Exam of Motor Function based physiotherycourse

Motor examinationed were discussed

1. EXAMINATION OF MOTOR FUNCTION

2. Motor examination comprise under three headings: Tone. Reflexes. Strength.

3. TONE It is defined as the resistance of muscle to passive elongation or stretch. It represents a state of slight residual contraction in normally innervated, resting muscle, or steady-state contraction. Our posture is maintained with the help of muscle tone as muscles remain activated.

4. ABNORMALITIES OF TONE Increased above normal resting levels Decreased below normal resting levels Impaired or disordered tonicity

5. HYPERTONIA Lead Pipe Cogwheel Decorticate Decerebrate

6. SPASTICITY Spasticity is a motor disorder characterized by a velocity dependent increase in muscle tone with increased resistance to stretch; the larger and quicker the stretch, the stronger the resistance of the spastic muscle. During rapid movement, initial high resistance (spastic catch) may be followed by a sudden inhibition or letting go of the limb (relaxation) in response to a stretch stimulus, termed Clasp-Knife Response.

7. RIGIDITY Rigidity is a hypertonic state characterized by constant resistance throughout ROM that is independent of the velocity of movement (Lead-pipe Rigidity). Cogwheel Rigidity refers to a hypertonic state with superimposed ratchet-like jerkiness and is commonly seen in upper extremity movements (e.g., wrist or elbow flexion and extension) in patients with Parkinson’s disease.

8. EXAMINATION OF TONE An examination of tone consists of: Initial observation of resting posture and palpation. Passive motion testing. Active motion testing .

9. EVALUATE OF UPPER EXTREMITY TONE To test muscle tone, have the patient fully relaxed. One way to do this is by distracting the patient with conversation. While the patient is seated, passively move each upper extremity at several joints to get a feeling for any resistance or rigidity that may be present. Hold the forearm and the elbow, and move the arm through the full range of flexion and extension at the elbow.

10. EVALUATE OF UPPER EXTREMITY TONE Then take the hand as if to shake it, and hold the forearm. First pronate and supinate the forearm. Then roll the hand around at the wrist. Feel the patient's tone. Assess if the tone is normal, decreased (hypotonia) or increased (hypertonia).

11. EVALUATE OF LOWER EXTREMITY TONE With the patient in a supine position, place your hands behind the patient's knee, and lift the leg in a sudden motion. Observe if the heel drags along the bed. With normal muscle tone, the heel will drag along the surface of the bed. However, if there is an increased tone or spasticity, the foot may not make contact with the bed.

12. EVALUATE OF LOWER EXTREMITY TONE Another technique for assessing the muscle tone in the lower extremities is to support the patient's thigh with one hand, while holding the foot with the other hand, and alternately extending and flexing the patient's knee and ankle. Note rigidity and spasticity (suggesting increased tone) or flaccidity (decreased muscle tone).

13. REFLEX INTEGRITY A reflex is an involuntary, predictable, and specific response to a stimulus dependent on an intact reflex arc.

14. DTR DTRs are tested by tapping sharply over the muscle tendon with a standard reflex hammer or with the tips of the therapist’s fingers. To ensure adequate response, the muscle is positioned in midrange and the patient is instructed to relax.

15. 0 Absent, no response 1+ Slight reflex, present but depressed, low normal 2+ Normal, typical reflex 3+ Brisk reflex, possibly but not necessarily abnormal 4+ Very brisk reflex, abnormal, clonus

16. JENDRASSIK MANEUVER TO ELICIT LE RESPONSE

17. SUPERFICIAL CUTANEOUS REFLEXES Superficial cutaneous reflexes are elicited with a light stroke applied to the skin. The expected response is brief contraction of muscles innervated by the same spinal segments receiving the afferent inputs from the cutaneous receptors.

18. CLONUS If the reflexes seem hyperactive, test for ankle clonus. Support the knee in a partly flexed position. With your other hand, dorsiflex and plantar flex the foot a few times while encouraging the patient to relax, and then sharply dorsiflex the foot and maintain it in dorsiflexion.

19. CLONUS Look and feel for rhythmic oscillations between dorsiflexion and plantar flexion. In most normal people, the ankle does not react to this stimulus. A few clonic beats may be seen and felt, especially when the patient is tense or has exercised.

20. EXAMINATION OF

21. STRENGTH The quality or state of being physically strong. The ability to resist being moved or broken by a force. The quality that allows someone to deal with problems in a determined and effective way.

22. STRENGTH ASSESSMENT The strength is assessed by 2 ways: