Directed Neurological Examination

In assessing hypokinesia or hyperkinesia, the directed neurological examination aims to categorize the disorder phenomenologically and to detect the activities that maximize abnormal movements. With this information and support from appropriate diagnostic tests (see Part II), the diagnosis of a movement disorder by specific name and etiology can be determined (see Chapter.34 ). In assessing hypokinesia or hyperkinesia, three primary testing paradigms are used: (1) rest, (2) maintenance of a static posture, and (3) volitional activity. Tone is determined at rest, with attention to changes with posture or activity. A final task that is requisite to any evaluation of hypokinesia or hyperkinesia is walking, because this activity integrates several functions, and specific patterns of gait dysfunction are particularly helpful in characterizing a movement disorder.

Patient at Rest. The patient needs to be observed sitting quietly in a comfortable position, and occasionally, it is necessary to observe the patient lying supine. In assessing the rest position, be certain that the extremities are fully relaxed and supported so that the patients are not holding a posture. When engaged in conversation, most individuals have spontaneous gestures of their hands, often cross one leg over the other, and smile when chatting. In hypokinetic disorders, there is a paucity of movement,

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