Sensory & Motor Examinations.pptx

Lecturer of physiology à Lyari Medical college karachi
25 Mar 2023

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Sensory & Motor Examinations.pptx

  1. Sensory & Motor Examinations Dr. Irtaza Rehman (Author of the book The Extraordinary Life)
  2. Learning Objectives • What is the lesion? • Where is the lesion? • Why has the lesion occurred?
  3. Neurological Examination • Mental Status • Speech • Cranial nerves • Motor Examination • Sensory Examination
  4. Motor System Corticospinal /Pyramidal Tract Anterior horn cell
  5. Motor System Cerebellum
  6. Motor System
  7. Motor Examination • Stance & Gait • Inspection & palpation • Tone • Power • Reflexes • Coordination
  8. 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.
  9. • Always get ready to catch them if they fall. Stance
  10. 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.
  11. Gait Tandem Gait
  12. Parkinsonian gait
  13. Wide based Gait Sensory Ataxia Cerebellar Ataxia
  14. Foot Drop Peroneal nerve Injury
  15. Hemiplegic gait UMN Lesion
  16. 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.
  17. Muscle Bulk
  18. Fasciculation • Spontaneous, involuntary muscle contraction and relaxation. • Visible irregular twitches of resting muscle. • Lower motor neuron lesion
  19. 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
  20. Inspection • Scars • Wasting of muscles • Involuntary movements • Fasciculations • Tremors SWIFT
  21. 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)
  22. Tone Clasp Knife Spasticity Lead pipe rigidity UMN Lesion Parkinsons
  23. Clonus • Rhythmic series of contraction evoked by sudden stretch of the muscle and tendon. • UMN lesion
  24. 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
  25. 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
  26. Power
  27. Power Shoulder adduction Shoulder abduction
  28. Power Elbow flexion Elbow extension
  29. Power Wrist extension Wrist flexion
  30. Power Fingers extension Fingers flexion
  31. Power Fingers abduction Thumb adduction
  32. Sensory System • Light touch • Pain • Temperature • Vibration • Proprioception • Two point discrimination • Stereognosis (tactile recognition) • Graphaesthesia (identification of letters/numbers traced on skin)
  33. Sensory system • A dermatome is an area of skin that is mainly supplied by a single spinal nerve
  34. Cranial nerves Some Say Marry Money But My Brother Says Big Brains Matter More
  35. Jazakumullahu Khair ♥ (May ALLAH swt reward you with goodness)