Motor Exam I

Overview

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

Abnormalities in the motor function are associated with a wide range of diseases, from movement disorders and myopathies to strokes. The motor assessment starts with observation of the patient. When the patient enters the examination area, the clinician observes the patient's ability to walk unassisted and the speed and coordination while moving. Taking the patient's history provides an additional opportunity to observe for evidence of tremors or other abnormal movements, such as chorea or tardive dyskinesia. Such simple but important observations can yield valuable clues to the diagnosis and help to focus the rest of the examination. The motor assessment continues in a systematic fashion, including inspection for muscle atrophy and abnormal movements, assessment of muscle tone, muscle strength testing, and finally the examination of the muscle reflexes and coordination. The careful systematic testing of the motor system and the integration of all the findings provide insight to the level at which the motor pathway is affected, and also help the clinician to formulate the differential diagnosis and determine the course of the subsequent evaluation and treatment.

Procedure

1. Observation.

During the interview, observe the patient for abnormal movement. Observe for too little movement (hypokinesis), such as a masked facies, and for too much movement (hyperkinesis) such as tremor, tics, and chorea.
Answer questions like: Are tremors occurring at rest, as is typical of Parkinson's disease, or with action? Does the patient appear fidgety, or do they have choreiform movements? Is there a paucity of movement, as might be seen with Parkinsonian syndromes?

Application and Summary

Evaluation of the motor system starts with observation for abnormal movements, assessment of muscle bulk and tone, and the screening muscle exam prior to the systematic evaluation of the muscle strength. The patient's history and the previous sections of the physical examination can provide the clinician with the diagnostic clues that help to look for specific findings on this part of the neurological exam. Specific pathological signs (such as muscle atrophy, fasciculations, or abnormal muscle tone) also provide valu

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