1. Motor System Assessment
Sheeba Jacob BSN ,RN
Victorian Kim BSN ,RN

2. Motor System

3. What Is 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.

4. 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.

5. Motor System Assessment findings on YouTube

6. You Tube on Motor System Assessment

7. 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.

8. 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.

9. You Tube http://www.youtube.com/watch?v=Ul6sAiJY9cA

10. 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.

11. 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.

12. 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

13. 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

14. Tests used clinically to assess motor system function.
Tone: Flex and extend limbs. Rapidly pronate and supinate forearms. Look for spasticity ('clasp-knife'), rigidity
('lead-pipe'), and clonus.

15. Tests used clinically to assess 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).

16. Tests used clinically to assess 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.

17. 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

18. 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

19. Correct Answer
D. All of the above. The test includes strength, coordination, and balance

20. Post-Test True or False
It is not necessary to test extremities bilaterally and compare findings.

21. Correct Answer
False
It is necessary to compare extremities to determine if there is a weakness in one and perhaps the degree of weakness

22. Post-Test
Which of the following is an example of how to test coordination
A. 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 hands
C. Have a patient in a sitting position push both feet up against your hands

23. 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.

24. References