神经外科下肢查体


    0 absent
    1 altered
    2 normal
    NT not testable
    0 absent
    1 altered
    2 normal
    NT not testable
    C2
    C3
    C4
    S3
    S2
    L5
    S1
    L5
    L4
    L3
    L2
    L1
    T12
    T11
    T10
    T9
    T8
    T7
    T6
    T5
    T4
    T3
    C4
    C3
    C2
    T2
    C5
    T1
    C6
    Palm
    Dorsum
    C6
    C8
    C7
    0 absent
    1 altered
    2 normal
    NT not testable
    Dorsum
    C6
    C8
    C7
    S45
    • Key Sensory
    Points
    0 absent
    1 altered
    2 normal
    NT not testable
    0 absent
    1 altered
    2 normal
    NT not testable
    C2
    C3
    C4
    S3
    S2
    L5
    S1
    L5
    L4
    L3
    L2
    L1
    T12
    T11
    T10
    T9
    T8
    T7
    T6
    T5
    T4
    T3
    C4
    C3
    C2
    T2
    C5
    T1
    C6
    Palm
    Dorsum
    C6
    C8
    C7
    0 absent
    1 altered
    2 normal
    NT not testable
    Dorsum
    C6
    C8
    C7
    S45
    • Key Sensory
    Points
    C5
    C6
    C7
    C8
    T1
    L2
    L3
    L4
    L5
    S1
    MOTOR
    KEY MUSCLES
    SENSORY
    KEY SENSORY POINTS
    Pin Prick (PPR)Light Touch (LTR)
    (VAC) Voluntary anal contraction
    (YesNo)
    Comments (Nonkey Muscle Reason for NT Pain)
    NEUROLOGICAL
    LEVELS
    Steps 15 for classifcation
    as on reverse
    1 SENSORY
    2 MOTOR
    R L
    3 NEUROLOGICAL
    LEVEL OF INJURY
    (NLI)
    4 COMPLETE OR INCOMPLETE
    Incomplete Any sensory or motor function in S45
    5 ASIA IMPAIRMENT SCALE (AIS)
    (In complete injuries only)
    ZONE OF PARTIAL
    PRESERVATION
    Most caudal level with any innervation
    SENSORY
    MOTOR
    R L
    REV 0213This form may be copied freely but should not be altered without permission from the American Spinal Injury Association
    RIGHT
    UER
    (Upper Extremity Right)
    T2
    T3
    T4
    T5
    T6
    T7
    T8
    T9
    T10
    T11
    T12
    L1
    LER
    (Lower Extremity Right)
    S2
    S3
    S45
    MOTOR
    KEY MUSCLES
    SENSORY
    KEY SENSORY POINTS
    Pin Prick (PPL)Light Touch (LTL) LEFT
    UEL
    (Upper Extremity Left)
    T2
    T3
    T4
    T5
    T6
    T7
    T8
    T9
    T10
    T11
    T12
    L1
    LEL
    (Lower Extremity Left)
    S2
    S3
    S45
    Elbow fexors
    Wrist extensors
    Elbow extensors
    Finger fexors
    Finger abductors (little fnger)

    Hip fexors
    Knee extensors
    Ankle dorsifexors
    Long toe extensors
    Ankle plantar fexors
    C2
    C3
    C4
    C2
    C3
    C4
    (DAP) Deep anal pressure
    (YesNo)
    UER + UEL UEMS TOTAL
    (25) (25) (50)
    MOTOR SUBSCORES
    MAX
    LER + LEL LEMS TOTAL
    (25) (25) (50)MAX
    LTR + LTL LT TOTAL
    (56) (56) (112)MAX
    SENSORY SUBSCORES
    MAX
    PPR + PPL PP TOTAL
    (56) (56) (112)
    4 active movement against some resistance
    5 active movement against full resistance
    5* normal corrected for paindisuse
    NT not testable
    MOTOR
    (SCORING ON REVERSE SIDE)
    0 total paralysis
    1 palpable or visible contraction
    2 active movement gravity eliminated
    3 active movement against gravity
    Elbow fexors
    Wrist extensors
    Elbow extensors
    Finger fexors
    Finger abductors (little fnger)

    Hip fexors
    Knee extensors
    Ankle dorsifexors
    Long toe extensors
    Ankle plantar fexors
    RIGHT TOTALS
    (MAXIMUM)
    C5
    C6
    C7
    C8
    T1
    L2
    L3
    L4
    L5
    S1
    LEFT TOTALS
    (MAXIMUM)
    SENSORY
    (SCORING ON REVERSE SIDE)
    0 absent
    1 altered
    2 normal
    NT not testable
    INTERNATIONAL STANDARDS FOR NEUROLOGICAL
    CLASSIFICATION OF SPINAL CORD INJURY
    (ISNCSCI)
    Patient Name_____________________________________ DateTime of Exam _____________________________
    Examiner Name ___________________________________ Signature _____________________________________

    0 absent
    1 altered
    2 normal
    NT not testable
    0 absent
    1 altered
    2 normal
    NT not testable
    C2
    C3
    C4
    S3
    S2
    L5
    S1
    L5
    L4
    L3
    L2
    L1
    T12
    T11
    T10
    T9
    T8
    T7
    T6
    T5
    T4
    T3
    C4
    C3
    C2
    T2
    C5
    T1
    C6
    Palm
    Dorsum
    C6
    C8
    C7
    0 absent
    1 altered
    2 normal
    NT not testable
    Dorsum
    C6
    C8
    C7
    S45
    • Key Sensory
    Points
    C5
    C6
    C7
    C8
    T1
    L2
    L3
    L4
    L5
    S1
    MOTOR
    KEY MUSCLES
    SENSORY
    KEY SENSORY POINTS
    Pin Prick (PPR)Light Touch (LTR)
    (VAC) Voluntary anal contraction
    (YesNo)
    Comments (Nonkey Muscle Reason for NT Pain)
    NEUROLOGICAL
    LEVELS
    Steps 15 for classifcation
    as on reverse
    1 SENSORY
    2 MOTOR
    R L
    3 NEUROLOGICAL
    LEVEL OF INJURY
    (NLI)
    4 COMPLETE OR INCOMPLETE
    Incomplete Any sensory or motor function in S45
    5 ASIA IMPAIRMENT SCALE (AIS)
    (In complete injuries only)
    ZONE OF PARTIAL
    PRESERVATION
    Most caudal level with any innervation
    SENSORY
    MOTOR
    R L
    REV 0213This form may be copied freely but should not be altered without permission from the American Spinal Injury Association
    RIGHT
    UER
    (Upper Extremity Right)
    T2
    T3
    T4
    T5
    T6
    T7
    T8
    T9
    T10
    T11
    T12
    L1
    LER
    (Lower Extremity Right)
    S2
    S3
    S45
    MOTOR
    KEY MUSCLES
    SENSORY
    KEY SENSORY POINTS
    Pin Prick (PPL)Light Touch (LTL) LEFT
    UEL
    (Upper Extremity Left)
    T2
    T3
    T4
    T5
    T6
    T7
    T8
    T9
    T10
    T11
    T12
    L1
    LEL
    (Lower Extremity Left)
    S2
    S3
    S45
    Elbow fexors
    Wrist extensors
    Elbow extensors
    Finger fexors
    Finger abductors (little fnger)

