Upper Motor Neurone Testing

• Upper Motor Neurone Testing:

  • Indications: part of any full neurological testing
  • Unsteadiness of gait
  • Bilateral non-dermatomal distribution of symptoms
  • Exaggerated tendon reflex response
  • Bowel or bladder dysfunction (can also implicate cauda equina compression)
  • Babinski
  • Clonus
  • Reflexes: lower quadrant:
  • L3 Knee Jerk
  • S1 Ankle Jerk
• Upper Motor Neurone Testing - Babinski:

  • Test for evidence of an Upper motor neurone lesion
  • Patient position: In supine
  • Therapist action: Use the end of the reflex hammer over the sole of the patient’s foot
  • Start at the medial aspect of their heel, then along the lateral aspect of the sole of their foot and across medially to their big toe
  • Normal response would be no change in the position of the toes, or curling/flexion of the toes
  • Positive response indicating a UMN lesion would be big toe extension with fanning of the other toes
  • Compare to the other side
• Upper Motor Neurone Testing - Clonus:

  • Test for evidence of an Upper motor neurone lesion
  • Patient position: In supine
  • Therapist action: stabilise the tibia with one hand, the other hand holding the foot. Apply a quick stretch to their calf by moving their ankle into dorsiflexion. This needs to be done with some speed!
  • Normal response 0- 3 beats of the foot into plantarflexion
  • Abnormal/Positive response indicating a UMN lesion: Foot continued to beat into plantarflexion for more than 3 beats
  • Compare to the other side