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\author{hjsdhaj}
\pdfinfo{
  /Title (neurological-examination-of-the-lower-limbs.pdf)
  /Creator (Cheatography)
  /Author (hjsdhaj)
  /Subject (Neurological Examination of the Lower Limbs Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Neurological Examination of the Lower Limbs Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{hjsdhaj} via \textcolor{DarkBackground}{\uline{cheatography.com/201639/cs/42746/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}hjsdhaj \\
  \uline{cheatography.com/hjsdhaj} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 10th April, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{p{0.88 cm} x{7.12 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Preperation and Equipment:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{W}} & Wash Hands \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{I}} & Introduce Yourself + Patient's Identity \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{P}} & Permission \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{P}} & Patient Position + Pain \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{E}} & Explaination \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Patient must be placed at 45° and {\emph{limbs exposed}}}} \{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} x{7.2 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Equipment:}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & Cotton Wool\{\{nl\}\}Neurotips\{\{nl\}\}Tendon Hammer\{\{nl\}\}128Hz Tuning Fork \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4.24 cm} x{3.76 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{General Inspection:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•Postural abnormalities and deformities} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•Leaning or facial asymmetry} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•Muscle wasting, fasciculations, or tremor} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•Abnormal movements} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•Obvious discomfort or pain} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
•Medical paraphernalia: & Walking aids, Calipers \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.204 cm} x{2.66 cm} x{2.736 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Tone:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{{\emph{Check for pain}}}}\{\{ac\}\}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Check tone:}} & Roll the relaxed leg from side to side and watch foot & Extra movement =\textgreater{} Decreased tone\{\{nl\}\}\{\{nl\}\}Less movement =\textgreater{} Rigidity \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
 & Flex and extend knee & + check for clonus at knee \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Check for clonus:}}\{\{nobreak\}\} & Rotate ankle & {\bf{{\emph{Ensure no pain}}}}\{\{nl\}\}Relax foot\{\{nl\}\}Hold lower leg with one hand and extend the ankle joint with the other\{\{nl\}\}Suddenly dorsiflex ankle and hold in position\{\{nl\}\}{\bf{Compare with other leg}} \tn 
% Row Count 22 (+ 14)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{Clonus is seen in {\bf{upper motor neuron lesions}}\{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
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\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.672 cm} x{2.964 cm} x{2.964 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Power:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Test both left and right limbs, directly comparing each movement in turn.\{\{nl\}\}\{\{nl\}\}The patient should perform each movement on their own and then attempt with the examiner resisting the movement}}\{\{ac\}\}} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
{\bf{Hips:}} & •Flexion\{\{nl\}\}•Abduction\{\{nl\}\}•Adduction\{\{nl\}\}•Extension & Patient straightens leg, raises leg off the bed, lowers it to the bed \tn 
% Row Count 10 (+ 5)
% Row 2
\SetRowColor{LightBackground}
{\bf{Knee:}} & •Flexion\{\{nl\}\}•Extension & Patient flexes hip and knee, secure thigh with one hand, ask patient to kick out towards the end of the bed, pull in heel towards bum \tn 
% Row Count 19 (+ 9)
% Row 3
\SetRowColor{white}
{\bf{Ankle:}} & •Dorsiflexion\{\{nl\}\}•Plantarflexion & Leg flat on bed, secure leg, dorsiflex foot, plantarflex foot \tn 
% Row Count 24 (+ 5)
% Row 4
\SetRowColor{LightBackground}
{\bf{Big Toe:}}\{\{nobreak\}\} & •Flexion\{\{nl\}\}•Extension & Hold foot secure, flex big toe (towards patient), extend (away from patient) \tn 
% Row Count 30 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
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\par\addvspace{1.3em}

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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Coordination:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Heel-shin test:}}\{\{nobreak\}\} & Place heel on one knee and run up and down the shin \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Toe Tapping:}} & Patient taps floor/your hand with their foot \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Must be completed for both sides}} and the patient should be asked to {\bf{perform the actions as quickly as possible}}\{\{ac\}\}}  \tn 
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\begin{tabularx}{8.4cm}{x{1.596 cm} x{2.964 cm} x{3.04 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Tendon Reflexes:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Limb must be totally relaxed}}\{\{ac\}\}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Knee:}} & Support the leg above the knee, with the knee flexed, strike directly below the patella & {\bf{{\emph{L3/4}}}} \tn 
% Row Count 7 (+ 6)
% Row 2
