2. ASSESSMENT OF MOTOR SYSTEM
A. Bulk of muscle
B. Tone of the muscle
C. Strenght of the muscle
D. Reflexes
E. Co-ordination of movements
F. Gait
G. Presence and Absence of involuntary movements.
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4. INSPECTION AND PALPATION OF MUSCLE
Requires full exposure of muscle
Looks for asymmetry, inspecting both proximally and
distally
Note any deformities
measure the circumference of
arm, foearm
thigh and leg identical level on both side.
mention in report in cm
compare on both sides
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5. MEASURING THE BULK OF MUSCLE
at above and below knee joint
at above and below elbow joint
measure using meter tape on both right and left side. and
record
RIGHT side LEFT side
ABOVE KNEE
JOINT 7 cm
20 cm 20 cm
BELOW KnEE
JOINT 7 cm
14 cm 14 cm
ABOVE ELBOW
JOINT 8 cm
16 cm 16 cm
BELOW ELBOW
JOINT 8 CM
10 cm 10cm 5
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11. COMMON ABNORMALITIES
1. Lower Motor Neuron lesion cause in specific muscle
atrophy
2. Upper Motor Neuron damage can cause disuse atrophy
of muscle groups
3. Certain occupation and sports leads to muscle
Hypertrophy
4. Wasting of muscle is associated with diseases like
rheumatoid arthritis,Cachexia
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12. Fasciculation: looks like a regular twitches under the
skin overlying the muscle at rest ,commonly seen in
lower motor neurone lesion
Myoclonic jerk : it is the sudden shock like contraction
of one or more muscles, associated with epilepsy, diffuse
brain damage and dementia
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14. TONE OF MUSCLE
Definition
Certain amount of tension present in the resting muscle
due to low frequency and asynchronous discharge of α -
motor neuron which produces resistance of a muscle to
strecth( or lengthening).
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18. ASSESSMENT OF MUSCLE TONE
Tone is the resistance felt by examiner when moving a
joint passively through its range of movement.
site to check
upper extremities - wrist and elbow joint
lower extremities -knee level, ankle joint
common abnormalities Muscle Tone may be
decreased(hypotonia) or increased (hypertonia)
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19. HOW CLINICALLY
passively moving the
joint of subject n one
hand and in another hand
palpate the muscle in
passive movement .
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20. • Hypotonia: is decreased tone
• seen physiologicaly
1. resting muscle tone in sleep
and usually associated with disease
1. polio myelitis
2. tabes dorsalis etc
• Hypertonia: there are two principal types of
hyper tonia
1 .spasticity
2. rigidity 20
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21. SPASTICITY
means increased tone throughout range of motion
and there is sudden release (catch) so called"
Clasp knife effect." (activation of inverse strecth
reflex)
Seen in upper motor neurone lesion pyramidal
pathway lesion
In second type there is equal resistance in both
agonistic and antagonistic muscles at any point so
called" Plastic or lead pipe rigidity"
Seen in extrapyramidal lesion
Spasticity is velocity dependent (sudden release)
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23. RIGIDITY
In increase the tone of muscle with no range of
motion
The agonist and antagonist contract alternatively
rapidly so-called" Cog wheel rigidity"
Seen in extrapyramidal diseases such as
Parkinson's disease.
Rigidity is not velocity dependent (continuous).
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28. GENERAL EXAMINATION PRINCIPLES
Power
1. Use power grading scale
2. Test 2 Movements of each joint (agonist and
antagonist)
3. Alway compare left and right side at each level
4. work from proximal to distal
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29. TESTING FOR THE MUSCLES OF UPPER LIMB
1. Abuductor pollicis brevis
2. Interossei and lumbricals
3. Flexors of the fingers
4. Flexors of the wrist
5. Extensor of the wrist
6. Brachioradialis
7. Biceps
8. Triceps
9. Supraspinatus and Deltoid
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30. TESTING MOVEMENT AND MUSCLE POWER
score description
0 absent voluntary contraction
1 feeble contractions that are
unable to move a joint
2 movement with gravity
eliminated
3 movement against Gravity
4 movement against partial
resistance
5 full strength( movement
against full resistance)
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43. SLN
O
MUSCLE TONE RIGHT
SIDE
LEFT SIDE
1. Abuductor pollicis brevis NORMAL NORMAL
2. Interossei and lumbricals NORMAL NORMAL
3. Flexors of the fingers NORMAL NORMAL
4. Flexors of the wrist NORMAL NORMAL
5. Extensors of the wrist NORMAL NORMAL
6. Brachioradialis NORMAL NORMAL
7. Biceps NORMAL NORMAL
8. Triceps NORMAL NORMAL
9. Supraspinatus and Deltoid NORMAL NORMAL
10.