    Hip fexors
    Knee extensors
    Ankle dorsifexors
    Long toe extensors
    Ankle plantar fexors
    C2
    C3
    C4
    C2
    C3
    C4
    (DAP) Deep anal pressure
    (YesNo)
    UER + UEL UEMS TOTAL
    (25) (25) (50)
    MOTOR SUBSCORES
    MAX
    LER + LEL LEMS TOTAL
    (25) (25) (50)MAX
    LTR + LTL LT TOTAL
    (56) (56) (112)MAX
    SENSORY SUBSCORES
    MAX
    PPR + PPL PP TOTAL
    (56) (56) (112)
    4 active movement against some resistance
    5 active movement against full resistance
    5* normal corrected for paindisuse
    NT not testable
    MOTOR
    (SCORING ON REVERSE SIDE)
    0 total paralysis
    1 palpable or visible contraction
    2 active movement gravity eliminated
    3 active movement against gravity
    Elbow fexors
    Wrist extensors
    Elbow extensors
    Finger fexors
    Finger abductors (little fnger)

    Hip fexors
    Knee extensors
    Ankle dorsifexors
    Long toe extensors
    Ankle plantar fexors
    RIGHT TOTALS
    (MAXIMUM)
    C5
    C6
    C7
    C8
    T1
    L2
    L3
    L4
    L5
    S1
    LEFT TOTALS
    (MAXIMUM)
    SENSORY
    (SCORING ON REVERSE SIDE)
    0 absent
    1 altered
    2 normal
    NT not testable
    INTERNATIONAL STANDARDS FOR NEUROLOGICAL
    CLASSIFICATION OF SPINAL CORD INJURY
    (ISNCSCI)
    Patient Name_____________________________________ DateTime of Exam _____________________________
    Examiner Name ___________________________________ Signature _____________________________________

    C5
    C6
    C7
    C8
    T1
    L2
    L3
    L4
    L5
    S1
    MOTOR
    KEY MUSCLES
    SENSORY
    KEY SENSORY POINTS
    Pin Prick (PPR)Light Touch (LTR)
    (VAC) Voluntary Anal Contraction
    (YesNo)
    Comments (Nonkey Muscle Reason for NT Pain)
    NEUROLOGICAL
    LEVELS
    Steps 15 for classification
    as on reverse
    1 SENSORY
    2 MOTOR
    R L
    3 NEUROLOGICAL
    LEVEL OF INJURY
    (NLI)
    4 COMPLETE OR INCOMPLETE
    Incomplete Any sensory or motor function in S45
    5 ASIA IMPAIRMENT SCALE (AIS)
    (In complete injuries only)
    ZONE OF PARTIAL
    PRESERVATION
    Most caudal level with any innervation
    SENSORY
    MOTOR
    R L
    REV 0415This form may be copied freely but should not be altered without permission from the American Spinal Injury Association
    RIGHT
    UER
    (Upper Extremity Right)
    T2
    T3
    T4
    T5
    T6
    T7
    T8
    T9
    T10
    T11
    T12
    L1
    LER
    (Lower Extremity Right)
    S2
    S3
    S45
    MOTOR
    KEY MUSCLES
    SENSORY
    KEY SENSORY POINTS
    Pin Prick (PPL)Light Touch (LTL) LEFT
    UEL
    (Upper Extremity Left)
    T2
    T3
    T4
    T5
    T6
    T7
    T8
    T9
    T10
    T11
    T12
    L1
    LEL
    (Lower Extremity Left)
    S2
    S3
    S45
    Elbow flexors
    Wrist extensors
    Elbow extensors
    Finger flexors
    Finger abductors (little finger)

    Hip flexors
    Knee extensors
    Ankle dorsiflexors
    Long toe extensors
    Ankle plantar flexors
    C2
    C3
    C4
    C2
    C3
    C4
    (DAP) Deep Anal Pressure
    (YesNo)
    UER +UEL UEMS TOTAL
    (25) (25) (50)
    MOTOR SUBSCORES
    MAX
    LER + LEL LEMS TOTAL
    (25) (25) (50)MAX
    LTR + LTL LT TOTAL
    (56) (56) (112)MAX
    SENSORY SUBSCORES
    MAX
    PPR + PPL PP TOTAL
    (56) (56) (112)
    4 active movement against some resistance
    5 active movement against full resistance
    5* normal corrected for paindisuse
    NT not testable
    MOTOR
    (SCORING ON REVERSE SIDE)
    0 total paralysis
    1 palpable or visible contraction
    2 active movement gravity eliminated
    3 active movement against gravity
    RIGHT TOTALS
    (MAXIMUM)
    C5
    C6
    C7
    C8
    T1
    L2
    L3
    L4
    L5
    S1
    LEFT TOTALS
    (MAXIMUM)
    SENSORY
    (SCORING ON REVERSE SIDE)
    0 absent
    1 altered
    2 normal
    NT not testable
    INTERNATIONAL STANDARDS FOR NEUROLOGICAL
    CLASSIFICATION OF SPINAL CORD INJURY
    (ISNCSCI)
    Patient Name_____________________________________ DateTime of Exam _____________________________
    Examiner Name ___________________________________ Signature _____________________________________



    ASIA 评分感觉运动面检查
    dwr 20150622 首医科学宣武医院神外科脊柱组
    2
    关键感觉点 5
    运动系统检查 7
    C5 肘屈肌群(肱二头肌) 7
    C6 腕伸肌群(桡侧腕长伸肌桡侧腕短伸肌)
    10
    C7 肘伸肌群 (肱三头肌) 13
    C8 指长屈肌群(指深屈肌) 16
    T1 指收肌(指收) 19
    L2 屈髋肌群(髂腰肌) 22
    L3 伸膝肌群 (股四头肌) 25
    L4 踝关节背伸肌群(胫前肌) 28
    L5 趾长伸肌 (拇长伸肌) 31
    S1 踝跖屈肌群(腓肠肌目鱼肌) 35 首医科学宣武医院神外科脊柱组
    3
    首医科学宣武医院神外科脊柱组
    4


