voluntary movement check

Casual exercise refers to the action under the control of consciousness, and the loss of random motor function is called 瘫痪. Due to different performance, the degree can be divided into completeness and incompleteness (light), and can be divided into single sputum, hemiplegia, paraplegia and cross sputum. A random motion check is to check the form of the flaw. Before the examination, the patient's emotions should be calmed down to prevent them from being too excited and the examination could not proceed smoothly. Basic Information Specialist classification: neurological examination classification: neuroelectrophysiology Applicable gender: whether men and women apply fasting: not fasting Reminder: Try to relax as much as possible during the examination. Don't be too nervous and affect the results of the examination. At the same time, actively cooperate with the doctor's work. Normal value Quadriplegia reflexes are normal. Clinical significance Abnormal result 1. Hemiplegia is a loss of voluntary movement of one limb, accompanied by ipsilateral central facial paralysis and tongue. Found in cerebral hemorrhage, cerebral arterial thrombosis, cerebral embolism, subarachnoid hemorrhage, brain tumors, etc. 2, single 瘫 (monoplegia) is a single limb of voluntary movement loss, more common in polio. 3, Paraplegia (paraplegia) is the loss of bilateral lower extremity voluntary movement, is the result of transverse spinal cord injury, seen in spinal cord trauma, myelitis, spinal tuberculosis. Internal cystic lesions cause hemiplegia: 4. Crossed paralysis is the ipsilateral peripheral cranial nerve palsy caused by one side of the brain nerve damage and the central hemiplegia of the contralateral limb. 5, quadriplegia seen in the high position (neck section) spinal cord transection. People who need to be examined: patients with unstable walking and muscle weakness. Precautions Contraindications before the examination: Before the examination, the patient's emotions should be calmed down to prevent them from being too excited and the examination could not proceed smoothly. Requirements for inspection: It is best to be accompanied by a family member during the examination, especially to prevent the patient from falling and being injured. Inspection process Hemiplegia is most common in sputum, and there are many types of clinics that cannot be distinguished. In essence, it may be different stages of the disease process. (1) Disorders of consciousness disorder: Consciousness disorder and hemiplegia often occur suddenly, and clinically common to hemiplegia caused by cerebrovascular accidents. Most of them started with headache, vomiting or aphasia and partial sensation. When coma or deep coma often makes it difficult to judge whether there is partiality or which side hemiplegia, but pay attention to the following signs to help early diagnosis of hemiplegia. 1. Facial examination: When coma is accompanied by hemiplegia, the cheeks are blown up when exhaling, and when inhaled. After the pain is stimulated on the cheeks, the mouth is biased toward the healthy side. When the lesions were above the bridge, the eyes and heads were biased to the side of the lesion (the side of the limbs). When the brain was damaged, the eyes and heads were biased to the opposite side of the lesion (the side of the limbs). 2, limb examination: the limbs are lifted up and let it fall naturally, the speed of the hemiplegia side is significantly increased, while the health side is not, the examination can be found that the lateral hemorrhoids side reflection is weakened or disappeared. The pathological sign of the hemiplegia was positive, and the ipsilateral abdominal wall or cremaster reflex disappeared. After the disturbance of consciousness improved, the hemiplegic side gradually turned from soft palate to hard palate, while the contralateral limb quickly returned to normal. (B) flaccid hemiplegia (soft palate): often caused by acute lesions of pyramidal tract shock, radial movement of the upper and lower extremities numbness, muscle tension is significantly lower or sputum reflex disappeared. It is often caused by early performance characteristics of hemiplegia or damage to lower motor neurons. 1, facial examination: early visible hemiplegia lateral muscle paralysis, mouth squat to the healthy side, hemiplegia side nasolabial fold shallow, drumstick whistling obstacles, can not fully close the eyes, forcibly closed eyes can not be completely hidden in the eyelids. 2, limb examination: lower limb muscle strength of the hemiplegic side, muscle relaxation, tendon reflex disappeared, limb movement and tension recovery from the near heart end, with daily shifting behavior increased muscle tension, sputum reflex into Babinski sign positive. The pathological signs of the lower motor neuron lesions were negative. (3) Sexual hemiplegia: Most of them are caused by flaccid hemiplegia. Some patients with subacute or chronic onset can gradually develop into hard sputum without soft palate. 