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Upper Limb Neuro
 
 

Assessing Tone

 
 
 
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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 wrists and elbows passively through their range of motion, assessing for rigidity.
  • Interpretation

  • Increased: resistance to passive movementUpper motor neuron lesion
  • Normal: minimal resistance
  • Decreased: no resistanceLower motor neuron or cerebellar lesion

Spasticity

Spasticity, or clasp-knife rigidity, is a velocity-dependent increase in tone seen with rapid flexion or extension of a joint.
  • How to Assess

  • Rapidly flex or extend the elbow or knee joint, assessing for a sudden increase in resistance.
  • Significance

  • Suggests the presence of an upper motor neuron lesion.

Lead Pipe Rigidity

  • Feel For

  • A continuous and non-velocity dependent increase in tone. This is best assessed at the elbow, wrist and knee joints.
  • 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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