    首医科学宣武医院神外科脊柱组
    5
    关键感觉点

    C2:枕骨隆突外少 1cm者定
    位耳 3cm
    C3:锁骨窝锁骨中线
    C4:肩锁关节方
    C5:桡侧肘窝
    C6:拇指端指关节背侧
    C7:中指端指关节背

    C8:指端指关节背

    首医科学宣武医院神外科脊柱组
    6
    T1:尺侧肘窝肱骨髁附
    T2:腋窝顶端
    T3:锁骨中线第三肋间
    T4:锁骨中线第四肋间乳头面
    T5:锁骨中线第五肋间乳头剑突间
    T6:锁骨中线剑突面
    T7:锁骨中线剑突脐 14 面
    T8:锁骨中线剑突脐中央面
    T9:锁骨中线剑突脐 34 面
    T10:锁骨中线脐面
    T11:锁 骨 中 线 脐 腹 股 沟 韧 带 中 央

    T12:锁骨中线腹股沟韧带中点

    L1:T12 L2 关键感觉点中点
    L2:腿前侧腹股沟韧带中点
    股骨侧髁假想连线中点
    L3:膝股骨侧髁
    L4:踝
    L5:足背侧第三跖趾关节
    首医科学宣武医院神外科脊柱组
    7
    S1:骨外侧面
    S2:腘窝中点
    S3:坐骨结节
    S45:肛周 1 厘米区域
    皮肤黏膜连接处外侧



    动系统检查
    C5 肘屈肌群(肱二头肌)
    3 级
    • 患者体位:肩部中立旋转位中立屈伸位收
    肘部完全伸直掌心腕关节中立屈伸位 首医科学宣武医院神外科脊柱组
    8
    • 检查者体位:握住
    患者腕部
    • 指令:弯曲肘关
    节试着您手
    摸您鼻子
    • 动作:患者试图弯
    曲肘关节活动范围

    45 级
    • 患者体位:肩关
    节中立旋转位
    中立屈伸位
    收肘关节弯曲
    90 度掌心
    • 检查者体位:手前方固定患者肩部握住
    腕关节掌侧力伸肘方拉力
    • 指令:保持住您胳膊位置拉动
    • 动作:患者抗检查者拉力试图保持肘关节
    90 度弯曲
    June 2008 page 1
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    C5 Elbow Flexors | Biceps Brachii Brachialis
    Grade 3
    Patient Position The shoulder is in neutral rotation
    neutral flexionextension and adducted The elbow is fully
    extended with the forearm in full supination The wrist is in
    neutral flexionextension
    Examiner Position Support the wrist
    Instructions to Patient Bend your elbow and try to reach your
    hand to your nose
    Action The patient attempts to move through the full range of
    motion in elbow flexion
    Grades 4 & 5
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adducted The elbow is flexed to 90° and
    the forearm is fully supinated
    Examiner Position Place a stabilizing hand on the anterior
    shoulder Grasp the volar aspect of the wrist and exert a pulling
    force in the direction of elbow extension
    Instructions to Patient Hold your arm Don’t let me move it
    Action The patient resists the examiner’s pull and attempts to
    maintain the elbow flexed at 90°
    Grade 2
    Patient Position The shoulder is in internal rotation and
    adducted with the forearm positioned above the abdomen just
    below the umbilicus The elbow is in 30° of flexion The forearm
    and wrist are in neutral pronationsupination Sufficient flexion of
    the shoulder must be permitted to allow the forearm to
    comfortably move over the abdomen
    Examiner Position Support the arm
    Instructions to Patient Bend your elbow and try to bring your
    hand to your nose
    Action The patient attempts to move the elbow through a full
    range of motion in elbow flexion
    June 2008 page 1
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    C5 Elbow Flexors | Biceps Brachii Brachialis
    Grade 3
    Patient Position The shoulder is in neutral rotation
    neutral flexionextension and adducted The elbow is fully
    extended with the forearm in full supination The wrist is in
    neutral flexionextension
    Examiner Position Support the wrist
    Instructions to Patient Bend your elbow and try to reach your
    hand to your nose
    Action The patient attempts to move through the full range of
    motion in elbow flexion
    Grades 4 & 5
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adducted The elbow is flexed to 90° and
    the forearm is fully supinated
    Examiner Position Place a stabilizing hand on the anterior
    shoulder Grasp the volar aspect of the wrist and exert a pulling
    force in the direction of elbow extension
    Instructions to Patient Hold your arm Don’t let me move it
    Action The patient resists the examiner’s pull and attempts to
    maintain the elbow flexed at 90°
    Grade 2
    Patient Position The shoulder is in internal rotation and
    adducted with the forearm positioned above the abdomen just
    below the umbilicus The elbow is in 30° of flexion The forearm
    and wrist are in neutral pronationsupination Sufficient flexion of
    the shoulder must be permitted to allow the forearm to
    comfortably move over the abdomen
    Examiner Position Support the arm
    Instructions to Patient Bend your elbow and try to bring your
    hand to your nose
    Action The patient attempts to move the elbow through a full
    range of motion in elbow flexion首医科学宣武医院神外科脊柱组
    9

    2 级
    • 患者体位:肩关
    节旋收
    前臂放腹部
    脐方肘部呈
    30 度弯曲前
    臂腕关节中
    立旋转位肩关
    节应足够弯曲前臂腹部舒适活动
    • 检查者体位:扶住患者手臂
    • 指令:弯曲您肘部试着您手模您鼻

