IC3 OSCE Lower Limb Motor
“This is a neurology station. You have 5 minutes to complete a motor examination of this patient’s lower limbs. I will then ask you
to present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene
• Cleans hands with alcohol gel
Introduction, explanation and consent ‘Hi my name is X. I’m a third year medical
• Introduces self with name and level, student at RCSI. What’s your name? Nice to
explains what he/she will be doing and meet you. I’ve been asked to examine your
obtains consent for same
legs today. That will involve looking at your
legs, moving them around, checking the
power, then testing your co-ordination and
your reflexes. Would that be ok?’
Position and exposure ‘Mr/Mrs A is appropriately positioned and
• Patient at 45 degree angle exposed for this examination.’
• Legs exposed from mid-thigh
Enquires about pain ‘Are you in any pain?’
• Prior to examining
General Inspection
Performed from the end of the bed ‘On general inspection Mr/Mrs A appears Patient
Inspects for well, with normal posture, no peripheral o Abnormal posture/movements, focal neuro
o Patient stigmata of neurological disease and no Equipment
o Equipment equipment around the bed.’ o Walking aids, assistive devices
Closer Inspection
Neurocutaneous stigmata
Performed from right hand side of bed o Scars, ulcers, rashes
Inspects for Asymmetry
o Neurocutaneous stigmata Muscles
‘On closer inspection of the lower limbs
o Symmetry there are no stigmata of neurological o Wasting/hypertrophy, R/L _x_
o Muscles disease, such as asymmetry or abnormal Abnormal movements
o Abnormal movements movements‘ o Fasciculations, myoclonic jerks, dystonia,
chorea, athetosis, ballism, tics
Tone
Encourages patient to relax
Places hands above and below the ‘Tone is increased/decreased on the right/left side
patient’s knee and rocks the leg back at the hip/knee/ankle’
and forth, observing the foot Tone increased - hypertonic +/- clonus, as in an
Places hands under the knee and ‘Tone is normal bilaterally, with no evidence
upper motor neuron lesion.
passively flexes/extends knee joint of ankle clonus.’
Tone decreased - hypotonic, as in a lower motor
Check for ankle clonus neuron lesion
o Holds leg, rolls ankle then sharply
dorsiflexes foot, holds & observes
Power
Attempt to isolate the joints
Compares like with like
Hip
Flexion – Asks the patient to raise straight
leg, resisting movement by pushing down
above the patient’s knee.
Extension – Asks the patient to maintain tleg
in extension flat on bed and not allow
examiner to pull the leg up.
Abduction – Asks the patient to move the leg
to the side, from the midline, and not allow
the examiner to push it back in.
Adduction – Asks the patient to keep the legs
together and not allow the examiner to
‘Power is 5/5 throughout.’ ‘Power is reduced to x/5 on left/right _joint_
separate them
_movement(s)_’
Knee (isolates by placing hand on hip/thigh)
Flexion – Asks the patient to bend the knee
and not allow it to be straightened
Extension – With the knee bent, asks the 0/5 Complete paralysis
“This is a neurology station. You have 5 minutes to complete a motor examination of this patient’s lower limbs. I will then ask you
to present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene
• Cleans hands with alcohol gel
Introduction, explanation and consent ‘Hi my name is X. I’m a third year medical
• Introduces self with name and level, student at RCSI. What’s your name? Nice to
explains what he/she will be doing and meet you. I’ve been asked to examine your
obtains consent for same
legs today. That will involve looking at your
legs, moving them around, checking the
power, then testing your co-ordination and
your reflexes. Would that be ok?’
Position and exposure ‘Mr/Mrs A is appropriately positioned and
• Patient at 45 degree angle exposed for this examination.’
• Legs exposed from mid-thigh
Enquires about pain ‘Are you in any pain?’
• Prior to examining
General Inspection
Performed from the end of the bed ‘On general inspection Mr/Mrs A appears Patient
Inspects for well, with normal posture, no peripheral o Abnormal posture/movements, focal neuro
o Patient stigmata of neurological disease and no Equipment
o Equipment equipment around the bed.’ o Walking aids, assistive devices
Closer Inspection
Neurocutaneous stigmata
Performed from right hand side of bed o Scars, ulcers, rashes
Inspects for Asymmetry
o Neurocutaneous stigmata Muscles
‘On closer inspection of the lower limbs
o Symmetry there are no stigmata of neurological o Wasting/hypertrophy, R/L _x_
o Muscles disease, such as asymmetry or abnormal Abnormal movements
o Abnormal movements movements‘ o Fasciculations, myoclonic jerks, dystonia,
chorea, athetosis, ballism, tics
Tone
Encourages patient to relax
Places hands above and below the ‘Tone is increased/decreased on the right/left side
patient’s knee and rocks the leg back at the hip/knee/ankle’
and forth, observing the foot Tone increased - hypertonic +/- clonus, as in an
Places hands under the knee and ‘Tone is normal bilaterally, with no evidence
upper motor neuron lesion.
passively flexes/extends knee joint of ankle clonus.’
Tone decreased - hypotonic, as in a lower motor
Check for ankle clonus neuron lesion
o Holds leg, rolls ankle then sharply
dorsiflexes foot, holds & observes
Power
Attempt to isolate the joints
Compares like with like
Hip
Flexion – Asks the patient to raise straight
leg, resisting movement by pushing down
above the patient’s knee.
Extension – Asks the patient to maintain tleg
in extension flat on bed and not allow
examiner to pull the leg up.
Abduction – Asks the patient to move the leg
to the side, from the midline, and not allow
the examiner to push it back in.
Adduction – Asks the patient to keep the legs
together and not allow the examiner to
‘Power is 5/5 throughout.’ ‘Power is reduced to x/5 on left/right _joint_
separate them
_movement(s)_’
Knee (isolates by placing hand on hip/thigh)
Flexion – Asks the patient to bend the knee
and not allow it to be straightened
Extension – With the knee bent, asks the 0/5 Complete paralysis
