Motor, sensory and reflex findings
8 questions on this concept, from 4 angles.
The idea in full
The motor, sensory and reflex examination is read for pattern rather than for single findings — strength graded and compared side to side with a pronator drift sought, tone felt as flaccid, spastic or rigid, coordination and gait observed, sensation tested with the eyes closed and compared limb to limb, and the reflexes graded with clonus and an extensor plantar response recognised as signs of an upper motor neuron lesion — so that in the patient who cannot follow commands the motor response to a central stimulus is itself the examination, with localising read as best, abnormal flexion as worse, abnormal extension as worse still and flaccidity as worst, any move down that order reported as deterioration of the brain rather than as tiredness, and in the older patient the symmetrical, gradual and long-standing changes of aging — a slower reaction and gait, diminished ankle reflexes, reduced vibration and position sense in the feet, and slower processing that is not confusion — are recognised as aging that raises the risk of falls and injury but is not disease, while a new, one-sided, sudden or progressive finding is never attributed to age.
Beliefs this concept corrects
- 1A weaker grip or a drifting arm on one side is fatigue, arthritis or the side the patient does not favour, not the brain
- 2A slower, stiffer older patient with one new weak leg is showing their age
- 3Abnormal flexion posturing is worse than abnormal extension because the patient looks more contracted
- 4A patient who has gone from posturing to lying flaccid has relaxed and is improving
- 5A patient who moves both arms when a nailbed is pressed has no weakness on either side
- 6Sensation is tested with the patient watching so they know where to expect the touch
- 7An extensor plantar response is a normal finding in an adult as it is in an infant
- 8Diminished ankle reflexes and reduced vibration sense in the feet of a healthy older adult are a neuropathy or a stroke to be worked up
- 9A patient who is confused cannot cooperate, so the motor and sensory examination is skipped rather than adapted
- 10Spasticity in a limb after a stroke means the nerves are recovering
- 11An older patient's slower answers and slower processing are confusion or early dementia
- 12The changes of aging are harmless, so an older patient with a slower gait and less feeling in the feet needs no fall or injury precautions
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