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Differential Diagnosis for Physical Therapy: Introduction: Summary
■ IX,X (Glossopharyngeal/Vagus) - Swallowing, gag reflex ■ V,VII,X,XII (Trigeminal, Facial, Vagus, Hypoglossal) - Voice and speech ■ XI (Accessory) - upper trap/SCM ■ XII (Hypoglossal) - Movement and protrusion of tongue
– Normal – no movement felt, 2-3 beats can be normal if no other signs are present ■ Hoffman response – Positive sign - the other fingers flex transiently after the "click"
4. Tone
○ Hypertonic ○ Hypotonic ○ Flaccidity ○ Rigidity 5. Sensory Integrity
3. Reflexes ○ Levels of Deep Tendon Reflexes (DTR) Biceps C5-C6 Brachioradialis C5-C6 Triceps C7 Patellar L2-L4 Achilles S1-S2 ○ Grading DTR's ■ 0 – Absent ■ 1 – Decreased but present ■ 2 – Normal ■ 3 – Brisk and excessive ■ 4 – With clonus ○ Abnormal reflexes ■ Babinski - – Normal reflex - toe flexion – Abnormal reflex- toes extend and separate- positive Babinski sign ■ Clonus -
○ Dermatomal Sensory Testing ■ C4 – Shawl area ■ C5 – Lateral Deltoid ■ C6 – Posterior Thumb ■ C7 – Posterior distal 3rd finger ■ C8 – Ulnar pinkie ■ L2 – Mid Anterior Thigh ■ L3 – Medial Femoral Condyle ■ L4 – Medial Malleolus ■ L5 – Dorsum 3rd MTPJ ■ S1 – Lateral Heel ■ S2 – Popliteal Fossa ○ Upper Extremity Key Muscle Testing ■ C4 - Shoulder shrug ■ C5 - Shoulder abduction ■ C6 - Elbow flexion/wrist extension ■ C7 - Elbow extension/wrist flexion
– Feel for oscillations between flexion and extension of the foot indicating clonus
■ C8 - Thumb extension ■ T1 - Finger abduction
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