Sensory &
Motor
Examinations
Dr. Irtaza Rehman
(Author of the book The Extraordinary Life)

Learning Objectives
• What is the lesion?
• Where is the lesion?
• Why has the lesion occurred?

Neurological Examination
• Mental Status
• Speech
• Cranial nerves
• Motor Examination
• Sensory Examination

Motor System
Corticospinal
/Pyramidal
Tract
Anterior horn cell

Motor System
Cerebellum

Motor System

Motor Examination
• Stance & Gait
• Inspection & palpation
• Tone
• Power
• Reflexes
• Coordination

Stance
• Ask the patient to stand with their (preferably
bare) feet close together and eyes open.
• Swaying, lurching or an inability to stand with
the feet together and eyes open suggests
cerebellar ataxia
• Romberg sign: When the patient is unable to
maintain the balance with their eyes closed.
Dorsal column lesion.

• Always get ready
to catch them if
they fall.
Stance

Gait
• Time the patient walking a measured 10 meters,
then turning through 180 degrees and returning.
• Note stride length, arm swinging, steadiness
(turning), limping or other difficulties.
• Ask the patient to walk heel to toe in a straight
line (Tandem gait). Abnormal in cerebellar
lesions.

Gait
Tandem Gait

Parkinsonian gait

Wide based Gait
Sensory
Ataxia
Cerebellar
Ataxia

Foot Drop
Peroneal nerve
Injury

Hemiplegic gait
UMN Lesion

Inspection & Palpation
• Completely expose the muscle to be examined
• Look for asymmetry, inspecting both proximally
and distally.
• Inspect for wasting or hypertrophy, fasciculation
and involuntary movement.

Muscle Bulk

Fasciculation
• Spontaneous, involuntary muscle contraction
and relaxation.
• Visible irregular twitches of resting muscle.
• Lower motor neuron lesion

Abnormal movements
• Myoclonic jerks: Sudden shock like contraction of one
or more muscle, singly or repetitively. (Hypnic jerks in
sleep).
• Tremors: Essential tremors, Intentional tremors, Pill
rolling tremors.
• Chorea, Athetosis, Hemiballismus

Inspection
• Scars
• Wasting of muscles
• Involuntary movements
• Fasciculations
• Tremors
SWIFT

Tone
• Resistance felt by the examiner when moving a
joint.
• Passively move each joint to be tested through as
full range possible
• Distract the patient for fully passive assesment
• Hypotonia (LMN) – Hypertonia (UMN)

Tone
Clasp Knife Spasticity Lead pipe rigidity
UMN Lesion Parkinsons

Clonus
• Rhythmic series of
contraction evoked
by sudden stretch
of the muscle and
tendon.
• UMN lesion

Power
• Strength varies with age, occupation and fitness.
• Observe the patient getting up from a chair and
walking
• Test upper limb power while patient sitting on
the edge of the couch. Test lower limb with
patient lying supine.
• Ask patient to lift their arms above their heads

Power
• MRC grading
• 0  No muscle contraction
• 1  Flicker or trace of contraction but no movement
• 2  Active movement, with gravity eliminated
• 3  Active movement against gravity
• 4  Active movement against gravity and resistance
• 5  Normal power

Power

Power
Shoulder adduction Shoulder abduction

Power
Elbow flexion Elbow extension

Power
Wrist extension Wrist flexion

Power
Fingers extension Fingers flexion

Power
Fingers abduction Thumb adduction

Sensory System
• Light touch
• Pain
• Temperature
• Vibration
• Proprioception
• Two point discrimination
• Stereognosis (tactile recognition)
• Graphaesthesia (identification of letters/numbers traced on skin)

Sensory system
• A dermatome is an
area of skin that is
mainly supplied by a
single spinal nerve

Cranial nerves
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Jazakumullahu Khair ♥
(May ALLAH swt reward you with goodness)