Neurological Examination Checklist: Lower limb

introduced self. Shook hands

explained procedure and confidentiality.
consent to examine
washed hands

st

black = 1 year knowledge

nd
blue = 2 years expected to know and do
nd
rd
green = 2 years know, and 3 years do

Inspection:
Surroundings for clues: eg. wheelchair, sling, nil orally sign, peak flow or spirometry equipment, IV
fluids, catheter
Patient from bed end: posture, muscle bulk/wasting, abnormal movts, skin (lesions, rash, scars etc),
fasciculations, symmetry incl face, obvious ptosis
Gait if possible: normal walking with quick turn; heel to toe (midline cerebellar lesion); walk on toes
(S1), walk on heels (L4,5), squat and stand (L3,4). (If very time limited, this gives good overview of
power)
Romberg test (ie test station): Correct positioning; prepared to steady patient if falling; Steadiness
with eyes open vs eyes closed.
Positioned pt in bed, correct exposure of lower limb
Inspection of lower limb: as above esp muscle bulk (+ feel), wasting (feel along shin) plus close
(obvious) look for fasciculations.
Palpation: Muscle bulk
Tone: Rating: normal, increased, decreased
Tone: lifted knee for hip tone; flex/extend knee; ankle tone.
Clonus: checked at ankle and patella bilaterally.
Power: Rating 0-5. Simple, clear instructions to patient. Compared sides.
Hip flex (L2,3)/extension (L5,S1,2)
Hip adduction (L2,3,4)/abduction (L4,5,S1)
Knee extension (L3,4)/flexion (L5,S1)
Ankle dorsi (L4,5)/plantar flexion (S1,2)
Foot inversion/eversion (both L5-S1, tho via different nerves). Sciatic damage, cant do either;
common peroneal nerve damage, can invert but cant evert.)
Reflex: Rating 0 to ++++ (++ being normal), reinforced any reflexes if absent
Knee jerk (L3,4)
Ankle jerk (S1-2)
Plantar reflex (Babinski) (L5,S1,2): No sharp implements.
Coordination:
Heel-shin test (mod speed); eyes open and closed
Toe to Drs finger bilaterally.
Foot tap
Sensation:
Pain (and temp): Pinprick sharp or dull. Demonstrated first on chest. Started proximally ?Dermatomal
?Peripheral nerve distribution ?Symmetrical.
Vibration: Correct tuning fork (use 128Hz ie low C; 256Hz ie middle C used for hearing tests).
?symmetry. Start distally.
Proprioception: Explanation. Start distally.
Light touch: Explanation. Technique: Dab not wipe.
Other:
Complete the neurological exam ie higher centres, cranial nerves, upper limb as necessary. Spinal
level if bilateral UMN lesion in lower limbs.
Repeat handwash