mer)s for a

ro$on/e" erio" of time 4hen an intoxi!ate" erson $oses !ons!io)sness 4ith

the insi"e ase!t of the )er arm restin/ a/ainst a so$i" o5@e!t 6no4n as a

+at)r"ay Ni/ht #a$sy7.


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Elbo+ 3lexion 'C 6, 5(Ha(e the atient 5en" their e$5o4 to ninety "e/rees 4hi$e eein/ their

a$m "ire!te" )4ar"s. Then "ire!t them to f$ex their forearm 4hi$e yo)

ro(i"e resistan!e.

The main fle4or "and supinator# of the forearm is the !rachialis Muscle"along &ith the !iceps Muscle#% These muscles are innervated by the

Musculocutaneous 2erve


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Elbo+ Extension 'C 4, 1(

Ha(e the atient exten" their e$5o4 a/ainst resistan!e 4hi$e the arm is

he$" o)t 6a5")!te" at the sho)$"er7 from the 5o"y at ninety "e/rees.

The main e4tensor of the forearm is the triceps muscle% The Triceps isinnervated by the Radial 2erve%


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S-oulder Adduction 'C6 t-ru T2( Ha(e the atient f$ex at the e$5o4 4hi$e the arm is he$" o)t from the

5o"y at fortyDfi(e "e/rees. Then ro(i"e resistan!e as they try to f)rther

a"")!t at the sho)$"er.

The main muscle of adduction is the Pectoralis Maor, though the)atissiumus and others contribute as &ell%


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S-oulder Abduction 'C 6, 5( Ha(e the atient f$ex at the e$5o4 4hi$e the arms is he$" o)t from the

5o"y at fortyDfi(e "e/ress. Then ro(i"e resistan!e as they try to f)rther

a5")!t at the sho)$"er.

The deltoid muscle, innervated by the a4illary nerve, is the main muscleof abduction%


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7i 3lexion '* 8, 9, :( =ith the atient seate"3 $a!e yo)r han" on to of one thi/h an"

instr)!t the atient to $ift the $e/ ) from the ta5$e.

The main hip fle4or is the 0liopsoas muscle, innervated by the femoral

nerve%


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7i Extension '*6, S2( =ith the atient $yin/ rone3 "ire!t the atient to $ift their $e/ off the

ta5$e a/ainst resistan!e.

The main hip e4tensor is the gluteus ma4imus, innervated by inferior

gluteal nerve%


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7i Abduction '* :, 6, S2( #$a!e yo)r han"s on the o)tsi"e of either thi/h an" "ire!t the atient

to searate their $e/s a/ainst resistan!e.

This movement is mediated by a number of muscles%


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7i Adduction '*8, 9, :( #$a!e yo)r han"s on the inner ase!ts of the thi/hs.

number of muscles are responsible for adduction% They are

innervated by the obturator nerve


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;nee Extension '*8, 9, :(Ha(e the seate" atient stea"i$y ress their $o4er extremity into yo)r

han" a/ainst resistan!e.

E4tension is mediated by the $uadriceps muscle group, &hich is

innervated by the femoral nerve%


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;nee .lexion '*6, S2, 8( Ha(e the atient rest rone. Then ha(e them )$$ their hee$ ) an" off

the ta5$e a/ainst resistan!e.

3le4ion is mediated by the hamstring muscle group, via branches of the

sciatic nerve%


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An$le /orsi.lexion '*:, 6( 'ire!t the atient to )$$ their toes )4ar"s 4hi$e yo) ro(i"e

resistan!e 4ith yo)r han".

The muscles &hich mediate dorsifle4ion are innervated by the deep

peroneal nerve% The peroneal nerve is susceptible to inury at the point&here it crosses the head of the fibula "laterally, belo& the knee#% 0f

inured, the patient develops 63oot -rop,7 an inability to dorsifle4 the

foot%


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An$le lantar 3lexion 'S 2, S 8(Ha(e the atient ste on the /as 4hi$e yo) ro(i"e resistan!e.

The gastrocnemius and soleus, the muscles &hich mediate this

movement, are innervated by a branch of the sciatic nerve% Plantar

fle4ion and dorsifle4ion can also be assessed by asking the patient to&alk on their toes "plantar fle4ion# and heels "dorsifle4ion#%


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It is /enera$$y )ite he$f)$ to "ire!t$y !omare ri/ht (s $eft

si"e" stren/th3 as they sho)$" more or $ess 5e e)i(a$ent6tain/ into a!!o)nt the han"e"ness of the atient7. If there

is 4eaness3 try to i"entify a attern3 4hi!h mi/ht ro(i"e a

!$)e as to the etio$o/y of the o5ser(e" "e!rease in stren/th.

In arti!)$ar3 mae note of "ifferen!es 5et4een%

Ri/ht (s Left #roxima$ m)s!$es (s "ista$ Uer extremities (s $o4er

Or is the 4eaness /enera$i-e"3 s)//esti(e of a systemi!

ne)ro$o/i!a$ "isor"er or /$o5a$ "e!on"itionin/


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Speial Testing for s!"tle #eakness:

+)5t$e 4eaness !an 5e har" to "ete!t. #ay attention to

ho4 the atient 4a$s3 )ses an" ho$"s their arms an"

han"s as they enter the room3 /et ) an" "o4n from a

seate" osition3 mo(e onto the examination ta5$e3 et!.

