Movement disorders - Clinical assessment

Lower motor neurone

• Inspection - Severe wasting, Fasciculation
• Tone - v
• Power - v
• Reflex- v
• Plantar - absent or v (normal)
• Co-ordination - normal (difficult to examine if weakness++)

Pyramidal (Cortico-spinal, Upper Motor Neuron)

• Inspection - Mild wasting (if chronic)
• Tone - ^ (v acutely), clasp-knife rigidity
• Drift - pronator drift
• Power - v
• Reflex- ^ (v acutely), clonus
• Co-ordination - normal (difficult to examine if weakness++)
• Plantar - ^
• Gait - scissoring gait, hip & knee extended, platarflexion, leg 'swings around' (hip circumduction)
  
  (sensory and cortical higher functions may also be affected)

Extrapyramidal (Parkinson's)

• Inspection - resting tremor, mask-like facies, slowed movement (bradykinesia)
• Tone - Cogwheel rigidity, Lead pipe rigidity
• Power - normal
• Reflex - normal
• Plantar - v (normal)
• Co-ordination - slowed
• Gait - shuffling, festinating, gait, start hesitation, turn hesitation
• Other - micrographia (small writing)

Extrapyramidal (other)

• Inspection - chorea, athetosis, hemiballismus

Cerebellar

• Inspection - normal
• Tone - v
• Drift - Upward drift
• Power - Normal
• Reflex - v
• Plantar - v (normal)
• Co-ordination - dysdiachokinesis, intention tremor, past-pointing (dysmetria)
• Gait - broad based
• Other - scanning speech, slurred speech, explosive speech