1, unique posture check: visible shoulder height, forearm adduction, elbow, wrist flexion. The hand twists the front finger to the palm side, and the thumb height is adducted. The lower extremity of the temporal side is overextended, the hip joint is adducted, the knee joint is straightened, the ankle joint is adducted, the toe is curved and the claw toe or the horseshoe is turned over, and the walking gait is drawn. 2, facial examination: above the eye crack usually no paralysis or only slight paralysis, closed eyes are not tight, eyelash sign positive, forced shut up can be found that the side of the hemiplegia is weak, the natural position when the side of the mouth is biased downward to the outside, mouth mouth mouth It is obliquely elliptical. 3, physical examination: limb muscle tension is significantly increased, limb movement is significantly weakened, some patients can not exercise at all or forearm adduction, manifested as upper extremity extensor muscles, lower extremity flexor muscles, and the most serious hands and feet, The upper limbs are heavier than the lower limbs. 4, the examination of increased muscle tone: the upper limbs of the temporal side increased flexor muscle tension, the lower extremity increased the extensor muscle tension, and the passive motion impedance of the joints on the hemiplegic side was significant. Resistance increases with the increase of the amount of tension, and finally the resistance disappears. It is often called "knife knives" more common in pyramidal tract lesions. 5, deep reflection hyperthyroidism examination: due to the deep reflection threshold is reduced, the muscle's reflective contraction amplitude is enhanced, the upper limb biceps tendon reflex, triceps tendon reflex, periosteal reflex and lower limb knee reflex, The intrusion of 腱 reflection. 6, myoclonus examination: when the knee or achilles tendon is stretched after a series of rhythmic contractions, is a sudden passive stretch of pressure on the extensor muscles, often called "髌 挛", " "踝 挛 挛", "Wrist 挛 挛" and so on. 7, pathological reflex examination: no matter any cause of pyramidal tract damage can be pathologically positive, the upper limb flexor pathological reflex can appear Hoffman sign positive, lower extremity extensor pathological reflex can appear Babinski sign positive, etc. . 8. The shallow reflex is weakened or disappeared: the abdominal wall reflex and the cremaster reflex are weakened or disappeared in the hemiplegia caused by the damage of the pyramidal tract. 9. There are 4 ways to check the pathological joint movement: (1) sacral joint movement: the increase of muscle tension is more significant in the external stimuli of the hemiplegic side. For example, when the elbow joint is passively flexed, the wrist and finger flexion occur. (2) imitating the contralateral joint movement: when the contralateral limb is doing random exercise, similar movements appear in the corresponding part of the paralysis limb. For example, when the contralateral hand clenches the fist, the affected side also has involuntary flexion movement. However, the opposite action can also occur. For example, when the fist is in the side of the hand, the finger on the side of the jaw appears as a straightening motion. (3) Synaptic joint exercise: When the patient is in bed, the knee is stretched when the wrist is extended, and the knee joint is automatically flexed when the hip is flexed. (4) Coordinated joint movement: When the limbs move, they are accompanied by the non-free movement of the muscles in other parts of the limb. When the patient is supine, the patient flexes the hip and knee joints on the temporal side. At this time, the ipsilateral dorsiflexion may occur, and the tibialis anterior muscle contraction and bulge. 10. There are 6 ways to check the hemiparesis: (1) Examination of facial paralysis: 1 The strength of the closed eye is weakened, the eyelids are closed slowly and the closure is not tight, and the eyelids are easy to open. Commonly known as "closed eye test positive"; 2 sacral lateral eye cracks larger than the healthy side, the supine position can be significantly enlarged ocular fissure; 3 嘱 patients in the smile movement can be expressed as unequal contraction of the two lateral muscles. The sacral side of the nasolabial fold is shallow, and the mouth angle is biased to the healthy side; 4 嘱 patients close their eyes, and the lashes on both sides can still be buried between the upper and lower eyelids, and then the lashes are exposed in a short time, so it is called " Eyelash sign positive." (2) Examination of limb paralysis: When the cone bundle is slightly damaged, the limb can be expressed as hemiparesis. Because the degree of muscle strength is not equal, it should be carefully examined to find the weakening of muscle strength. 