Babinski's rising test NORMAL NORMAL
11.
diaphargm NORMAL NORMAL
12.
trapezius NORMAL NORMAL
13
Abuctors of hip NORMAL NORMAL
14.
Adductors of hip NORMAL NORMAL
15.
flexsors of hip NORMAL NORMAL
16.
extensors of hip NORMAL NORMAL
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44. SLNO MUSCLE TONE RIGHT SIDE LEFT SIDE
1. flexsors of knee NORMAL NORMAL
2. extensors of knee NORMAL NORMAL
3. dorsiflexsors of foot NORMAL NORMAL
4. plantar flexsors of foot NORMAL NORMAL
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45. MUSCLES OF THE TRUNK
muscles of abdomen:
Babinski's rising up
sign
Diaphargm
Trapezius
upper part
lower part
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46. MUSCLE OF THE LOWER LIMB
Extensor of the hip
Flexors of the hip
abuctors of hip
adductors of hip
Flexors of the knee
Extensor of the knee
Dorsiflexion and plantar flexion of the feet
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56. SLN
O
MUSCLE power RIGHT
SIDE
LEFT SIDE
1. Abuductor pollicis brevis 5 5
2. Interossei and lumbricals 5 5
3. Flexors of the fingers 5 5
4. Flexors of the wrist 5 5
5. Extensors of the wrist 5 5
6. Brachioradialis 5 5
7. Biceps 5 5
8. Triceps 5 5
9. Supraspinatus and Deltoid 5 5
10.
Babinski's rising test 5 5
11.
diaphargm 5 5
12.
trapezius 5 5
13
Abuctors of hip 5 5
14.
Adductors of hip 5 5
15.
flexsors of hip 5 5
16.
extensors of hip 5 5
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57. SLNO MUSCLE power RIGHT SIDE LEFT SIDE
1. flexsors of knee 5 5
2. extensors of knee 5 5
3. dorsiflexsors of foot 5 5
4. plantar flexsors of foot 5 5
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58. PARALYSIS
first to weakness or loss of voluntary movement
1. monoplegia paralysis of one extremity only
2. Paraplegia asymmetrical paralysis of both
extremity
3. quadriplegia paralysis of all four extremities
4. hemiplegia paralysis of one side of the body
limited by median line
5. crossed paralysis a paralysis of one or more
ipsilateral cranial nerve and contralateral
hemiplegia
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61. ULTIMATE GOAL OF STRENGTH TESTING
is to decide
? neurogenic weakness by which muscle movements
are affected
? upper or lower motor neuron
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65. CO-ORDINATION OF MOVEMENTS
means the smooth recruitment, interaction and
cooperation of separate muscles or group of
muscles in order to perform a definite motor act.
it depends on
sense of position of limb
cerebellar function
the state of tone of muscles
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66. TESTS FOR CO-ORDINATION
in upper limb
1. finger nose test :R/L
2. Drawing a circle in air:R/L
3. Diadochokinesia:R/L
in lower limb
1. Knee heel test:R/L
2. drawing circle in air:R/L
walking on a striaght line
Rhomberg's test
With eyes open
with eyes closed 66
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71. ATAXIA
A disturbance in the coordination of muscle
movement is called Ataxia.
Sensory Ataxia
Cerebellar Ataxia
Sensory Ataxia may be compensated by vision
disturbance of movement may be apparent only on
closing eyes.
