Motor, Reflex, Coordination and Sensory Screening Examination
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1 Motor, Reflex, Coordination and Sensory Screening Examination K. Jeffrey Miller, DC, DABCO Miller K Jeffrey Miller DC DABCO
2 Motor Function Neurological Testing
3 Handedness Right or Left Handed Ambidextrous Shoulder Height-levelness Dominant side lower Grip Strength Dominant side stronger by 10% Female grip strength is 50% of males Miller 2002
4 Handedness Impairment Rating Non-dominant often rated lower Side Posture Adjusting Farfan s Torsion Test Side of handedness up Miller 2002
5 Handedness Pseudoambidexterity Miller 2002
6 Handedness Pseudoambidexterity Miller 2002
7 True Ambidexterity Both ambidextrous and multilingual, 20 th president James Garfield could write Greek with one hand while writing Latin with the other. Miller 2002
8 Bilateral Hand Shake Quick Assessment of Lower Cervical and Upper Thoracic Nerve Root Motor Function C5-T1 Miller 2002
9 Miller 2002
10 Bilateral Hand Shake Test Flexion of the Shoulder-C5 Extension of The Elbow and Fingers-C7 Extending the Thumb-C6 Spreading the Fingers-T1 Bringing the Fingers Together-T1 Flexing the Fingers-C8 Wrist Stabilization-C6/C7 Shaking (flex and extend the elbow)-c5/c7
11 Bilateral Hand Shake Test Shoulder Flexion and Elevation to reach for the Handle Bars-C5 Spreading and Extending the Fingers Preparing to Grip the Bar-T1/C7 Bringing the Fingers together and Flexing them to Grip Bar- T1/C8 Using the Throttle-C8/C6 Using the Clutch or Brake- C7/C8
12
13 Grip Strength Miller 2002
14 Grip Strength Miller 2002
15 Muscle Testing Rules Test distal to the joint without crossing the next joint Hold for 5 seconds Do Not pump the muscle/joint Grade the contraction Differentiate between true weakness and reflexive weakness due to pain
16 Quick Test Test for Motor Function Of Nerve Roots L2-S2 and Lower Extremity Range of Motion (hip, knee and ankle) Alternate Version Miller 2002
17 Quick Test Motor innervation for lower extremity movements performed during deep knee bends Movement Nerve Root Level HIP flexion L2-L3 extension L4-L5 KNEE extension L3-L4 flexion L5-S1 ANKLE dorsiflexion L4-L5 planar flexion S1-S2
18 The IT Band Snapping Crepitus Repetitive Non-repetitive Trochanteric Bursitis Ober s and Noble s Tests Miller 2002
19 Heel Walking L4-L5 Marching in place on the heels Stabilize Space considerations
20 Toe Raises S1-S2 25 Bilateral Repetitions McNab 15 unilateral Hoppenfeld Hop on foot Manual? Stabilize Space Considerations
21 Muscle Testing at the Feet Foot Dorsiflexion L4 Great Toe Extension L5 Toe Flexion S1-S2
22
23 Hautant s - Drift Test Vertebral Artery Test Doctor Should Position Patient s Head Eyes Must be Closed Held Seconds Each Side Drift Objective Validity by Common Use Miller 2002
24 Arm Rolling Test for UMN Forward and backward backward Finger Rolling
25 Reflex Function Neurological Testing
26 Biceps Reflex C5-C6 Symmetry Multiple Taps Miller 2002
27 Brachioradialis Reflex C5-C6 Symmetry Multiple Taps Miller 2002
28 Triceps Reflex C7 Symmetry Multiple Taps Miller 2002
29 Patellar Reflex L2, L3 & L4 Symmetry Multiple Taps Miller 2002
30 Achilles Reflex S1-S2 Symmetry Multiple Taps Miller 2002
31 Deep Tendon Reflex (DTR) Summary Biceps Musculocutaneous C5-C6 Brachioradialis Radial C5-C6 Radial Radial C5-C6 Triceps Radial C7 Patellar Femoral L2-L4 Achilles Tibial S1-S2
32 Hoffman s Reflex Test for UMN Lesions Upper Extremity Equivalent of Babinski s Sign Must Be Firm Miller 2002
33 Hoffman s Reflex Miller 2002
34 Babinski s Reflex Test for UMN Lesions Most Common UMN Test Must Be Firm Present or Absent Up Going or Down Going Miller 2002
35 Babinski s Reflex Miller 2002
36 Hammer Selection
37 Hammer Selection
38 Coordination Function Neurological Testing
39 Finger to Nose Test Cerebellar Test Coordination Eyes Closed This isn t Just Touching the Nose Fast, Smooth and on Target Miller 2002
40 Heel to Shin test Coordination
41 Cerebellar Test Coordination Tandem Stance Eyes Closed Tandem stance is Harder than Tandem Walking Magee Miller 2002
42 Sensory Function Neurological Testing
43 Sensory Major Dermatomes and Peripheral Nerves of the Hand and Foot Why test these locations? Sensory tests are my least favorite neurological tests- subjective Dermatome and Peripheral nerve innervation of the skin is highly variable
44 Upper Extremity Sensory
45 Foot Sensation
46 What can be done at the hands and feet? Motor C5 T1 Sensory C6, C7 & C8 Motor L4 S1 Sensory L4 S1
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