Escolar Documentos
Profissional Documentos
Cultura Documentos
2. Babinski sign is present: The great toe becomes dorsiflexed and the other toes fan outward in response to sensory stimulation along the lateral aspect of the sole of the foot. The normal response is plantar flexion of all the toes.
Babinski Reflex 3. Loss of performance of fine-skilled voluntary movements especially at the distal end of the limbs.
7. Exaggerated deep tendon reflexes and clonus may be present. Signs of Lower Motor Neuron Lesions (LMNL) 1. Flaccid paralysis of muscles supplied.
4. Muscles fasciculation (contraction of a group of fibers) due to irritation of the motor neurons seen with naked eye.
8. Reaction of degeneration: When the LMN is cut, a muscle will no longer respond to interrupted electrical stimulation 7 days after nerve section, although it will still respond to direct current. After 10 days, response to direct current also ceases.
A lower motor neuron travel then from the ventral horn of the spinal cord, out the ventral root through the spinal nerve (to either or dorsal rami) and then to a named nerve (ex: musculocutaneousnerve) to a specific group of now innervated muscles (the musc. cutaneousnerve supplies the biceps brachiimuscle))ventral
Muscle Girth
Fasciculations
Hypotonia
o o
Hypertonia
Spasticity
- UMN lesion. Pyramidal tract involved limb moves, then catches, and then goes past catch (clasp-knife) o test by rapidly supinating forearm Rigidity o UMN lesions, extrapyrimidal tract lesion o increased tone throughout ROM (cog-wheeling, lead-pipe) o circumducting the wrist
Power
UMN
o o
flexors > extensors in upper limbs extensors > flexors in lower limbs
LMN reduced power in specific motor neuron distribution deltoids - arm abduction - C5 C6 (axillary) biceps - elbow flexion - C5 C6 (musculocutaneous) triceps - elbow extension - C6 C7 C8 (radial) thumb flexion - C6 C7 (median) wrist extensors - C7 C8 (radial) interossei of hand - finger abduction/adduction - C8 T1 (ulnar) hip flexion - L1 L2 L3 (femoral) hip adduction - L2 L3 L4 (obturator) hip abduction - L4 L5 S1 (superior gluteal) knee extension - L2 L3 L4 (femoral) knee flexion - L5 S1 S2 (sciatic) ankle dorsiflexion - L4 L5 (deep peroneal) ankle plantar flexion - S1 S2 (tibial) foot inversion - L4 L5 (posterior tibial) foot eversion - L5 S1 (superficial peroneal)
o
compare between L and R GRADE o 0 nil o 1 flicker of movement o 2 movement cannot overcome gravity o 3 movement cannot overcome any resistance o 4 movement is weaker than normal o 5 normal
Special Tests
Pronator Drift have the patient stand with eyes closed and arms held straight out and hands supinated + patient cannot maintain this position o muscle weakness (pronation and outward drift) o UMN lesion (pronation and downward drift) standing problemes
Fine Finger Movements ask patient to touch each finger to crease of thumb (show patient how) and speed it up look for right and left differences, slow if UMN lesion
Clonus
biceps tendon (C5-6) brachioradialis tendon (C5-6) triceps tendon (C6-8) knee jerk (L2-4) Achilles tendon (S1-2) hyperactive ankle jerk examine for clonus at knee and
ankle absent use reinforcements (teeth clenching for UL, Jendrassiks maneuver for LL)
Grading
4 clonus (sustained > 3 beats) note if reinforcements used (teeth clenching, hand grips)
Babinskis reflex (L5-S1) + dorsiflexion of the big toe with/without fanning of the other toes (UMN lesion)