    • 动作:患者试图活动肘部屈肘角度

    01 级:
    • 患者体位: 2
    June 2008 page 1
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    C5 Elbow Flexors | Biceps Brachii Brachialis
    Grade 3
    Patient Position The shoulder is in neutral rotation
    neutral flexionextension and adducted The elbow is fully
    extended with the forearm in full supination The wrist is in
    neutral flexionextension
    Examiner Position Support the wrist
    Instructions to Patient Bend your elbow and try to reach your
    hand to your nose
    Action The patient attempts to move through the full range of
    motion in elbow flexion
    Grades 4 & 5
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adducted The elbow is flexed to 90° and
    the forearm is fully supinated
    Examiner Position Place a stabilizing hand on the anterior
    shoulder Grasp the volar aspect of the wrist and exert a pulling
    force in the direction of elbow extension
    Instructions to Patient Hold your arm Don’t let me move it
    Action The patient resists the examiner’s pull and attempts to
    maintain the elbow flexed at 90°
    Grade 2
    Patient Position The shoulder is in internal rotation and
    adducted with the forearm positioned above the abdomen just
    below the umbilicus The elbow is in 30° of flexion The forearm
    and wrist are in neutral pronationsupination Sufficient flexion of
    the shoulder must be permitted to allow the forearm to
    comfortably move over the abdomen
    Examiner Position Support the arm
    Instructions to Patient Bend your elbow and try to bring your
    hand to your nose
    Action The patient attempts to move the elbow through a full
    range of motion in elbow flexion
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 2
    Grades 0 & 1
    Patient The patient is in the grade 2 position with the shoulder in
    internal rotation and adducted The palm and ventral forearm are
    positioned above the abdomen The elbow is in 30° of flexion
    The forearm and wrist are in neutral pronationsupination
    Sufficient flexion of the shoulder must be permitted to allow the
    forearm to comfortably move over the abdomen
    Examiner Position One hand supports the forearm while the
    other hand palpates the biceps tendon in the cubital fossa The
    belly of the biceps brachii muscle may also be palpated or
    observed for movement
    Instructions to Patient Bend your elbow and try to bring your
    hand to your nose
    Action The patient attempts to move the elbow through a full
    range of motion in elbow flexion
    C 6 Wrist Extensors | Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis
    Grade 3
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adducted The elbow is fully extended the
    forearm is fully pronated and the wrist flexed
    Examiner Position One hand supports the distal forearm to
    allow the wrist to be prepositioned in sufficient flexion for testing
    Instructions to Patient Bend your wrist upwards Lift your
    fingers toward the ceiling
    Action The patient attempts to extend the wrist through a full
    range of motion首医科学宣武医院神外科脊柱组
    10
    级查体体位
    • 检查者体位:手扶住患者手臂手
    肘窝处触肱二头肌肌腱时应触肱二头肌
    肌腹做动作时予观察
    • 指令:弯曲您肘部试着您手模您鼻

    • 动作:患者试图活动肘部

    C6 腕伸肌群(桡侧腕长伸肌桡侧腕
    短伸肌)
    3 级
    • 患者体位:肩
    部中立旋转
    位中立屈伸
    位收肘
    部伸位掌心
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 2
    Grades 0 & 1
    Patient The patient is in the grade 2 position with the shoulder in
    internal rotation and adducted The palm and ventral forearm are
    positioned above the abdomen The elbow is in 30° of flexion
    The forearm and wrist are in neutral pronationsupination
    Sufficient flexion of the shoulder must be permitted to allow the
    forearm to comfortably move over the abdomen
    Examiner Position One hand supports the forearm while the
    other hand palpates the biceps tendon in the cubital fossa The
    belly of the biceps brachii muscle may also be palpated or
    observed for movement
    Instructions to Patient Bend your elbow and try to bring your
    hand to your nose
    Action The patient attempts to move the elbow through a full
    range of motion in elbow flexion
    C 6 Wrist Extensors | Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis
    Grade 3
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adducted The elbow is fully extended the
    forearm is fully pronated and the wrist flexed
    Examiner Position One hand supports the distal forearm to
    allow the wrist to be prepositioned in sufficient flexion for testing
    Instructions to Patient Bend your wrist upwards Lift your
    fingers toward the ceiling
    Action The patient attempts to extend the wrist through a full
    range of motion首医科学宣武医院神外科脊柱组
    11
    腕屈
    • 检查者体位: 手扶住前臂远端腕屈
    检查动作足够活动角度
    • 指令:弯曲您手腕手指指天花板
    • 动作:患者试图伸腕角度

    45 级
    • 患者体位: 3
    级体位腕
    部完全背伸

    • 检查者体位:握
    住前臂远端固定掌部施加压力
    指腕部掌屈尺侧方注意施加腕部力
    应偏尺侧非垂直查肌肉桡
    侧腕伸肌
    • 指令:保持住您手腕位置压
    • 动作:患者抗检查者压力试图保持腕部背
    伸位
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 3
    Grades 4 & 5
    Patient Position Same as grade 3 except the wrist is
    fully extended
    Examiner Position Grasp the distal forearm to stabilize the
    wrist Apply pressure across the metacarpals in a downward
    direction toward flexion and ulnar deviation
    The force applied should be angled toward the ulnar side of the
    wrist rather than directly downward since it is the radial wrist
    extensors that are being tested
    Instructions to Patient Hold your wrist up Don’t let me
    push it down
    Action The patient resists the examiner’s push and attempts to
    maintain the wrist in the fully extended position
    Grades 0 1 & 2
    Patient Position Position the patient with the arm resting on the
    exam table The shoulder is in neutral flexionextension neutral
    rotation and adducted The elbow is fully extended The forearm
    is in neutral pronationsupination and the wrist fully flexed
    The patient may also be positioned with the shoulder in slight
    flexion internal rotation and adducted with the patient’s arm
    above the abdomen The elbow is flexed to 90° and the forearm
    is in full supination The wrist is flexed
    Examiner Position Support the forearm and ask the patient to
    bend the wrist backwards into extension For trace function
    palpate the radial wrist extensors just proximal to the wrist on
    the radial aspect of the distal forearm Observe the muscle belly
    for movement
    Instructions to Patient Bend your wrist backwards
    Action The patient attempts to extend the wrist though a full
    range of motion in wrist extension
    C6 Common Muscle Substitution
    Wrist extension can be mimicked by forearm supination and the use of gravity The examiner needs to make sure the
    forearm is stabilized and is in proper position首医科学宣武医院神外科脊柱组
    12

    012 级
    • 患者体位: 患者手臂放检查桌(床)
    肩部中立屈伸位中立旋转位收肘关节全
    伸前臂中立旋转位腕关节完全掌屈
    肩部微屈旋转收手臂放腹部
    肘关节屈 90 度
    掌心腕

    • 检查者体位:
    扶住前臂求
    患者腕部背
    伸腕关节
    端前臂远端桡
    侧触桡侧腕伸肌患者做动作时观察肌腹活

    • 指令:您手腕背侧弯曲
    • 动作:患者试图背屈腕部活动范围

    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 3
    Grades 4 & 5
    Patient Position Same as grade 3 except the wrist is
    fully extended
    Examiner Position Grasp the distal forearm to stabilize the
    wrist Apply pressure across the metacarpals in a downward
    direction toward flexion and ulnar deviation
    The force applied should be angled toward the ulnar side of the
    wrist rather than directly downward since it is the radial wrist
    extensors that are being tested
    Instructions to Patient Hold your wrist up Don’t let me
    push it down
    Action The patient resists the examiner’s push and attempts to
    maintain the wrist in the fully extended position
    Grades 0 1 & 2
    Patient Position Position the patient with the arm resting on the
    exam table The shoulder is in neutral flexionextension neutral
    rotation and adducted The elbow is fully extended The forearm
    is in neutral pronationsupination and the wrist fully flexed
    The patient may also be positioned with the shoulder in slight
    flexion internal rotation and adducted with the patient’s arm
    above the abdomen The elbow is flexed to 90° and the forearm
    is in full supination The wrist is flexed
    Examiner Position Support the forearm and ask the patient to
    bend the wrist backwards into extension For trace function
    palpate the radial wrist extensors just proximal to the wrist on
    the radial aspect of the distal forearm Observe the muscle belly
    for movement
    Instructions to Patient Bend your wrist backwards
    Action The patient attempts to extend the wrist though a full
    range of motion in wrist extension
    C6 Common Muscle Substitution
    Wrist extension can be mimicked by forearm supination and the use of gravity The examiner needs to make sure the
    forearm is stabilized and is in proper position首医科学宣武医院神外科脊柱组
    13
    C6 肌力误判
    腕伸前臂旋前(利重力)混淆 ( 检 查
    C6 肌力时)检查者需确保前臂稳定合适位


