Overview
Assessment of tone is the first part of the motor assessment, and is a good starting point and screening tool in that abnormal tone can immediately suggest an upper motor neuron lesion or Parkinsonism.
How to Assess
- Ask the patient to relax and allow you to move their arms. Move the shoulder, elbow, wrist and fingers passively through their range of motion, looking for rigidity.
Interpretation
- Increased: resistance to passive movementUpper motor neuron lesion
- Normal: minimal resistance
- Decreased: no resistanceLower motor neuron or cerebellar lesion
Spasticity
Also known as clasp-knife rigidity.
Feel For
- Velocity dependant rigidity, with quick flexion / extension of the joint. Works best on the knee or elbow.
Signifiance
- Indicative of upper motor neuron lesion.
Lead Pipe Rigidity
Feel For
- Continuous rigidity that is not velocity dependant, resulting in slow flexion and extension.
Significance
- Caused by Parkinson's disease, other causes of parkinsonism, and contractures.
Cog Wheel Rigidity
Feel For
- Rigidity associated with tremor, resulting in jerky start / stop movement of the joint.
Significance
- Caused by Parkinson's disease, other causes of parkinsonism, and contractures.
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