Motor Assessment of the Lower Limbs - OSCE Guide | UKMLA | CPSA

Summary

This video demonstrates a leg and foot neurological examination, guiding viewers through various strength and reflex tests. The examiner asks the patient to relax their legs while assessing muscle strength by having them lift and push against resistance. Reflexes are checked by tapping at the knees and ankles, followed by sensory testing using a dull instrument on the foot. The demonstration highlights key skills necessary for a clinical examination, useful for students preparing for practical exams. The video promotes the Geeky Medics clinical examination guide for further learning.

Takeaways

• 🦵 The examiner starts by testing muscle tone in the patient's legs, asking the patient to relax their legs and ankles.
• 👣 The examiner checks the strength of the patient's legs by asking them to lift their legs off the bed and resist pushing.
• 🦶 The examiner also tests leg strength by placing their hand under the patient's leg and asking the patient to push down.
• 🦵 Knee bending is tested, with the patient asked to bend their knee and bring their ankle back toward them.
• 🦾 The patient is instructed to kick out against resistance, testing the strength of the quadriceps.
• 👟 Ankle and toe movements are assessed by asking the patient to pull their toes up and push them down against resistance.
• 🦶 The examiner tests the ability to turn the foot inward and outward, checking foot mobility and strength.
• 🎯 Reflexes are checked at both the knee and ankle, with the patient asked to keep their legs as relaxed as possible.
• 👣 The foot reflex is tested using a dull instrument to stimulate a reaction, which may feel ticklish.
• 📚 The video promotes a clinical examination guide by Geeky Medics for students preparing for practical exams.

Q & A

What is the purpose of the leg tone test at the beginning of the examination?

The leg tone test is used to assess muscle tone and identify any abnormalities in muscle stiffness or looseness, which may indicate neurological or muscular issues.

Why is the patient asked to relax their ankle during the initial part of the examination?

The patient is asked to relax their ankle so the examiner can move it freely to assess joint flexibility and muscle responsiveness without interference from voluntary movement.

What is the significance of testing leg strength by asking the patient to lift their leg and resist pressure?

This test assesses the muscle strength of the legs, helping to identify any weakness or inability to resist external force, which could indicate a neurological or muscular disorder.

Why does the examiner place their hand under the patient's leg and ask them to push down?

This tests the patient's ability to exert force in the opposite direction, assessing muscle strength and control when pushing down into the bed, which is crucial for overall lower limb function.

What is being tested when the patient is asked to bring their ankle back towards them and kick out against the examiner?

This tests the flexion and extension of the knee joint and the strength of the muscles responsible for these movements, such as the quadriceps and hamstrings.

What is the purpose of asking the patient to lift their toes and push down against the examiner’s resistance?

This test evaluates the strength of the ankle and foot muscles, specifically testing dorsiflexion (toes up) and plantarflexion (toes down), which are important for walking and balance.

Why is the examiner asking the patient to turn their foot in and out?

The foot inversion (turning in) and eversion (turning out) tests assess the muscles and nerves controlling foot movement, checking for any limitations in range of motion or muscular weakness.

What is the purpose of testing reflexes in the knees and ankles during the examination?

Reflex tests are used to assess the integrity of the nervous system, particularly the spinal cord and peripheral nerves. Abnormal reflexes can indicate nerve damage or neurological issues.

Why does the examiner bend the patient's leg and let it flop to the side?

The examiner is checking for passive range of motion and muscle tone, ensuring that the muscles relax properly when no effort is exerted by the patient, which helps identify any spasticity or rigidity.

What is the purpose of using the dull end of a tip on the patient's foot?

This is part of a test to check for the plantar reflex, also known as the Babinski reflex, which helps to assess the function of the corticospinal tract. A normal response would involve the toes curling downward.