    C7 肘伸肌群 (肱三头肌)
    3 级
    • 患者体位: 肩
    部正中旋转位
    收90 度弯
    曲肘关节全
    屈手掌扶住耳

    • 检查者体位:
    扶住患者臂
    • 指令:伸直您手臂
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 4
    C7 Elbow Extensors | Triceps
    Grade 3
    Patient Position The shoulder is in neutral rotation adducted
    and 90°of flexion The elbow is fully flexed with the palm of the
    hand resting by the ear
    Examiner Position Support the upper arm
    Instructions to Patient Straighten your arm
    Action The patient attempts to move through the full range of
    elbow extension
    Grades 4 & 5
    Patient Position Same as grade 3 except the elbow is in
    45° of flexion
    Examiner Position Support the upper arm Grasp the wrist
    and apply resistance to the distal forearm in the direction of
    elbow flexion
    Instructions to Patient Hold this position Don’t let me bend
    your elbow
    Action The patient resists the examiner’s pressure and attempts
    to maintain the position of the elbow in 45° of flexion
    Grade 2
    Patient Position The shoulder is in internal rotation and
    adducted with the forearm positioned above the abdomen The
    forearm is in neutral pronationsupination The elbow is fully
    flexed When checking Grade 2 sufficient flexion of the shoulder
    must be permitted to allow the forearm to clear and move over
    the chest and abdomen
    Examiner Position Support the patient’s arm
    Instructions to Patient Straighten your arm
    Action The patient attempts to move through the full range of
    elbow extension首医科学宣武医院神外科脊柱组
    14
    • 动作:患者试图肘部伸直活动范围

    45 级
    • 患者体位:
    3 级查
    体肘
    关节屈 45

    • 检查者体位: 扶住臂握住患者手腕前
    臂远端施加指屈肘方力
    • 指令:保持住位置弯曲您肘部
    • 动作:患者抗检查者力量试图保持肘屈 45
    度姿势

    2 级
    • 患者体位:肩
    部重力旋转
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 4
    C7 Elbow Extensors | Triceps
    Grade 3
    Patient Position The shoulder is in neutral rotation adducted
    and 90°of flexion The elbow is fully flexed with the palm of the
    hand resting by the ear
    Examiner Position Support the upper arm
    Instructions to Patient Straighten your arm
    Action The patient attempts to move through the full range of
    elbow extension
    Grades 4 & 5
    Patient Position Same as grade 3 except the elbow is in
    45° of flexion
    Examiner Position Support the upper arm Grasp the wrist
    and apply resistance to the distal forearm in the direction of
    elbow flexion
    Instructions to Patient Hold this position Don’t let me bend
    your elbow
    Action The patient resists the examiner’s pressure and attempts
    to maintain the position of the elbow in 45° of flexion
    Grade 2
    Patient Position The shoulder is in internal rotation and
    adducted with the forearm positioned above the abdomen The
    forearm is in neutral pronationsupination The elbow is fully
    flexed When checking Grade 2 sufficient flexion of the shoulder
    must be permitted to allow the forearm to clear and move over
    the chest and abdomen
    Examiner Position Support the patient’s arm
    Instructions to Patient Straighten your arm
    Action The patient attempts to move through the full range of
    elbow extension
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 4
    C7 Elbow Extensors | Triceps
    Grade 3
    Patient Position The shoulder is in neutral rotation adducted
    and 90°of flexion The elbow is fully flexed with the palm of the
    hand resting by the ear
    Examiner Position Support the upper arm
    Instructions to Patient Straighten your arm
    Action The patient attempts to move through the full range of
    elbow extension
    Grades 4 & 5
    Patient Position Same as grade 3 except the elbow is in
    45° of flexion
    Examiner Position Support the upper arm Grasp the wrist
    and apply resistance to the distal forearm in the direction of
    elbow flexion
    Instructions to Patient Hold this position Don’t let me bend
    your elbow
    Action The patient resists the examiner’s pressure and attempts
    to maintain the position of the elbow in 45° of flexion
    Grade 2
    Patient Position The shoulder is in internal rotation and
    adducted with the forearm positioned above the abdomen The
    forearm is in neutral pronationsupination The elbow is fully
    flexed When checking Grade 2 sufficient flexion of the shoulder
    must be permitted to allow the forearm to clear and move over
    the chest and abdomen
    Examiner Position Support the patient’s arm
    Instructions to Patient Straighten your arm
    Action The patient attempts to move through the full range of
    elbow extension首医科学宣武医院神外科脊柱组
    15
    位收前臂放腹部前臂位中立旋转位
    肘关节全屈肩关节应微屈保证前臂
    胸部腹部轻松移动
    • 检查者体位: 扶住患者手臂
    • 指令:伸直您手臂
    • 动作:患者试图肘部伸直活动范围

