Neurological Examination - Test for Massage Therapist

Dermatome – Upper limb, Lower limb
1. Narration
  - Hello, I am your RMT, today I am going to assess your upper/lower limb dermatome. It is very essential part of neurological examination to check your spinal nerve function
  - I am now going to be using this piece of cotton wool and running it down different aspects of your arm and hand/leg. If it feel same on the right as it does on the left, please let me know. Do you have any questions before start testing?
  - Alright. Please close your eyes for me.
  - So, does this feel the same as this?
  - (If say, No) How does it feel different? If I ask you as a percentage, how much sensation do you feel on the right compare to the left?
2. Upper limb dermatome area, Lower limb dermatomes area
3. Useful Video

Myotome – Upper limb, lower limb
1. Narration
  - Hello, I am your RMT, today I am going to assess your upper/lower limb myotomes. It is very essential part of neurological examination to check your spinal nerve function
  - I am now going to through your myotome testing and we are going to start cervical with neck flexion.
  - C1 : Can you move your head down, and agaist me
  - C2: Can you tilt your head backwards and push against me?
  - C3 : Can you bend your head left/right side and push against me?(bilaterally).
  - C4 : Please lift your shoulder up and against me(bilaterally).
  - C5 : Please pull your shoulder away and push against me(bilaterally).
  - C6 : Can you bend your elbow up, and push up agaist me.(bilaterally).
  - C7 : Can you be dowards your elbow, and aginst me.(bilaterally)
  - C8 : Please lift your thum upwards, and Push up against me(bilaterally)
  - T1 : Please bring your fingers out like so, then squezze it. (bilaterally). Finally, I am going to ask you to pull your fingers together and I want you to open them up.
  - L2 : Please lift up to celing your leg against my pressure(bilaterally).
  - L3 : Please kick your leg forwards, push aginst me(bilaterally).
  - L4 : Can you lift up your foot, then push against me?(bilaterally).
  - L5 : Please lift up just your big toe then push against me(bilaterally).
  - S1 : Please your foot down towards to the floor, then push against me(bilaterally).
  - S2 : Please push backward your leg, then push against me(bilaterally).
2. Upper limbs myotomes, Lower limbs myotomes
3. Useful Video
  - Upper Limb Myotomes | Clinical Physio – YouTube
  - Lower Limb Myotomes | Clinical Physio – YouTube

Deep Tendon Reflex
1. DTR Biceps(C5-C6)
  1. Procedure
    1. Relax arm
    2. Practitioner support client’s elbow and forearm.
    3. Place thumb on the around(one thumb distally from the cubital fossa) cubital fossa, then give three reflex to know average patient’s relfex
    4. Observe for contraction of the biceps muscle(elbow flexion)
    5. Test other side as well as
  2. Interpretation : Absence, hyporeflex, normal, hypereflex, bilaterally or unilaterally
  3. Useful Video : Upper Limb Reflex Tests | Clinical Physio – YouTube
2. DTR Brachioradialis(C6-C7)
  1. Procedure
    1. Relax arm, Patient’s thum pointing towards celing.(arm neutral position )
    2. Practitioner support hold client’s wrist, and cradle forearm
    3. Place thumb on the styloid process of radius, then move one thumb proximally, then give three reflex to know average patient’s relfex
    4. Observe for contractino of the brachioradialis muscle(forearm supination)
    5. Test other side as well as
  2. Interpretation : Absence, hyporeflex, normal, hypereflex, bilaterally or unilaterally
  3. Useful Video : Upper Limb Reflex Tests | Clinical Physio – YouTube
3. DTR Triceps(C7-C8)
  1. Procedure
    1. Relax arm,
    2. Practitioner hold client’s distal humerus
    3. Place thumb on the Olecranon process, then move proximally one thumb, then give three reflex to know average patient’s relfex
    4. Observe for contraction of the triceps(extension elbow)
    5. Test other side as well as
  2. Interpretation : Absence, hyporeflex, normal, hypereflex, bilaterally or unilaterally
  3. Useful Video : Upper Limb Reflex Tests | Clinical Physio – YouTube
4. DTR Patella = Knee reflex = Knee jerk (L3-L4)
  1. Procedure
    1. Relax leg
    2. Place thumb on between the tibial tuberosity and distal patella. then give three reflex to know average patient’s relfex
    3. Observe Quadriceps muscles contraction(knee extension)
    4. Test other side as well as
  2. Interpretation : Absence, hyporeflex, normal, hypereflex, bilaterally or unilaterally
  3. Useful Video : Lower Limb Reflex Tests | Clinical Physio – YouTube
5. DTR Mdeial Hamstring(L5)
  1. Procedure
    1. Relax leg
    2. Place thumb on distal semitendinous which is posterior knee, then give three reflex to know average patient’s relfex
    3. Observe hamstrings muscles contraction( knee flexion)
    4. Test other side as well as
  2. Interpretation : Absence, hyporeflex, normal, hypereflex, bilaterally or unilaterally
  3. Useful Video : Hamstring reflex – YouTube
6. DTR Achillies=Ankle reflex = Ankle jerk (S1-S2)
  1. Procedure
    1. Relax leg
    2. Place thumb on the Achillies which is between lateral malleous and medial malleous, then give three reflex to know average patient’s relfex
    3. Observe or palpate contraction of the gastrocnemius and soleus(plantarflexion of ankle)
    4. Test other side
  2. Interpretation : Absence, hyporeflex, normal, hypereflex, bilaterally or unilaterally
  3. Useful Video : Lower Limb Reflex Tests | Clinical Physio – YouTube

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