Motor System Assessment

Sheeba Jacob BSN ,RN

Victorian Kim BSN ,RN

Motor System

What Is Motor System Assessment

• Motor System Assessment

• Assessment of the motor system include evaluation of bilateral muscle strength and coordination and balance tests. Be sure to assess bilaterally and compare findings.

Motor system

• Inspection

• Start by looking at the patient. Do muscles look wasted? Is there asymmetry?

• If the nurse strike the affected muscle with a jerk hammer, it may induce fasciculation.

Motor System Assessment findings on YouTube

• http://www.youtube.com/watch?v=z62JMY2dKjU&feature=related

• http://www.youtube.com/watch?v=Ul6sAiJY9cA&feature=related

• http://www.youtube.com/watch?v=UgycfWSn_0w&feature=related

You Tube on Motor System Assessment

• http://www.youtube.com/watch?v=UgycfWSn_0w&feature=related

• http://www.youtube.com/watch?v=hvkT08HYEbM&feature=related

• http://www.youtube.com/watch?v=15oh7rs-1jE&feature=related

• http://www.youtube.com/watch?v=Ul6sAiJY9cA&feature=related

• http://www.youtube.com/watch?v=PcZuTEwHSrw&feature=related

How To Examine Muscle Strength

• Examine arm and leg muscles looking for atrophy and abnormal movements such as tremors. For a quick check of muscle tone, perform passive range of motion exercises and note any resistance.

• Assess upper leg muscle strength of a bed patient by having him flex his hip and knee so that the knee is about 8 inches off the bed.

Coordination and Balance Tests

• Coordination can be checked by having the patient close the eyes and touch the finger to the nose. Coordination can also be assessed by having the patient perform rapid alternating movements (RAMs).

• These tests will help you evaluate coordination and detect intentional tremors.

You Tube

• http://www.youtube.com/watch?v=Ul6sAiJY9cA

• http://www.youtube.com/watch?v=6XAPsAKLJN4

• http://www.youtube.com/watch?v=oYeqavQiZdg

Rapid alternating movements test

• Seat the patient. Instruct him to pat his knees with his hands, palms down then palms up. Have him alternate palms down and palms up rapidly.

• Watch the patient to notice if his movements are stiff, slow, nonrhythmic, or jerky.

• The movements should be smooth and rhythmic as he does the task faster.

Rapid alternating movements test

• Ask the patient to walk back and forth across the room.

• Observe for equality of arm swing , balance and rapidity and ease of turning.

• Next, ask the patient to walk on his tiptoes, then on heels.

• Ask the patient to tandem walk.

Rom berg test

• Instruct the patient to stand with his feet together and his arms at his side.

• Have the patient do this with his eyes open and then with his eyes closed. (Stand close to the patient to keep him upright if he starts to sway.)

• Expect the patient to sway slightly but not fall. This is a test of balance

A reflex

• A reflex is defined as an immediate and involuntary response to a stimulus.( Details were covered in the DTR PPT)

• Superficial reflexes. • Stroke the skin with a hard object such as an applicator

stick. What is felt is a superficial reflex• •5 Ps• –Pain• –Pallor• –Pulses• –Paresthesia• –Paralysis

Tests used clinically toassess motor system function.

Motor system

• Tone: Flex and extend limbs. Rapidly pronate and supinate forearms. Look for spasticity ('clasp-knife'), rigidity

• ('lead-pipe'), and clonus.

Tests used clinically toassess motor system function.

• Power:

• oppose active flexion and extension at each major joint: biceps (C5,6); triceps (C6-8); grip (C8); psoas

• (L2,3); quadriceps (L2-4); glutei (L5;S1); hamstrings (L5;S1); tibialis anterior (L4); extensor hallucis longus (L5).

Tests used clinically toassess motor system function.

• Reflexes:

• biceps (C5,6); patellar (L3,4); wooden spatula along outer sole, note first movement of big toe. Flexor

• (downgoing) is normal. Extensor response indicates upper motor neurone lesion.

• Stance and gait:

• observe and record.

DVD’s Available • PHYSICAL EXAMINATION AND HEALTH ASSESSMENT DVD

SERIES: DVD 1: NEUROLOGIC: MOTOR SYSTEM AND REFLEXES, VERSION 2

• • To order this title, and for more information, click here

By Carolyn Jarvis, PhD, APN, CNP, Family Nurse Practitioner, Chestnut Health Systems, Bloomington; Adjunct Assistant Professor of Nursing, School of Nursing, Illinois Wesleyan University, Bloomington, IL

•http://www.elsevier.com/wps/find/bookdescription.cws_home/713169/description#description

Post-Test

• 1. Assessment of the motor system include:

A. Bilateral muscle strength

B. Bilateral muscle coordination

C. Balance test

D. All of the above

Correct Answer

• D. All of the above. The test includes strength, coordination, and balance

Post-Test

• True or False

It is not necessary to test extremities bilaterally and compare findings.

Correct Answer

• False

It is necessary to compare extremities to determine if there is a weakness in one and perhaps the degree of weakness

Post-Test

• Which of the following is an example of how to test coordinationA. Have the patient push up both of their hands as you push down with your hands to create resistance B. Have a patient touch the nose with the tip of their index finger, alternating fingers from both handsC. Have a patient in a sitting position push both feet up against your hands

Correct Answer

• B. Having the patient place their finger to nose will show how well the patient is coordinating movements. A and C will help you to test muscle strength.

References

• http://nursinglink.monster.com/training/articles/240-physical-assessment---chapter-8-neurological-system

• http://www.google.com/search?hl=en&q=motor+system++assessment&start=20&sa=N