Lakhasly

2.Goniometry values may also be compared with functional activities, such as reaching up above the head and touching the top of the ear at the shoulder level.For example, Parkinson's disease is characterized by hypokinesia and resting tremor, whereas chorea is rapid, jerky movement which is characteristically seen in Huntington's disease.Examination Techniques A nervous system physical examination can initially seem like an overwhelming task due to the diversity of symptoms potentially attributable to any given lesion in the central or peripheral nervous system.Nervous system physical examination can be characterized by a high level of complexity, and it often requires a significant emphasis to be placed on the history of presenting complaint and information processing.Decerebrate or decorticate posturing is an abnormal posture the limbs adopt with spasticity following severe brain injury.However, a systematic approach will give focus and relevance by enabling you to localize a lesion by identifying its functional characteristics.Dystonia is sustained muscle contraction, frequently causing twisting movements and abnormal postures.Thus, abnormal movements are important in localizing the lesion and may provide clues to the underlying pathology.It is a characteristic hallmark of cerebellar disease and may also be seen with a lesion of the cerebellar pathways, basal ganglia, or the anterior horn cells.Palpation is an important part of the examination method as, through touch, various lesions and abnormalities can be located, and it helps to alert the physician to abnormalities of muscle tone.Then, if an abnormality is detected, the examination is pursued more intensively and the nature of the abnormality is clarified by delving into the depth.Spinal cord disease may result in a pattern of muscle weakness usually symmetrical and of the lower limb, so examination of the whole limb is important for accurate diagnosis.Intention tremor is typified by worsening oscillations as the limb approaches a target (such as the nose or the examiner's finger).It is important to determine if the tremor occurs at rest or is compounded by a specific task and in which limbs it is manifest.Wasting of individual muscles can be particularly difficult to assess in the limbs with more muscle bulk, such as the thighs or calves.This is where a good knowledge of the anatomy and the function of individual muscle groups is essential in deciding which muscles to test and examine.Different systems of goniometry are also available, such as the universal goniometer and the fluid goniometer system, but their reliability and preference are disputed at best.This assessment is important in evaluating the patient's progress, diagnosing the cause of movement limitations, and establishing the severity of the problem.- To establish a baseline functional ability if no previous examination has been performed.- To evaluate the effectiveness of treatment, for example, if a patient has undergone a decompressive operation for carpal tunnel syndrome.Tremor can be coarse (regular or irregular oscillations of the muscle) or fine (more rapid, irregular movement).A coarse resting tremor suggests extrapyramidal disease or cerebellar disease.2.2.2.3.

2. Examination Techniques
   A nervous system physical examination can initially seem like an overwhelming task due to the diversity of symptoms potentially attributable to any given lesion in the central or peripheral nervous system. However, a systematic approach will give focus and relevance by enabling you to localize a lesion by identifying its functional characteristics. This will lead you to perform a more precise impairment-based assessment. This will soon become a familiar and logical routine, and as always, the more examinations you perform, the more proficient you will become.

• To confirm a hypothesis, for example, localizing a lesion of the facial nerve.


• To establish a baseline functional ability if no previous examination has been performed.


• To evaluate the effectiveness of treatment, for example, if a patient has undergone a decompressive operation for carpal tunnel syndrome.


• To assess changes in a patient's condition, including exacerbation of symptoms or improvement following a rehabilitation program.