#ronator "rift is a test for s$i/ht 4eaness of the )er

extremities. As the atient to stan" for D0 se!on"s 4ith 5oth

arms strai/ht for4ar"3 a$ms )3 an" eyes !$ose". Instr)!t the atient to ee the arms sti$$ 4hi$e yo) ta

them 5ris$y "o4n4ar".

The atient 4i$$ not 5e a5$e to maintain extension an"s)ination 6an" "rift into ronation7 4ith )er motor

ne)ron "isease.


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Common erihera$ ner(es3 territories of inner(ation3 an" !$ini!a$

!orre$ates.

Peripheral Ner$e Sensory

Inner$ation

Motor Inner$ation %ontri"!ting Spinal

Ner$e &oots

%linial

Ra"ia$ Ner(e &a! of th)m53in"ex3 mi""$e3 an" Jrin/ fin/erK 5a! offorearm

=rist extension an"a5")!tion of th)m5in a$mer $ane

C:3 ;3 < At ris for !omression ath)mer)s3 no4n as+at)r"ay Ni/ht #a$sy

U$nar Ner(e #a$mar an" "orsa$ase!ts of iny an"

J of rin/ fin/er

A5")!tion of fin/ers6intrinsi! m)s!$es of

han"7

C;3 < an" T1 At ris for in@)ry 4ithe$5o4 fra!t)re.

Can /et transientsymtoms 4hen insi"e ofe$5o4 is str)! 6f)nny5one "istri5)tion7

Me"ian Ner(e #a$mar ase!t of theth)m53 in"ex3 mi""$ean" J rin/ fin/erKa$m 5e$o4 thesefin/ers.

A5")!tion of th)m5eren"i!)$ar toa$m 6thenarm)s!$es7.

C


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Neurologic examination%AIT < STATION
http://eduserv.hscer.washington.edu/scripts/hubio553/case.pl?Case3


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A5i$ity to stan" an" 4a$ norma$$y is "een"ent onin)t from se(era$ systems3 in!$)"in/% (is)a$3(esti5)$ar3 !ere5e$$ar3 motor3 an" sensory.

The re!ise !a)se6s7 of the "ysf)n!tion !an 5e

"etermine" 5y i"entifyin/ 4hi!h ase!t of /ait isa5norma$ an" in!ororatin/ this information 4ith thato5taine" ")rin/ the rest of the exam. 'iffi!)$ty /ettin/o)t a !hair an" initiatin/ mo(ement3 for exam$e34o)$" 5e !onsistent 4ith #arinson9s 'isease. On the

other han"3 $a! of 5a$an!e an" a 4i"e 5ase" /ait4o)$" s)//est a !ere5e$$ar "isor"er.

%AIT TESTIN%


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'sk the patient to:

=a$ a!ross the room3 t)rn an" !ome 5a!

=a$ hee$DtoDtoe in a strai/ht $ine

=a$ on their toes in a strai/ht $ine

=a$ on their hee$s in a strai/ht $ineHo in $a!e on ea!h foot

'o a sha$$o4 nee 5en"

Rise from a sittin/ osition


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Cere5e$$ar ataxia is not ame$iorate" 5y (is)a$ orientation

Ha(e the atient stan" in one $a!e. This is a test of5a$an!e3 in!ororatin/ in)t from the (is)a$3 !ere5e$$ar3rorio!eti(e3 an" (esti5)$ar systems. If they are a5$e

to "o this3 ha(e them !$ose their eyes3 remo(in/ (is)a$in)t. This is referre" to as the Rom5er/ test. Loss of5a$an!e s)//ests imaire" rorio!etion.

In "isease of the !ere5e$$)m%

D $atera$ $o5e3 fa$$in/ is to4ar" the affe!te" si"e

D fronta$ $o5e3 fa$$in/ is to the oosite si"e

D mi"$ine or (ermis3 fa$$in/ in"is!riminate$y

TESTIN% O3 STATION

'E=&I*I"RATORY COOR/INATION(


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As the atient to stan" from a !hair3 4a$ a!ross theroom3 t)rn3 an" !ome 5a! to4ar"s yo). #ay arti!)$arattention to%

'iffi!)$ty /ettin/ ) from a !hair% Can the atient easi$y arise froma sittin/ osition #ro5$ems 4ith this a!ti(ity mi/ht s)//estroxima$ m)s!$e 4eaness3 a 5a$an!e ro5$em3 or "iffi!)$tyinitiatin/ mo(ements.

&a$an!e% 'o they (eer off to one si"e or the other as mi/ht o!!)r4ith !ere5e$$ar "ysf)n!tion 'isor"ers affe!tin/ the $eft !ere5e$$arhemishere 6as mi/ht o!!)r 4ith a stroe or t)mor7 4i$$ !a)seatient9s to fa$$ to the $eft. Ri/ht si"e" $esions 4i$$ !a)se theatient to fa$$ to the ri/ht. 'iff)se "isease affe!tin/ 5oth !ere5e$$arhemisheres 4i$$ !a)se a /enera$i-e" $oss of 5a$an!e.

