Examination of the patient should include a thorough look into heart, lung, abdominal organs, and urine conditions. Urine must be carefully examined due to its role in uremia which causes various neurological symptoms. In all doubtful cases, chemical tests should be supplemented by microscopic examination and consideration of total quantity and specific gravity of 24-hour urine.
Motor disorders such as paralysis, ataxia, spasm, and tremor need careful observation. A general test for motility involves walking forward and backward, turning, standing on either foot with eyes open and closed, grasping the examiner's hands strongly, spreading fingers apart, touching the tip of the nose with each forefinger while eyes are closed, drawing up mouth corners to show upper teeth, closing eyes tightly, wrinkling forehead, and protruding tongue. If all these actions can be performed without abnormality, motor disorders in limbs, face, and tongue are excluded.
An abnormal gait may conform to various types which can best be understood by comparison with a normal gait. In normal walking, the swinging foot is kept clear of the ground partly because the hip is slightly raised and mainly due to flexion of the knee and dorsal flexion of the foot. Pathological changes in gait are caused by something preventing proper support or forward swing.
<Callout type="important" title="Key Observation">An abnormal gait may indicate weakness, paralysis, spastic paraplegia, hysterical paralysis, multiple neuritis, poliomyelitis, and other conditions.</Callout>
Weakness of the lower part of the face may also be apparent. The gait characteristic of hysterical paralysis is very different from that of organic hemiplegia and resembles children imitating lameness in play.
<Callout type="risk" title="Risk">Spastic paraplegia can cause difficulty getting one foot in advance of the other, leading to a forward and sideways lean.</Callout>
The steppage gait characteristic of multiple neuritis is caused by flabby paralysis of dorsal flexors. When the heel is raised, the foot hangs down of its own weight. <Callout type="gear" title="Equipment">Use a laryngoscope to observe defective movement of vocal cords in cases of paralysis.</Callout>
In many cases, the third method of testing joint movement gives the most reliable results. These tests may be varied and extended by having the patient perform various actions such as stooping and rising on one leg, standing on tiptoe, mounting a chair, picking up an object from the floor, arising from a recumbent position, forming a ring with the thumb and forefinger, etc.
Paralysis of one side of the face is indicated by comparative smoothness in repose and less movement than occurs on the sound side. Bilateral paralysis of the face is not so easily detected but when considerable in degree it is revealed by lack of expression and defect of movement on both sides.
Key Takeaways
- Motor disorders such as paralysis, ataxia, spasm, and tremor must be carefully observed during patient examination.
- A thorough gait analysis can reveal various neurological conditions including weakness, hemiplegia, hysterical paralysis, multiple neuritis, poliomyelitis, and more.
- Detailed tests for motor function include walking patterns, grasping hands, touching nose with eyes closed, drawing up mouth corners, closing eyes tightly, wrinkling forehead, and protruding tongue.
Practical Tips
- Carefully observe the patient's gait to detect signs of neurological disorders such as hemiplegia or multiple neuritis.
- Use a laryngoscope to accurately diagnose paralysis of laryngeal muscles by observing vocal cord movement during respiration and phonation.
- Perform detailed joint movement tests, including flexion, extension, adduction, abduction, and resistance testing.
Warnings & Risks
- Spastic paraplegia can cause significant difficulty in walking due to the inability to get one foot in advance of the other.
- Paralysis may be difficult to detect without patient cooperation, especially after apoplectic attacks or head injuries.
Modern Application
While this chapter focuses on diagnosing motor disorders and gait abnormalities through physical examination techniques from over a century ago, many of these methods remain relevant today. Modern medical practitioners still use similar tests for neurological assessments but with the aid of advanced imaging technologies like MRI and CT scans to confirm diagnoses.
Frequently Asked Questions
Q: What are some key signs of motor disorders during patient examination?
Key signs include paralysis, ataxia, spasm, tremor, and abnormal gait patterns. These can be detected through detailed tests such as walking forward and backward, turning, standing on either foot with eyes open and closed, grasping hands strongly, spreading fingers apart, touching the tip of the nose while eyes are closed, drawing up mouth corners to show upper teeth, closing eyes tightly, wrinkling forehead, and protruding tongue.
Q: How can a gait analysis help in diagnosing neurological conditions?
A gait analysis can reveal various neurological conditions such as weakness, hemiplegia, hysterical paralysis, multiple neuritis, poliomyelitis, and more. By observing the patient's walking patterns, one can detect abnormalities that indicate specific disorders.
Q: What equipment is recommended for diagnosing laryngeal muscle paralysis?
A laryngoscope is recommended to accurately diagnose paralysis of laryngeal muscles by observing vocal cord movement during respiration and phonation.