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Physical Therapy Examination for Patients with Neuromuscular Disorders

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Sensory Function Neuroanatomy and Pathology
Pathways Sensations Symptoms
Posterior (dorsal) columns Deep touch, 2-point discrimination, vibration, joint position Ipsilateral loss
Lateral spino-thalamic tract Pain & temperature Contralateral loss
Anterior spino-thalamic tract Nondiscriminative touch Contralateral loss


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Motor Function Neuroanatomy and Pathology
Pathways Functions Symptoms
Lateral corticospinal tract Contralateral limb voluntary movement Spasticity, Babinski's sign, synergistic movement
Ventral corticospinal tract Ipsilateral limb voluntary movement Spasticity, Babinski's sign, synergistic movement
Rubrospinal tract Muscle tone of flexors Spasticity
Vestibulospinal tract Ipsilateral upright posture & anti-gravity musculature Impaired posture & balance

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Autonomic Nervous System Functions
Organ and System Sympathetic Nervous System Parasympathetic Nervous System
Pupils Dilates Constricts
Saliva & tear glands Inhibits salivation & tearing Stimulates salivation & tearing
Bronchi (airways) Relaxes Constricts
Blood vessels Constricts  
Heart Accelerates heartbeat Slows heartbeat
Gastrointestinal system Inhibits digestion (slows peristalsis & decreases digestive enzyme secretion) Stimulates digestion (increases peristalsis & dilates intestinal blood vessels)
Adrenal medulla Stimulates epinephrine & norepinephrine secretion  
Urinary bladder Relaxes Contracts

Medical Red Flags

Red Flags indicate medical emergency situations. If the following signs or symptoms are demonstrated, terminate examination and intervention; then immediately call for medical assistance.

  • Abnormal breath or heart sounds

  • Blood pressure (systolic blood pressure > 200 mm Hg or < 90 mm Hg; diastolic blood pressure > 110 mm Hg)

  • Chest pain caused by exertion

  • Clonus onset

  • Cyanosis

  • Diaphoresis (excessive sweating)

  • Drastic mental status changes (sudden disorientation, confusion, drowsiness, lethargy)

  • Drastic mood changes (anxiety, apprehension)

  • Myasthenia crisis: muscle weakness interfering with vital functions (e.g., breathing, swallowing)

  • Nausea & vomiting in patients with shunts

  • Oxygen saturation < 90%

  • Seizure (lasting more than 5 minutes; two or more sequential seizures without recovery of consciousness)

  • Sudden:

    • Ataxia onset

    • Blood pressure changes (increase or decrease)

    • Coordination changes

    • Muscle tone changes (increase or decrease)

    • Pulse changes (regular to irregular; dropping by > 15 bpm; exceeding 75% of age-expected maximum)

    • Severe headache

    • Weakness, hemiparesis or paralysis

  • Syncope

  • Transient paralysis

  • Vision or speech distortion (slurred or hoarse voice)

Instruments Used for a Neuromuscular Examination

  • Blood pressure cuff

  • Circular disk (two point discrimination)

  • Extracts (vanilla & lemon) to test olfactory nerve

  • Flashlight

  • Frenzel lenses

  • Monofilament test kit

  • Cotton swab or a cotton ball to test light touch

  • Reflex hammer (with a small brush and sharp/dull metal component)

  • Stereognosis testing materials (penny, key, paper clip, & a small brown bag)

  • Stethoscope

  • Tape measure

  • Tongue depressor

  • Tuning fork (512 Hz)

  • Universal goniometer

Physical Therapy Examination

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