1嘱The patient flexes all the fingers, then straightens them one by one, performs several fingers movements or all the fingers straight out to make one by one flexion. At this time, there may be awkward or incapable of performing, commonly known as digital finger test, often the performance of mild damage of the pyramidal beam. 2嘱The patient bends the elbow, the forearm is vertical, and all the fingers are stretched hard. The thumb metacarpal can not fully dorsiflexion, and the palmar joint protrudes toward the palm. Therefore, the paralyzed concave hand is a manifestation of mild pyramidal tract damage; 3 patients in the supine position, the squatting patient flexes the hip and knee joint flexibly, such as when the patient is in the sitting position, the patient is lifted, and the patient is weakly observed. Therefore, it is called "positive lumbar muscle sign" positive; 4 first let the patient take the supine position, the doctor puts the hand under the foot of the foot, and then the patient lifts the lower limb, if there is a side of the squat, and the contralateral lower limb is pressed downwards Enhanced. Or the patient is standing, the flexion of the knee joint can not be straightened; 5 patients with two upper limbs flat, closed eyes, wait a few minutes, visible flank of the upper extremity pronation, and gradually falling. However, rickets often fall rapidly. Or the patient is lying prone, the two calves are raised and kept at 45°, and the calf side calf can be slowly dropped. The patient can also be lifted up on the back of the leg. After a short stop, the flick side can be seen to fall slowly. The palm of the hand may have a flickering of the little finger abduction, or the patient may flex the thumb. The examiner applies resistance on the dorsal side of the distal end of the thumb, and the dorsiflexion of the thumb is weakened. Or the patient is lying on his back, and the two hands are crossed on the chest. When the patient sits up, the hip joint flexion can occur, the heel is raised, and the healthy side is not moving. (3) Changes in muscle tone of sputum: 1 The squat limb is at rest, the muscle tension is reduced, the muscle abdomen is flat, and the normal shape or limb position abnormality is lost. At this time, it is called "positive muscle tension test at rest"; When the limb is doing rapid passive exercise, it begins to feel resistance in a short time, but it is quickly relieved, and the muscle tension of the folding knife is increased. The two sides can be found on the two sides. At this time, it is called "positive muscle tension test when passive". (4) Abnormal posture examination of squatting posture: 1 When the twitching muscles of the anterior muscles are stronger than the supinator muscles, the forearm flexes in the forearm, the forearm is rotated in the normal position, and the hand is in the pronation position when the pyramidal tract is damaged. 2嘱The patient's upper extremities are stretched horizontally, palms up, and eyes closed to maintain this position. The upper limbs of the squats are gradually shifted upwards or downwards, and the elbows are slightly flexed. This is the extensor muscle damage of the upper limbs. Caused by muscle tension, the performance of mild damage of the pyramidal tract; 3 嘱 patients in the supine position, the healthy side of the foot vertical, slightly outward, the affected side of the foot abduction. (5) Physiological and pathological reflex examination of palsy: 1 腱 reflex examination: 瘫 瘫 瘫 腱 可 可 可 可 可 可 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , At the patient's pubic symphysis, the examiner's finger is hit. At this time, the adductor muscles of both sides contract at the same time, and the contraction of the adductor muscle of the sacral side is enhanced; 2 跖 reflex and Babinski's sign determines the inner side of the foot. It is easier to induce ankle reflex than the outer side, and it is easy to induce the positive sign of Babinski sign on the outer side of the foot. Furthermore, the sacral side often has a slow dorsiflexion of the toe or a total toe dorsiflexion. This performance should be considered positive for pathology. If the toe is fixed, and 2 to 5 toe dorsiflexion, the contralateral foot is completely deformed, it should also be suspected of pathological signs. Another example is that after repeated examinations, the toes sometimes flex and sometimes stretch. When stretching, the toes are fan-shaped and open, and each side of the healthy side is inflexible, which should also be suspected as pathological. (6) Examination of abnormal gait in hemiparesis: When one side is lightly paralyzed, it is often found that one side of the lower limb is weak during rapid turning. When walking, the squatting side of the lap is lower than the healthy side or a drag gait. Not suitable for the crowd Inappropriate population: Patients with disabilities on their limbs or disease. Adverse reactions and risks Nothing.

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