Neuro Assessment

Motor Exam: Assess hand grips for

equality
• Bulk of muscles
• Tones of muscles
• Power
• Reflexes
 Bulk of muscles
• Wasting of muscles
• Hypertrophy
• Atrophy
• Pseudo hypertrophy
• Measuring tape
 Tones of muscles

• Hypertonia & Hypotonia & dystonia

• Spasticity…clasp knife like… clonus , babinski, decorticate,
decerebrate, opisthotonus
• Rigidity…leadpipe & cogwheel

• Flaccidity
• Hyper extensibility of joint

• LMN lesion
• Cerebellar dysfunction
• Cerebral shock & Spinal shock
 Examination of tone

• Initial observation of posture & palpation

• Passive movement
• Pendulum test
• Modified Ashworth scale (0 , 1 , 1+ , 2 , 3 , 4 )
 Scale to assess tone
• 0 No response(flaccidity)
• 1+ decreased response (hypotonia)
• 2+ Normal response
• 3+ exaggerated response (mild to moderate
hypertonia)
• 4+ Sustained response (severe hypertonia)
  Clinical Scale for Spastic Hypertonic (Modified Ashworth Scale)
0 No increase in tone

1 Slight increase in muscle tone, manifested by a catch and release or

minimal resistance at the end of the ROM when the affected part(s) is
moved in flexion or extension

1+ Slight increase in muscle tone, manifested by a catch, followed by

minimal resistance throughout the remainder (less than half) of the ROM

2 More marked increase in muscle tone through most of the ROM, but
affected part(s) easily moved

3 Considerable increase in muscle tone, passive movement difficult

4 Affected part(s) rigid in flexion or extension

 Power
• Manual muscle testing 0-5 scale
Ideal for LMN diseases
• UMN lesion….observation of active
movements during functional task

• Handheld dynamometer
• Diplegic . Hemi , Para , mono
 Reflexes
Superficial reflexes
• Planter reflex
• Abdominal reflex
Deep reflexes
• Ankle jerk
• Knee jerk
• Biceps jerk
• Triceps jerk
• Brachioradialis jerk
Reinforcement …Jendrassik maneuver
 Neuro Assessment
Abnormal Reflexes: Babinski:

Grasp: involuntary grasp in response to stimulation

of palm; abnormal in an adult Doll’s eyes:
impairment of eye movement to opposite side when head is
turned = damage to brainstem
Score Reflexes

• 0 Absent
• 1 Hypoactive or present only with reinforcement

• 2 Readily elicited with a normal response

• 3 Brisk
• 4 Associated with a few beats of unsustained clonus
• 5 Sustained clonus
THANKS