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73. SLN
O
TEST RIGHT SIDE LEFT SIDE
A in upper limb
1.finger nose test :
ABLE TO DO ABLE TO DO
2.Drawing a circle in air ABLE TO DO ABLE TO DO
3.Diadochokinesia ABLE TO DO ABLE TO DO
B in lower limb
1. Knee heel test
ABLE TO DO ABLE TO DO
2.drawing circle in air: ABLE TO DO ABLE TO DO
C walking on a striaght line ABLE TO DO
D. Rhomberg's test
1.With eyes opeN
NEGATIVE
2.with eyes closed NEGATIVE 73
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79. TREMORS
Oscillatory movement about a joint or group of
joints (alternating contraction and relaxation of
muscles)
common types
1. Physiological tremor OR fine tremors:
Anixety,Hyperthyroidism,
2. Coarse tremors (slow) :
3. Intention tremors : cerebellar damage
4. resting tremorsParkinson's disease
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82. Higher mental examination
1. General appearance and behaviour:normal
2. Emotional state:normal
3. Orientation to time,place,person :oriented
4. No hallucination,delusion,illusion
5. Intelligence: normal
6. Memory : recent and remote :normal
7. Speech :normal and no dysarthria
8. Language: normal
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83. MOTOR SYSTEM EXAMINATION
1. NUTURITION OR BULK OF MUSCLE
2. TONE OF MUSCLE
3. REFLEX
4. POWER OF MUSCLE
5. CO-ORDINATION OF MOVEMENT
6. GAIT
7. INVOLUNTARY MOVEMENTS
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84. BULK OF MUSCLE
RIGHT side LEFT side
ABOVE KNEE JOINT
7 cm
--cm --cm
BELOW KnEE JOINT
7 cm
--cm --cm
ABOVE ELBOW
JOINT 8 cm
--cm --cm
BELOW ELBOW
JOINT 8 CM
--cm --cm
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85. SLN
O
MUSCLE TONE RIGHT
SIDE
LEFT SIDE
1. Abuductor pollicis brevis NORMAL NORMAL
2. Interossei and lumbricals NORMAL NORMAL
3. Flexors of the fingers NORMAL NORMAL
4. Flexors of the wrist NORMAL NORMAL
5. Extensors of the wrist NORMAL NORMAL
6. Brachioradialis NORMAL NORMAL
7. Biceps NORMAL NORMAL
8. Triceps NORMAL NORMAL
9. Supraspinatus and Deltoid NORMAL NORMAL
10.
Babinski's rising test NORMAL NORMAL
11.
diaphargm NORMAL NORMAL
12.
trapezius NORMAL NORMAL
13
Abuctors of hip NORMAL NORMAL
14.
Adductors of hip NORMAL NORMAL
15.
flexsors of hip NORMAL NORMAL
16.
extensors of hip NORMAL NORMAL
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86. SLNO MUSCLE TONE RIGHT SIDE LEFT SIDE
1. flexsors of knee NORMAL NORMAL
2. extensors of knee NORMAL NORMAL
3. dorsiflexsors of foot NORMAL NORMAL
4. plantar flexsors of foot NORMAL NORMAL
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87. SLN
O
MUSCLE power RIGHT
SIDE
LEFT SIDE
1. Abuductor pollicis brevis 5 5
2. Interossei and lumbricals 5 5
3. Flexors of the fingers 5 5
4. Flexors of the wrist 5 5
5. Extensors of the wrist 5 5
6. Brachioradialis 5 5
7. Biceps 5 5
8. Triceps 5 5
9. Supraspinatus and Deltoid 5 5
10.
Babinski's rising test 5 5
11.
diaphargm 5 5
12.
trapezius 5 5
13
Abuctors of hip 5 5
14.
Adductors of hip 5 5
15.
flexsors of hip 5 5
16.
extensors of hip 5 5
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88. SLNO MUSCLE power RIGHT SIDE LEFT SIDE
1. flexsors of knee 5 5
2. extensors of knee 5 5
3. dorsiflexsors of foot 5 5
4. plantar flexsors of foot 5 5
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89. SLN
O
TEST of co-ordination RIGHT SIDE LEFT SIDE
A in upper limb
1.finger nose test :
ABLE TO DO ABLE TO DO
2.Drawing a circle in air ABLE TO DO ABLE TO DO
3.Diadochokinesia ABLE TO DO ABLE TO DO
B in lower limb
1. Knee heel test
ABLE TO DO ABLE TO DO
2.drawing circle in air: ABLE TO DO ABLE TO DO
C walking on a striaght line ABLE TO DO
D. Rhomberg's test
1.With eyes opeN
NEGATIVE
2.with eyes closed NEGATIVE
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90. gait is normal
no abnormal involuntory movements
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91. ASSIGNMENT
Difference b/w UMN AND LMN Lesion
Difference b/w spascity and rigidity
difference b/w muscle spindle and golgi tendon
organ
difference b/w tone and power assessment
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95. ASSIGNMENTS
1. Difference between spasticity and rigidity
2. Difference between muscle spindle and golgi
tendon organ
3. Draw a neat labelled diagram of muscle spindle
4. How length and force in muscle controlled and
maintaned?
5. Higer center functions in maintaince of muscle
tone
6. physiological basis of spasticity , clasp knife
phenomenon.
7. Difference between UMN and IMN.
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