    01 级
    • 患者体位: 2
    级查体体位
    类似肩部
    旋收前臂
    放腹部前臂
    中立旋转位
    肘关节 30 度

    • 检查者体位: 扶住患者手臂鹰嘴部触肱
    三头肌远端肱三头肌肌腹应时触患
    者完成指令动作时观察
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 5
    Grades 0 & 1
    Patient Position Maintain the grade 2 position with the shoulder
    in internal rotation and adduction and the forearm positioned
    above the abdomen The forearm is in neutral
    pronationsupination and the elbow is in 30° of flexion
    Examiner Position Support the arm For trace function
    palpate the distal triceps at its insertion on the olecranon
    The belly of the triceps muscle may also be palpated and
    observed for movement
    Instructions to Patient Straighten your arm
    Action The patient attempts to fully extend the elbow
    C7 Common Muscle Substitution
    Elbow extension can be mimicked by externally rotating the shoulder by quickly flexing the elbow and then relaxing
    and with spasticity of the triceps These substitutions can be minimized by maintaining the correct position for testing
    correct instructions to the patient and avoiding elbow flexion Palpation of the triceps should be done to confirm the
    patient is using the correct muscle for the test
    C8 Long Finger Flexors | Flexor Digitorum Profundus
    Grade 3
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adduction The elbow is fully extended
    with the forearm fully supinated The wrist is in neutral flexion
    extension The metacarpal phalangeal (MCP) and proximal
    interphalangeal joints (PIP) are stabilized in extension
    Examiner Position Using two hands grasp the patient’s hand
    and stabilize the wrist In neutral Secure the PIP and MCP joints
    in extension with both hands while isolating the middle finger for
    testing Stabilize the volar aspect of the 3rd middle phalanx with
    the thumb of the opposite hand
    As an alternate method 1 hand may be used to stabilize instead
    of 2 The PIP and MCP joints are stabilized as previously
    described with the thumb of the stabilizing hand now securing
    the middle phalanx
    Instructions to Patient Bend the tip of your middle finger
    Action The patient attempts to flex the distal interphalangeal
    (DIP) joint through the full range of motion in flexion首医科学宣武医院神外科脊柱组
    16
    • 指令:伸直您手臂
    • 动作:患者试图完全伸直肘部

    C7 肌力误判
    肘伸动作肩关节外旋快速屈肘放松肱
    三头肌强直混淆肌力误判作通保持
    正确检查姿势准确发出指令避免肘屈消
    触肱三头肌目确定患者做动作时
    检查肌肉

    C8 指长屈肌群(指深屈肌)
    3 级
    • 患者体位: 肩
    部中立旋转位
    中立屈伸位
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 5
    Grades 0 & 1
    Patient Position Maintain the grade 2 position with the shoulder
    in internal rotation and adduction and the forearm positioned
    above the abdomen The forearm is in neutral
    pronationsupination and the elbow is in 30° of flexion
    Examiner Position Support the arm For trace function
    palpate the distal triceps at its insertion on the olecranon
    The belly of the triceps muscle may also be palpated and
    observed for movement
    Instructions to Patient Straighten your arm
    Action The patient attempts to fully extend the elbow
    C7 Common Muscle Substitution
    Elbow extension can be mimicked by externally rotating the shoulder by quickly flexing the elbow and then relaxing
    and with spasticity of the triceps These substitutions can be minimized by maintaining the correct position for testing
    correct instructions to the patient and avoiding elbow flexion Palpation of the triceps should be done to confirm the
    patient is using the correct muscle for the test
    C8 Long Finger Flexors | Flexor Digitorum Profundus
    Grade 3
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adduction The elbow is fully extended
    with the forearm fully supinated The wrist is in neutral flexion
    extension The metacarpal phalangeal (MCP) and proximal
    interphalangeal joints (PIP) are stabilized in extension
    Examiner Position Using two hands grasp the patient’s hand
    and stabilize the wrist In neutral Secure the PIP and MCP joints
    in extension with both hands while isolating the middle finger for
    testing Stabilize the volar aspect of the 3rd middle phalanx with
    the thumb of the opposite hand
    As an alternate method 1 hand may be used to stabilize instead
    of 2 The PIP and MCP joints are stabilized as previously
    described with the thumb of the stabilizing hand now securing
    the middle phalanx
    Instructions to Patient Bend the tip of your middle finger
    Action The patient attempts to flex the distal interphalangeal
    (DIP) joint through the full range of motion in flexion首医科学宣武医院神外科脊柱组
    17
    收肘关节完全伸直掌心腕部中立屈伸
    位掌指骨(MCP)端指间关节(PIP)固
    定伸位
    • 检查者体位: 两手握住患者手腕部
    固定中立位双手固定 PIP MCP 关节
    伸直位中指手指分开备查侧手
    拇指掌侧固定第三中节指骨代方法
    手固定PIP MCP关节前述固定
    固定手拇指压住第三中节指骨
    • 指令:请弯曲您中指指尖
    • 动作:患者试图弯曲中指远端指(DIP)关节
    范围

    45 级
    • 患者体位: 3 级肌力检查类似远端指
    (DIP)关 节 完 全
    弯曲
    • 检查者体位: 固
    定住腕关节
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 6
    Grades 4 & 5
    Patient Position The same as grade 3 except the DIP joint is
    fully flexed
    Examiner Position Stabilize the wrist MCP and PIP joints as in
    grade 3 Apply pressure with the tip of the finger or thumb
    against the distal phalanx of the patient’s middle finger
    Instructions to Patient Hold the tip of your finger in this bent
    position Don’t let me move it
    Action The patient attempts to maintain the fully flexed position
    of the DIP joint and resist the pressure applied by the examiner
    in the direction of finger extension
    Grades 0 1 & 2
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adduction The elbow is fully extended
    The forearm is in neutral pronationsupination and the wrist in
    neutral flexionextension The MCP and PIP joints are stabilized
    in extension
    Examiner Position Stabilize the wrist in neutral and the MCP
    and PIP joints in extension For trace function palpate the
    tendons of the long finger flexors or observe the muscle belly for
    movement
    Instructions to Patient Bend the tip of your middle finger
    Action The patient attempts to flex the distal interphalangeal
    (DIP) joint through the full range of motion in flexion
    C8 Common Muscle Substitution
    When testing grades 1 through 3 the wrist must be carefully stabilized Involuntary movement of the distal phalanx
    can occur in the presence of active wrist extension This tenodesis movement could be misinterpreted as voluntary
    contraction of the long finger flexors
    While testing grades 4 and 5 the proximal phalanges must be well stabilized This will avoid misinterpretation of
    distal phalanx movement caused by contraction of the hand intrinsics or the flexor digitorum superficialis首医科学宣武医院神外科脊柱组
    18
    MCP PIP 关节 3 级肌力查体相似指尖
    拇指患者中指远端指节施加压力
    • 指令:保持您指尖弯曲扳动
    • 动作:患者试图保持 DIP 关节完全弯曲抗检
    查者施加指背伸压力

    012 级
    • 患者体位: 肩
    关节中立旋
    转位中立屈伸
    位收肘关节完全伸直前臂中立旋转位
    腕关节中立屈伸位MCP PIP 关节固定伸