• To screen individuals who do not report any overt nervous system-related signs or symptoms but are at risk due to occupational or other hazards.
  Nervous system physical examination can be characterized by a high level of complexity, and it often requires a significant emphasis to be placed on the history of presenting complaint and information processing. Although there are many reasons to perform a nervous system physical examination, these would include the following:
  2.1. Inspection
  Muscle strength examination is performed using the MRC scale. Note that the MRC scale is very subjective and examination should be compared to the contralateral limb if possible. Assess muscle bulk and note any wasting. Spinal cord disease may result in a pattern of muscle weakness usually symmetrical and of the lower limb, so examination of the whole limb is important for accurate diagnosis.
  Muscle tone can be increased (spasticity or rigidity) or decreased (flaccid). Assess tone by feeling the resistance to passive movement at a joint, asking the patient to relax. It is important to compare with the contralateral limb. High tone can interfere with the movement of the limb and be associated with abnormal posturing. Decerebrate or decorticate posturing is an abnormal posture the limbs adopt with spasticity following severe brain injury. A flaccid limb is a limb that has no tone and is weak. Heel to buttock testing will assess for proximal hamstring muscle tone. This is particularly important in back pain or radiculopathy. In a limb which is weak, it is important to determine whether the weakness is due to true weakness or due to increased tone.
  Dystonia is sustained muscle contraction, frequently causing twisting movements and abnormal postures. This is particularly characteristic of basal ganglia disease. Thus, abnormal movements are important in localizing the lesion and may provide clues to the underlying pathology. For example, Parkinson’s disease is characterized by hypokinesia and resting tremor, whereas chorea is rapid, jerky movement which is characteristically seen in Huntington’s disease.
  Tremor can be coarse (regular or irregular oscillations of the muscle) or fine (more rapid, irregular movement). Frequency, amplitude, and activation conditions should be noted. A coarse resting tremor suggests extrapyramidal disease or cerebellar disease. Intention tremor is typified by worsening oscillations as the limb approaches a target (such as the nose or the examiner's finger). It is a characteristic hallmark of cerebellar disease and may also be seen with a lesion of the cerebellar pathways, basal ganglia, or the anterior horn cells. It is important to determine if the tremor occurs at rest or is compounded by a specific task and in which limbs it is manifest.
  Identifying physical anomalies which may suggest neurologic or neuromuscular disease is the most important part of the motor examination. Wasting, fasciculation, abnormal movements, and posture may provide clues to the diagnosis. All four limbs should be adequately exposed. A well-muscled limb is more difficult to evaluate than one that is wasted. Comparison with the other side of the body is often useful. It is often easier to see wasting from the side, so when wasting is not evident on the arms, the patient should rest the hands in the lap and hold the forearms horizontally. Muscles of the thenar eminence can be compared by asking the patient to abduct and oppose the thumbs. Wasting of individual muscles can be particularly difficult to assess in the limbs with more muscle bulk, such as the thighs or calves. This is where a good knowledge of the anatomy and the function of individual muscle groups is essential in deciding which muscles to test and examine.
  2.2. Palpation
  Touching the patient is a very important behavior and reassures the patient that the physician has a competent and caring attitude. This, in turn, fosters the patient's confidence and cooperation with subsequent parts of the examination.
  Some abnormalities may be best located when the patient is relaxed, while others are best sought when the patient is making an effort or resisting. These various circumstances are created by different positions and actions, so it is often necessary to vary these in order to locate the abnormality and determine its exact nature. If the abnormality is static, it should be compared with a corresponding normal structure. For example, if checking for muscle atrophy and abnormal tone in the right shoulder, it should be compared with the normal contralateral side. Simulation of the conditions under which the abnormality appeared often gives a clue to its cause.
  Palpation is an important part of the examination method as, through touch, various lesions and abnormalities can be located, and it helps to alert the physician to abnormalities of muscle tone. Temperature and moisture aid in eliciting signs of discomfort that may have been overlooked during the interview. It begins with light, superficial touch – systematically covering the areas to be examined. Then, if an abnormality is detected, the examination is pursued more intensively and the nature of the abnormality is clarified by delving into the depth.
  2.3. Range of Motion
  The type of goniometer used varies depending on the site being assessed and the mobility of the patient. A standard goniometer should only be used when the patient's range of motion is near normal for their age group. A large goniometer is for assessment of hips, knees, and elbows, and a small finger goniometer is for assessment of the small joints, such as those of the hand. Different systems of goniometry are also available, such as the universal goniometer and the fluid goniometer system, but their reliability and preference are disputed at best.
  Which joint is being assessed?
  Range of motion is the measurement of movement around a specific joint or body part. It involves a goniometer assessment to measure joint angles in degrees. The expected values of goniometry have a great deal of normal variation, so the measurement involves not only the patient's affected side but also their unaffected side for comparison. Goniometry values may also be compared with functional activities, such as reaching up above the head and touching the top of the ear at the shoulder level. This test provides relatively reliable and valuable information regarding the patient's ability to move and their flexibility. This assessment is important in evaluating the patient's progress, diagnosing the cause of movement limitations, and establishing the severity of the problem. It is best combined with palpation, and palpation is necessary to find the precise locations for goniometer placement. Range of motion is an important assessment tool for many different conditions, including degenerative joint disease, bursitis, and tendonitis, and also for postoperative assessment to determine the success of surgery.