MIDTERM - Physical Tests

Question 1

List of UMN and LMN tests

Answer 1

• UMN (Pronator Drift, Hoffmans, Clonus, Babinski, Tone Assessment)
• LMN (DTRs)

Question 2

Pronator Drift

Answer 2

Instructions: Patient stands with both arms flexed at 90 and forearms supinated, eyes closed
Duration: 20-30 seconds
Positive: One arm starts to drift downward - indicates UMN disorder

Question 3

Examples of anticipatory, reactive and dynamic balance

Answer 3

Anticipatory
- Functional reach test
- Catching

Reactive
- Nudge/push test

Dynamic balance tests
- Berg Balance Scale
- Tinetti Balance Gait

Question 4

What is the primary nerve root and contributing roots for DTR?

Answer 4

• Biceps Brachialis: C5 (C6)
• Brachioradialis: C6 (C5)
• Triceps: C7 (C6)
• Quads: L4 (L2, L3)
• Achilles: S1 (S2)

Question 5

How do you perform a tone assessment? - UE

Answer 5

• Place patient in a supine position
• Support upper arm with one hand and move the forearm
• Slowly move patient through elbow ROM and increase speed with each cycle
• **Spasticity will more often be felt moving out of flexion into extension
• If resistance is greater as speed increases, spasticity is present**

Question 6

Tone Assessment - LE

Answer 6

• Place patient in a supine position
• Grasp plantar aspect of patient’s foot and the hand just distal to popliteal fossa
• Slowly move patient through knee and hip from extended to flexed
• Perform ROM several times and increase speed with each cycle
• **Spasticity will more often be felt moving out of extension into flexion
• If resistance is greater as speed increases, spasticity is present**

Question 7

Clonus

Answer 7

• Instructions: Patient in supine position. Knee flexed and limb supported. Gently move the patient’s ankle from PF/DF several times and then rapidly DF the ankle and hold
• Positive: Feel and observe oscillation equal or great than 3

Question 8

Babinski

Answer 8

• Instructions: Patient lies supine with skin below ankle exposed. Scrape bottom of foot from lateral calcaneous towards toes and then medially across metatarsals
• Normal: No response or first toe flexion
• Abnormal: 1st toe extension and splaying

Question 9

Hoffman’s

Answer 9

• Grasp distal phalanx of the middle finger between thumb and index finger. Apply pressure to distal fingernail to induce flexion and then quickly slip your thumb off the patient’s finger
• Normal: No response
• Abnormal: Thumb flexes, adducts and other fingers flex.

Question 10

How would you distract someone during DTR?

Answer 10

UE: Fingers grasp one another with eyes closed and pull
LE: Cross ankles and with eyes closed try to pull apart

Question 11

When do you ask AOx4? What does it stand for?

Answer 11

• People with Balance, Coordination, Cognition
• Name, Age, Date/Time, Event
• IF only AOx2: Name and Date? (You can choose)
• Alert and Oriented

Question 12

What is important to do when having the patient change positions?

Answer 12

Inquire if they are feeling dizzy after sitting/standing
Worried about orthostatic hypotension

Question 13

What should you aquire before coordination testing?

Answer 13

ROM Screen
Strength Screen

Question 14

What are some UE Coordination Tests?

Answer 14

• Rapid alternating Movements
• Finger Opposition
• Finger to Nose (Chin)
• Finger to Clincian Finger

Question 15

What are some LE Coordination Tests?

Answer 15

• Toe Tapping
• Heel to shin
• Romberg (Feet together)

Question 16

Rapid Alternating Movement (RAM)

Answer 16

Patient position: Arms ar sides, elbows flexed to 90 degrees
Test: patient moves both forearms repeated from supination to pronation
Duration: 10-15 seconds
Test Progression: Increase speed of movement
Abnormal test: Difficulty producing RAM (slow, irregular, clumsy

Question 17

Inability to produce ram is a condition called…

Answer 17

dysdiadochokinesia

Question 18

Finger Opposition

Answer 18

Patient Position: Arm at sides, elbows flexed to 90 degrees
Test: Thumb touches to the tip of each: ipsilateral finger in sequence
Duration: Several

Question 19

Finger to Nose (chin)

Answer 19

Patient Position: Arms abducted to 90 degrees
Test: Eyes open, patient brings tip of index finger to nose (chin)
Duration: Several sequences
Test progression: Finger to clinicial finger
Abnormal: Slow, irregular, clumsy

Question 20

Finger to Clinician Finger

Answer 20

Patient Position: Arms abducted to 90 degrees
Test: Sit in front of patient, ask patient to touch nose and then touch the tip of your finger
Duration: Several sequences
Test progression: move the target to several locations, increase speed of testing
Abnormal: Slow, Irregular, clumcy movement ot intention tremor

• Dysmetria or Past pointing

Question 21

Dysmetria or Past pointing

Answer 21

Patient will overshoot your finger which may indicate cerebellar dysfunction

Question 22

Toe Tapping

Answer 22

Patient position: Sitting with feet on floor
Test: Tap the bal of the foot on the floor repeatedly, do not raise the heel
Duration: Several sequences
Progression: Both feet at same time
Abnormal: Slow, irregular, clumsy movement

• If lacking DR ROM, can be performed in supine and patient taps clinicans hand

Question 23

Heel to Shin

Answer 23

Patient Position: Supine
Test: Ask patient to place heel of one foot on the opposite knee and then run heel down the shin and back to knee
Duration: Several Sequences
Progression: Weight bearing tests
Abnormal: Slow, irregular, clumsy movement

Question 24

Romberg (Feet Together)

Answer 24

Patient Position: Standing on the floor with feet touching and together
Test: Stand unsupported
Duration: 30 Seconds
Progression: Tandem Romberg (feet heel to toe), Eyes Closed, Balance Testing
Abnormal: Unable to maintain balance

ALWAYS NEED A GAIT BELT

Question 25

Potential UMN Findings

Answer 25

- Dysdiadochokinesia - Hyperreflexia - Hyper/hypotonia - +Clonus/Babinski - Dysmetria - Weakness - Sensory & Balance Deficits - CN Involvement

Question 26

Potential LMN Findings

Answer 26

- Hyporeflexia - Hypotonia - Weakness - Somatosensory Deficits - Pain, tingling and numbness along nerve - Negative UMN