    • 检查者体位:固定腕关节中立位MCP PIP
    关节伸位触指长屈肌肌腱观察指令动
    作时肌腹活动
    • 指令:弯曲您中指尖
    • 动作:患者试图弯曲远端指节(DIP)活
    动范围(掌屈)
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 6
    Grades 4 & 5
    Patient Position The same as grade 3 except the DIP joint is
    fully flexed
    Examiner Position Stabilize the wrist MCP and PIP joints as in
    grade 3 Apply pressure with the tip of the finger or thumb
    against the distal phalanx of the patient’s middle finger
    Instructions to Patient Hold the tip of your finger in this bent
    position Don’t let me move it
    Action The patient attempts to maintain the fully flexed position
    of the DIP joint and resist the pressure applied by the examiner
    in the direction of finger extension
    Grades 0 1 & 2
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adduction The elbow is fully extended
    The forearm is in neutral pronationsupination and the wrist in
    neutral flexionextension The MCP and PIP joints are stabilized
    in extension
    Examiner Position Stabilize the wrist in neutral and the MCP
    and PIP joints in extension For trace function palpate the
    tendons of the long finger flexors or observe the muscle belly for
    movement
    Instructions to Patient Bend the tip of your middle finger
    Action The patient attempts to flex the distal interphalangeal
    (DIP) joint through the full range of motion in flexion
    C8 Common Muscle Substitution
    When testing grades 1 through 3 the wrist must be carefully stabilized Involuntary movement of the distal phalanx
    can occur in the presence of active wrist extension This tenodesis movement could be misinterpreted as voluntary
    contraction of the long finger flexors
    While testing grades 4 and 5 the proximal phalanges must be well stabilized This will avoid misinterpretation of
    distal phalanx movement caused by contraction of the hand intrinsics or the flexor digitorum superficialis首医科学宣武医院神外科脊柱组
    19

    C8 肌力误判
    检查 13 级肌力时腕部必须严格制动腕部背
    伸时远端指关节活动种肌
    腱活动误作指长屈肌收缩
    检查 45 级肌力时端指关节必须严格制动
    会避免手固肌指浅屈肌收缩引起远指
    活动引起误判

    T1 指收肌(指收)
    3 级
    • 患者体位: 肩
    关节旋收
    15 度屈肘关
    节 90 度屈掌
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 7
    T1 Small Finger Abductor | Abductor Digiti Minimi
    Grade 3
    Patient Position The shoulder is in internal rotation adducted
    and at 15° flexion The elbow is at 90° flexion the forearm is
    pronated and the wrist is in neutral flexionextension
    Examiner Position Support the patient’s hand taking
    care to assure that the MCP joints are stabilized to
    prevent hyperextension
    Instructions to Patient Move your little finger away from your
    ring finger
    Action The patient attempts to move the little finger through the
    full range of motion in abduction
    Grades 4 & 5
    Patient Position Same as grade 3 except the little finger
    is fully abducted
    Examiner Position Support the patient’s hand taking care to
    assure that the MCP joints are stabilized to prevent
    hyperextension Use the index finger to apply pressure against
    the side of the patient’s distal phalanx
    Instructions to Patient Hold your little finger away from your
    ring finger Don’t let me push it in
    Action The examiner exerts a pushing force against the side of
    the distal phalanx and the patient attempts to resist the
    examiner’s force and keep the little finger fully abducted首医科学宣武医院神外科脊柱组
    20
    心手腕中立屈伸位
    • 检查者体位: 扶住患者手注意固定 MCP 关
    节防止伸
    • 指令:请指外展名指分开
    • 动作:患者试图指外展范围

    45 级
    • 患者体位:
    3 级肌力检查
    指完
    全外展
    • 检查者体位: 扶住患者手注意保持 MCP 关
    节固定防止伸示指患者远端指节外侧
    加压
    • 指令:保持您指名指分开
    压回
    • 动作:检查者远端指节外侧加压患者
    抗检查者力量保持指完全外展

    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 7
    T1 Small Finger Abductor | Abductor Digiti Minimi
    Grade 3
    Patient Position The shoulder is in internal rotation adducted
    and at 15° flexion The elbow is at 90° flexion the forearm is
    pronated and the wrist is in neutral flexionextension
    Examiner Position Support the patient’s hand taking
    care to assure that the MCP joints are stabilized to
    prevent hyperextension
    Instructions to Patient Move your little finger away from your
    ring finger
    Action The patient attempts to move the little finger through the
    full range of motion in abduction
    Grades 4 & 5
    Patient Position Same as grade 3 except the little finger
    is fully abducted
    Examiner Position Support the patient’s hand taking care to
    assure that the MCP joints are stabilized to prevent
    hyperextension Use the index finger to apply pressure against
    the side of the patient’s distal phalanx
    Instructions to Patient Hold your little finger away from your
    ring finger Don’t let me push it in
    Action The examiner exerts a pushing force against the side of
    the distal phalanx and the patient attempts to resist the
    examiner’s force and keep the little finger fully abducted首医科学宣武医院神外科脊柱组
    21
    012 级
    • 患者体位: 肩关
    节中立旋转位中
    立屈伸位收
    肘关节全伸前臂
    完全掌心腕
    关节中立屈伸位MCP 关节固定供代体
    位肩关节旋收中立屈伸位肘关节屈
    90 度前臂腕关节中立屈伸位MCP 关节固

    • 检查者体位: 固定腕关节背侧轻压患者手背
    注意 MCP 关节固定防度背伸触指展肌
    肌腱观察肌腹活动
    • 指令:您指名指分开
    • 动作:患者尝试指外展范围

    T1 肌力误判
    指伸第五指外展混淆合适位置固定
    减少类误判

    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 8
    Grades 0 1 & 2
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adducted The elbow is in full extension
    The forearm is in full pronation and the wrist in neutral flexion
    extension The MCP joint is stabilized
    An alternate position is with the shoulder in internal rotation
    adducted and neutral flexionextension The elbow is in 90° of
    flexion the forearm and wrist are in neutral flexion extension
    and the MCP joint is stabilized
    Examiner Position Stabilize the dorsal wrist and hand by
    pressing down lightly on the back of the hand Be sure that the
    MCP joints are stabilized to prevent hyperextension Palpate the
    abductor digiti minimi muscle and observe the muscle belly
    for movement
    Instructions to Patient Move your little finger away from your
    ring finger
    Action The patient attempts to abduct the little finger through the
    full range of motion
    T1 Common Muscle Substitution
    Finger extension can mimic 5th finger abduction Proper positioning and stabilization will minimize this error
    L2 Hip Flexors | Iliopsoas
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction with both the hip and knee in 15° of flexion
    Examiner Position Support the dorsal aspect of the distal thigh
    and leg Do not allow flexion beyond 90° when examining acute
    thoracolumbar injuries due to the kyphotic stress placed on the
    lumbar spine
    Instructions to Patient Lift your knee towards your chest as far
    as you can trying not to drag your foot on the exam table
    Action The patient attempts to flex hip to 90° of flexion首医科学宣武医院神外科脊柱组
    22
    L2 屈髋肌群(髂腰肌)
    3 级
    • 患者体位:髋部中立旋转位中立收外展位
    髋部膝均 15 度屈曲
    • 检查者体位:
    扶住腿远端
    背侧面注意
    检查胸腰椎损
    伤患者时
    脊柱凸
    张力作
    腰椎腿
    屈曲超 90 度
    • 指令:膝盖抬起量胸部
    脚检查床发力
    • 动作:患者尝试屈髋 90 度