Rate of 4a$in/% 'o they start off s$o4 an" then a!!e$erate3erhas $osin/ !ontro$ of their 5a$an!e or see" 6e./. as mi/hto!!)r 4ith #arinson9s 'isease7 Are they sim$y s$o4 mo(in/

se!on"ary to ain*$imite" ran/e of motion in their @oints3 as mi/hto!!)r 4ith "e/enerati(e @oint "isease et!.

Attit)"e of Arms an" Le/s% Ho4 "o they ho$" their arms an"$e/s Is there $oss of mo(ement an" e(i"en!e of !ontra!t)res6e./. as mi/ht o!!)r after a stroe7


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Hee$ to Toe =a$in/% As the atient to 4a$ in a

strai/ht $ine3 )ttin/ the hee$ of one foot "ire!t$y

in front of the toe of the other. This is referre" to

as tan"em /ait an" is a test of 5a$an!e. Rea$i-ethat this may 5e "iffi!)$t for o$"er atients 6")e to

the fre)ent !oexisten!e of other me"i!a$

!on"itions7 e(en in the a5sen!e of ne)ro$o/i!a$

"isease.


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Normal osture, ste si>e,

and arm s+ing

Tandem 0al$ing


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7emilegic %ait ar$insonian %ait
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Steage %ait Retroulsion
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CERE"E**AR TESTIN%

The !ere5e$$)m fine t)nes motor a!ti(ity an" assists 4ith5a$an!e. 'ysf)n!tion res)$ts ina $oss of !oor"ination an"ro5$ems 4ith /ait. The $eft !ere5e$$ar hemishere!ontro$s the $eft si"e of the 5o"y an" (i!e (ersa.

+e!ifi!s of Testin/% There arese(era$ 4ays of testin/!ere5e$$ar f)n!tion. ,or the s!reenin/ exam3 )sin/ onemo"a$ity 4i$$ s)ffi!e. If ana5norma$ity is s)se!te" ori"entifie"3 m)$ti$e tests sho)$" 5e "one to "etermine4hether the fin"in/ is ")ra5$e.That is3 if the a5norma$ity

on one test is tr)$y ")e to !ere5e$$ar "ysf)n!tion3 othertests sho)$" i"entify the same ro5$em. Gait testin/3 animortant art of the !ere5e$$ar exam.
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,in/er to nose testin/% =ith the atient seate"3 osition yo)r in"ex fin/er at a oint in sa!e in front ofthe atient.

Instr)!t the atient to mo(e their in"ex fin/er 5et4een yo)r fin/er an" theirnose.

Reosition yo)r fin/er after ea!h to)!h. Then test the other han".

Interpretation:The atient sho)$" 5e a5$e to "o this at a reasona5$e rateof see"3 tra!e a strai/ht ath3 an" hit the en" oints a!!)rate$y. Missin/the mar3 no4n as "ysmetria3 may 5e in"i!ati(e of "isease.

Rai" A$ternatin/ ,in/er Mo(ements% As the atient to to)!h the tis of ea!h fin/er to the th)m5 of the same han".

Test 5oth han"s.0nterpretation(The mo(ement sho)$" 5e f$)i" an" a!!)rate. Ina5i$ity to"o this3 no4n as "ys"ia"oinesia3 may 5e in"i!ati(e of !ere5e$$ar"isease.

CERE"E**AR TESTIN%


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Evaluation of cerebellar function.

While the examiner holds his fnger at arm's length rom thepatient, the patient touches her nose and then touches theexaminer's fnger. Ater several sequences, the patient is asked torepeat the exercise with her eyes shut. A patient with a cerebellardisorder tends to overshoot the target.


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Rai" A$ternatin/ Han" Mo(ements% 'ire!t the atient to to)!h first the a$m an" then the "orsa$ si"e of

one han" reeate"$y a/ainst their thi/h. Then test the other han".

0nterpretation(The mo(ement sho)$" 5e erforme" 4ith see"an" a!!)ra!y. Ina5i$ity to "o this3 no4n as "ys"ia"oinesia3 may5e in"i!ati(e of !ere5e$$ar "isease.

Hee$ to +hin Testin/% 'ire!t the atient to mo(e the hee$ of one foot ) an" "o4n a$on/ the

to of the other shin. Then test the other foot.

0nterpretation(The mo(ement sho)$" tra!e a strai/ht $ine a$on/the to of the shin an" 5e "one 4ith reasona5$e see".

CERE"E**AR TESTIN%


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Raid Alternating Mo#ements


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7eal S-in Test
http://medicine.tamu.edu/neuro/81ram.gif


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he Romberg test. Have the patient stand stillwith heels and toes together. Ask the patient toclose her eyes and balance -ersel.) I. t-e atient loses-er balance, t-e test is ositi#e)
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T7E EN/

Motor Testing

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Transcript of Motor Testing