Sensory & Motor Examinations

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

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

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

5. Motor System
Corticospinal
/Pyramidal
Tract
Anterior horn cell

6. Motor System
Cerebellum

7. Motor System

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

9. 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.

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

11. 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.

12. Gait
Tandem Gait

13. Parkinsonian gait

14. Wide based Gait
Sensory
Ataxia
Cerebellar
Ataxia

15. Foot Drop
Peroneal nerve
Injury

16. Hemiplegic gait
UMN Lesion

17. 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.

18. Muscle Bulk

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

20. 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

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

22. 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)

23. Tone
Clasp Knife Spasticity Lead pipe rigidity
UMN Lesion Parkinsons

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

25. 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

26. 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

27. Power

28. Power
Shoulder adduction Shoulder abduction

29. Power
Elbow flexion Elbow extension

30. Power
Wrist extension Wrist flexion

31. Power
Fingers extension Fingers flexion

32. Power
Fingers abduction Thumb adduction

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

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

36. Cranial nerves
Some
Say
Marry
Money
But
My
Brother
Says
Big
Brains
Matter
More

39. Jazakumullahu Khair ♥
(May ALLAH swt reward you with goodness)