Prepare patient
- Introduction
- Position lying in bed with lower limbs exposed Cover groin
Patient lying
- Room inspection
- Patient inspection
- Scars, skin
- Urinary catheter
Motor system
- Posture
- Inspect
- Wasting
- Fasciculation
- (LMN lesion, MND, root compression, peripheral neuropathy, primary myopathy, thyrotoxicosis)
- Tremor
- Palpate
- Muscle bulk
- Muscle tenderness
- Tone
- Ankle—and test for clonus
- Knee—and test for clonus
- dorsiflex ankle with knee bent and also move patella sharply down on extended knee
- Power
- Hip
- Flexion (L2/3)
- Extension (L5, S1/2)
- Abduction (L4/5, S1)
- Adduction (L2/3/4)
- Knee
- Flexion (L5, S1)
- Extension (L3/4)
- Ankle
- Plantar flexion (S1/2)
- Dorsiflexion (L4/5)
- Eversion (L5,S1)
- Inversion (L5,S1)
- Hip
Reflexes
- Knee (L3/4)
- Ankle (S1/2)
- Plantar (L5, S1/2) up lateral side or sole and curve inwards behind toes
- Anal S3-5
Coordination
- Heelshin test
- Toefinger test
- Foot tapping test
Sensory system
- Pain & Temp
- Dorsal columns
- Vibration
- Proprioception
- Light touch
- Saddle region sensation
Back
- Deformity
- Scars
- Tenderness
Standing
- Romberg
Gait
- If able to walk Types:
- Hemiplegia: the foot is plantar flexed and the leg is swung in a lateral arc
- Spastic paraparesis: scissors gait
- Parkinson’s: starting hesitation, shuffling, freezing, festination, pro/retropulsion
- Cerebellar: drunken wide-based or reeling on a narrow base gait; staggers towards side of cerebellar lesion
- Posterior column lesion: clumsy slapping down of the feet on a broad base
- Footdrop: high stepping gait
- Proximal myopathy: waddling gait
- Prefrontal lobe (apraxic): feet appear glued to floor when erect, but move more easily when the patient is supine
- Hysterical: characterised by a bizarre, inconsistent gait
- Test heel to toe walking unable to with a midline cerebellar lesion
- Test walking on toes (L4/5) & heels (S1)
- Squatting to standing test
- (L/4, proximal myopathy)
- Romberg test (stand feet together eyes open, when steady close eyes & if becomes markedly unsteady loss of proprioception)
- Unsteadiness with eyes open
- (cerebellar)
- Unsteadiness with eyes open
Ask for
- Urinalysis
- Residual volume