\SetRowColor{LightBackground}
{\bf{Ankle:}} & Leg flat on the bed, laterally rotate leg, flex knee, hold the foot dorsiflexed. Strike Achilles Tendon & {\bf{{\emph{S1/2}}}} \tn 
% Row Count 14 (+ 7)
% Row 3
\SetRowColor{white}
{\bf{Plantar Response:}} & {\bf{{\emph{Hold ankle with one hand}}}}.\{\{nl\}\}Warn the patient this may tickle.\{\{nl\}\}Scratch the sole of the foot with a tongue depressor, starting at the lateral side of the heel, up lateral sole, across base of toes. & {\bf{Must be first movement of the big toe}}\{\{nl\}\}\{\{nl\}\}Negative Babinski sign (normal except in the case of LMN disease): {\bf{{\emph{Flexion of the toes and pull away}}}}\{\{nl\}\}\{\{nl\}\}Positive Babinski sign:{\bf{{\emph{ Extension (upwards movement) of the toes}}}} {\emph{Indicates UMN damage}} \tn 
% Row Count 31 (+ 17)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{Muscle may just contract, {\bf{may not be an obvious movement}} \newline  \newline Reflex may be {\bf{present/absent}}, or {\bf{reduced/brisk}}\{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.052 cm} x{2.812 cm} x{2.736 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Sensation:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Light Touch:}} & {\emph{Important to touch rather then stroke}}\{\{nl\}\}\{\{nl\}\}Lightly {\bf{touch sternum}} first using cotton wool.\{\{nl\}\}{\bf{Ask patient to close eyes }} and tell you when they feel the touch.\{\{nl\}\} {\bf{Ask if touch feels the same on both sides}} &  \tn 
% Row Count 17 (+ 17)
% Row 1
\SetRowColor{white}
 & Proximal anterior upper thigh & {\emph{L1}} \tn 
% Row Count 20 (+ 3)
% Row 2
\SetRowColor{LightBackground}
 & Proximal anterior upper leg, between thigh and knee & {\emph{L2}} \tn 
% Row Count 24 (+ 4)
% Row 3
\SetRowColor{white}
 & Anterior surface of knee & {\emph{L3}} \tn 
% Row Count 26 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Medial aspect of lower leg & {\emph{L4}} \tn 
% Row Count 28 (+ 2)
% Row 5
\SetRowColor{white}
 & Lateral aspect of lower leg & {\emph{L5}} \tn 
% Row Count 30 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{2.052 cm} x{2.812 cm} x{2.736 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Sensation: (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
 & Lateral side of foot/small toe & {\emph{S1}} \tn 
% Row Count 3 (+ 3)
% Row 7
\SetRowColor{white}
 & Posterior vertical midline of leg & {\emph{S2}} \tn 
% Row Count 6 (+ 3)
% Row 8
\SetRowColor{LightBackground}
{\bf{Pain:}} & Repeat same process as for light touch.\{\{nl\}\}\{\{nl\}\}Tested using a {\bf{new}} neurotip.\{\{nl\}\}{\bf{Must be disposed of in the {\emph{sharps bin}}}}. &  \tn 
% Row Count 16 (+ 10)
% Row 9
\SetRowColor{white}
{\bf{Temperature:}}\{\{nobreak\}\} & Tested the same way as pain/light touch, rarely done. \{\{nl\}\}\{\{nl\}\}Tested using a {\emph{cold tuning fork}}. &  \tn 
% Row Count 24 (+ 8)
% Row 10
\SetRowColor{LightBackground}
{\bf{Vibration Sense:}} (128Hz) & Strike tuning fork and hold to patient's sternum.\{\{nl\}\}Ask patient to close eyes. &  \tn 
% Row Count 30 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{2.052 cm} x{2.812 cm} x{2.736 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Sensation: (cont)}}  \tn
% Row 11
\SetRowColor{LightBackground}
 & Begin on most distal bony prominance {\bf{(Big toe of each foot)}} &  \tn 
% Row Count 5 (+ 5)
% Row 12
\SetRowColor{white}
{\bf{Proprioception:}}\{\{nobreak\}\} & Ask patient to close eyes.\{\{nl\}\}Hold big toe at the sides, distal to the DIP joint. Stabilise the toe proximal to the tested joint.\{\{nl\}\}\{\{nl\}\}Demonstrate up/down for the patient, then repeat in a random direction, asking the patient to say which direction the toe is moving.\{\{nl\}\}\{\{nl\}\}Repeat 3 times & If normal, end here. If patient is unable to feel, move proximally up the joints.\{\{nl\}\}\{\{nl\}\}PIP, Ankle, Knee, etc. \tn 
% Row Count 27 (+ 22)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.52 cm} x{4.48 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Gait and Balance:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Examine Gait:}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Examine Balance:}}\{\{nobreak\}\} & Romberg's Test:\{\{nl\}\}Patient stands with their feet together and close their eyes.\{\{nl\}\}\{\{nl\}\}If they become unsteady -\textgreater{} Positive test \tn 
% Row Count 8 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Completing the Examination:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Thank the Patient}}\{\{ac\}\}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•Consider Upper Limbs Examinaiton} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•Consider Cranial Nerves Examination} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•Consider Examining Anal Tone} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{{\emph{Wash Hands}}}}\{\{ac\}\}} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.44 cm} x{4.56 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Common Disorders}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{B12 deficiency:}}\{\{nobreak\}\} & Commonest cause of {\bf{dorsal column problems }}- sub acute combined degeneration of the spinal cord \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Cerebellar disease is ipsilateral}} and causes horizontal nystagmus - Fast phase towards the side of the lesion} \tn 
% Row Count 8 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{MRC Muscle Power Scale:}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/hjsdhaj_1710806713_MRCMPS.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Lower Limbs Dermatome Map:}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/hjsdhaj_1710934808_Lower-limb-dermatome-map.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}