Motor Functions – Assessment (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Okay, so let's talk about assessing motor function.

    00:03 This one is really, really fun to try on a roommate, okay? So for accurate assessment, the patient needs to be awake.

    00:09 So you can't really test their motor function if they're not able to be awake and follow commands.

    00:16 So the idea is you wanna make sure it's equal on both sides, right and left.

    00:21 I guess that part of it I need to explain to you that sides meant right and left but there you go, that's a freebie.

    00:27 So here's the things you're gonna ask your patient to do.

    00:29 You're gonna ask them to flex and extend their arms against their hand, against your hand.

    00:36 So you wanna put some pressure on them to see what their strength is because you wanna see if it's equal on both sides.

    00:42 You can ask them to squeeze your fingers.

    00:44 So have them with their palms up, you lay your hand in theirs and just ask them to just squeeze your hands.

    00:50 Do both at one time and see if they have any difference between the right side and the left side.

    00:56 Now, I sometimes really have a hard time with my right hand.

    01:00 If it's particularly stiff, that is gonna be a little weaker.

    01:03 So you can talk to your patients and say, "Hey, do you have any problems with your grip? on the right or the left?" and they should be able to tell you if they do.

    01:12 Now you want to put gentle pressure on their thigh and see what their strength is if they lift the leg while you're putting that pressure down, same thing with the right and the left leg.

    01:22 Have them hold their legs straight and see that they lift up against gravity, good for their abs too, just kidding.

    01:27 Or you can have them flex and extend the foot against your hand.

    01:31 So if they're laying in bed, just put your palms of your hand against the bottoms of their feet and have them try flex and extend their feet against your hands that way you can see what their strength is there, too.

    01:43 Hey, while we're talking about feet, one of my least favorite parts of the patient's body sometimes.

    01:49 But remember, if that patient has socks on, everyone should take those socks off.

    01:55 Now, there's no telling what you're gonna find, but a thorough assessment of the patient, you wanna take those socks off, look at their feet, especially while you're doing this assessing the motor function, You wanna check and see if there's any wounds on their feet, how their feet look, if there's anything we need to follow up on.

    02:11 Because sometimes, we get these little elderly people that put those socks on and you know, 1984 and they haven't taken them off since.

    02:19 So, you wanna carefully take that off and assess those feet also for skin while you're assessing the motor function.

    02:26 Okay, what do you do for an unconscious patient? Well, we use noxious stimulus and we look how they respond to it.

    02:33 It's really not my favorite part because I wouldn't want this done to me but we need to figure out what's going on with their neuro status so that's what you do.

    02:41 So when we say noxious stimulus, can you remember what two examples we talked about? Okay, remember we put pressure on the nailbed, you can use a pen or you can use the end of a hammer, you could put it on the fingers or on their toes.

    02:56 Another thing we do is you kinda do this with your knuckles and you put it right on their sternum and you press and twist.

    03:03 Okay, that's another very noxious form of stimulus.

    03:07 So two ways, nailbed pressure is usuallly enough, this is more, I mean, more noxious than nailbed pressure, you can also try that.

    03:16 What you wanna watch for is any asymmetrical response.

    03:20 So, do both arms respond the same way, do both legs respond the same? Is there anything that's unequal? Do you notice anything about their muscle tone or are they just flaccid when yo do that? Now, the worst case scenario we're talking about is decorticate posturing or decerebrate posturing.

    03:37 This looks really bizarre, you're gonna know right away when your patient does this that this is not a great sign.

    03:44 Okay, so let's talk about decerebrate posturing.

    03:47 They have straight arms and legs or toes are pointed downwards, they arch their neck and their back and they do like kind of this thing.

    03:54 Now, I usually remember this because they'd do the arms like this looks like, I kind of think about them celebrating.

    04:00 But this is caused by a problem with the brainstem, this is not a cause to celebrate, right? So you know, I've tried to remember like, they're celebrating, decerebrate, it's nothing to party about because once your brainstem is affected, we're really talking about severe, severe problems.

    04:20 So decerebrate posture, straight arms and legs, they move their arms like this but it's a really, really bad sign.

    04:29 Decorticate posture, arms are stiff and bent, legs stick out straight but they clench their wrist and they bend their fingers, pressed against their chest.

    04:37 I remember this one by thinking like - to the cord, it's "decorticate".

    04:42 Okay, so that's with problems due to their corticospinal pathways.

    04:46 I wouldn't want to be doing either one of these, I wouldn't want somebody I care about or any patient to be decerebrate or decorticate posturing, but it happens.

    04:54 It's important that you as a nurse recognize the difference between decerebrate posturing, decorticate posturing and what that really translates in the meaning.

    05:05 So I would pause the video for just a minute if I were you and I would practice that yourself.

    05:10 Can you mimic what I would look like? Put your body in the position of decerebrate posturing and decorticate posturing and do that 2 or 3 times, back and forth to really lay that down in your brain.

    05:25 That way, if you see it on a test question, you got it.

    05:29 And if you see it in a patient more importantly, you'll know what it means and you know what to do.

    05:35 Now this is a new assessment on your patient, this is immediately call the healthcare provider.

    05:41 If this is continued, then alright, then we know that's it's just a trend and it's been going on, we handle that differently.

    05:48 But if this is new, this is a big deal.

    05:50 This is something you would absolutely let the healthcare provider know.

    About the Lecture

    The lecture Motor Functions – Assessment (Nursing) by Rhonda Lawes, PhD, RN is from the course Neurological Assessment (Nursing) . It contains the following chapters:

    • Assessing Motor Function
    • Decerebrate vs. Decorticate

    Included Quiz Questions

    1. Flexion and extension of the arms
    2. Squeezing of the fingers
    3. Strength of the leg while pressing down and lifting against the nurse's hand
    4. Dexterity of the fingers
    5. Coordination by asking the client to walk in a straight line
    1. Put pressure on the client's nail bed, or apply a sternal rub.
    2. Yell loudly, or rub your hand across the client's forehead.
    3. Rub upward on the bottom of the client's foot, or apply a light hammer to their patella tendon.
    4. Stand directly in front of the client and wave, or put their hand lightly.
    1. Decerebrate posturing
    2. Decorticate posturing
    3. Decompensation posturing
    4. Detachment posturing

    Author of lecture Motor Functions – Assessment (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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