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Osce guide OSCE guide Lower limb neurological assessment Equipment Tuning fork - Neurotip Cotton wool - Tendon hammer Inspection Observe for clues around bed- mobility aid etc General appearance- posture limb deformities Scars Wasting muscles Involuntary

OSCE guide Lower limb neurological assessment Equipment Tuning fork - Neurotip Cotton wool - Tendon hammer Inspection Observe for clues around bed- mobility aid etc General appearance- posture limb deformities Scars Wasting muscles Involuntary movements Fasciculation Tremor Gait Walk to the end of the room and back - Speed symmetry arm swing Tandem heel to toe gait Heel walking Romberg ? s test Stand with feet together and eyes closed Observe for - mins Positive if lose balance sensory ataxia Tone Ataxic broad-based and unsteady As if drunk Parkinsonian small shu ing steps stooped posture and reduced arm High-stepping weakness of ankle dorsi exion won ? t be able to walk on their heel Waddling gait shoulders sway from side to side legs lifted o ? ground with the aid of tilting the trunk Hemiparetic one leg held sti y and swings round in an arc with each stride circumduction Spastic paraparesis similar to above but bilateral ?? both are sti ? and circumducting Leg roll - watch foot as you roll should op independently of leg Leg lift- briskly lift leg o ? bed at knee point- heel should stay in contact with bed Ankle clonus Knee ankle slightly ex support leg with hand under knee - Rapidly dorsi ex and partially evert foot - rhythmical beats of dorsi exion plantar exion clonus Power Use MRC muscle power scale COSCE guide Hip Flexion L ?? ??raise your leg o ? the bed and stop me from pushing it down ? Extension L S ?? ??stop me from lifting your leg o ? the bed ? ABduction L ?? ??push your legs out ? ADduction L ?? ??squeeze your legs in Ankle Dorsi exion L ?? ??keep your legs at on the bed ? cock your foot up towards your face ? don ? t let me push it down ?? Plantar exion S ?? ??push down like on a pedal ? Inversion L ?? ??push your foot in against my hand ? Eversion L S ?? ??push your foot out against my hand ? ? Knee Flexion S ?? ??bend your knee and stop me from straightening it ? Extension L ?? ??kick out your leg ? Big toe Extension L ?? ??don ? t let me push your big toe down ? Deep tendon re exes Knee jerk L Ankle jerk L S Plantar re ex S Normal exion of toes - Abnormal Babinski sign extension big toe spread of others Co-ordination Sensation Demonstrate on sternum with eyes open ?rst Light touch - Assesses dorsal posterior columns and spinothalamic tracts - Use cotton to touch each dermatome on both sides - Eyes closed compare left to right Pin-prick sensation - Assesses spinothalamic tracts - Same as light touch but with sharp end of neurotip Vibration - Assesses dorsal posterior columns - Tap place on distal phalanx of great toe - Move proximally if vibration not felt Proprioception - Assesses dorsal posterior columns - Hold distal phalanx of great