    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 8
    Grades 0 1 & 2
    Patient Position The shoulder is in neutral rotation neutral
    flexionextension and adducted The elbow is in full extension
    The forearm is in full pronation and the wrist in neutral flexion
    extension The MCP joint is stabilized
    An alternate position is with the shoulder in internal rotation
    adducted and neutral flexionextension The elbow is in 90° of
    flexion the forearm and wrist are in neutral flexion extension
    and the MCP joint is stabilized
    Examiner Position Stabilize the dorsal wrist and hand by
    pressing down lightly on the back of the hand Be sure that the
    MCP joints are stabilized to prevent hyperextension Palpate the
    abductor digiti minimi muscle and observe the muscle belly
    for movement
    Instructions to Patient Move your little finger away from your
    ring finger
    Action The patient attempts to abduct the little finger through the
    full range of motion
    T1 Common Muscle Substitution
    Finger extension can mimic 5th finger abduction Proper positioning and stabilization will minimize this error
    L2 Hip Flexors | Iliopsoas
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction with both the hip and knee in 15° of flexion
    Examiner Position Support the dorsal aspect of the distal thigh
    and leg Do not allow flexion beyond 90° when examining acute
    thoracolumbar injuries due to the kyphotic stress placed on the
    lumbar spine
    Instructions to Patient Lift your knee towards your chest as far
    as you can trying not to drag your foot on the exam table
    Action The patient attempts to flex hip to 90° of flexion首医科学宣武医院神外科脊柱组
    23
    45 级
    • 患者体位: 屈髋 90
    度膝盖放松
    • 检查者体位: 压住
    侧髂嵴前
    方手扶住
    腿远端前方
    膝伸髋方予压力
    • 指令:膝盖保持位置压

    • 动作:患者试图抗检查者压力保持屈髋 90


    2 级
    • 患者体位:(
    卧)受重力影
    响 髋部外旋
    45 度屈膝关
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 9
    Grades 4 & 5
    Patient Position The hip is in 90° of flexion with the
    knee relaxed
    Examiner Position Brace the anterior superior iliac spine
    on the opposite side and place a hand on the distal anterior
    thigh just above the knee Pressure is applied in the direction of
    hip extension
    Instructions to patient Hold your knee in this position Don’t
    let me push it down
    Action The patient attempts to resist the examiner’s push and
    keep the hip flexed at 90°
    Grade 2
    Patient Position Place the patient in the gravity eliminated
    position with the hip in external rotation and 45°of flexion The
    knee is flexed at 90°
    Examiner Position Support the leg
    Instructions to Patient Try to bring your knee out to the side
    or Try to flex your thigh toward the side of the body
    Action The patient attempts to move through the full range of
    motion in hip flexion
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 9
    Grades 4 & 5
    Patient Position The hip is in 90° of flexion with the
    knee relaxed
    Examiner Position Brace the anterior superior iliac spine
    on the opposite side and place a hand on the distal anterior
    thigh just above the knee Pressure is applied in the direction of
    hip extension
    Instructions to patient Hold your knee in this position Don’t
    let me push it down
    Action The patient attempts to resist the examiner’s push and
    keep the hip flexed at 90°
    Grade 2
    Patient Position Place the patient in the gravity eliminated
    position with the hip in external rotation and 45°of flexion The
    knee is flexed at 90°
    Examiner Position Support the leg
    Instructions to Patient Try to bring your knee out to the side
    or Try to flex your thigh toward the side of the body
    Action The patient attempts to move through the full range of
    motion in hip flexion首医科学宣武医院神外科脊柱组
    24
    节屈 90 度
    • 检查者体位: 扶住患者腿部
    • 指令:试着膝盖侧移面者试
    着腿侧身体弯曲
    • 动作:患者尝试屈髋范围

    01 级
    • 患者体位: 3
    级查体髋部呈
    中立旋转位中
    立收外展位
    腿膝盖弯
    曲 15 度
    • 检查者体位: 适抬起腿消摩擦素
    触摸表面屈髋肌髂嵴前方远侧
    • 指令:患者量胸前方抬起膝盖
    • 动作:患者试图屈髋
    • 注意:判断 1 级肌力时检查者观察表浅屈
    髋肌收缩事实缝匠肌股直肌髂
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 10
    Grades 0 & 1
    Patient Position Place the patient in the grade 3 position with
    the hip in neutral rotation neutral adductionabduction and the hip
    and knee flexed to 15°
    Examiner Position Support the thigh to eliminate friction while
    palpating the superficial hip flexors just distal to the anterior
    superior iliac spine
    Instructions to Patient Ask the patient to lift your knee towards
    your chest as far as you can
    Action The patient attempts to flex the hip
    Note For Grade 1 the examiner is actually palpating the more
    superficial hip flexors ie sartorius and rectus femoris rather than
    the iliopsoas The insertion of the iliopsoas is too deep to be
    seen or felt when it possesses only Grade 1 strength When
    examining a patient with an acute traumatic lesion below T8 the
    hip should not be allowed to flex passively or actively beyond 90°
    Flexion beyond 90° may place too great a kyphotic stress on the
    lumbar spine
    L2 Common Muscle Substitution
    Any muscle of the trunk that can elevate or rotate the pelvis can trick the examiner into thinking that the hip flexor
    muscles are active This could include the rectus abdominus the adductor muscles obliques or the quadratus
    lumborum With accurate palpation correct patient instructions and observation of any trunk movement this
    substitution can be avoided
    L3 Knee Extensors | Quadriceps
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction and 15° of flexion The knee is in 30°
    of flexion
    Examiner Position Place the arm under the tested knee and
    rest the hand on the patient’s distal thigh This causes the tested
    knee to flex to approximately 30°
    Instructions to Patient Straighten your knee
    Action The patient attempts to straighten the knee through the
    full range of motion in extension首医科学宣武医院神外科脊柱组
    25
    腰肌髂腰肌止点太深1 级肌力收缩时法
    触检查者 T8 急性创伤
    患者髋部允许动屈曲 90 度动活动超
    90 度超 90 度屈髋腰椎施加度
    凸张力

    L2 肌力误判
    躯干肌检查骨盆抬升转动检查者
    误髋部屈肌活动包括腹直肌收肌斜方
    肌腰方肌通准确触诊正确指令注意观
    察躯干活动避免类误判

    L3 伸膝肌群 (股四头肌)
    3 级
    • 患者体位: 髋
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 10
    Grades 0 & 1
    Patient Position Place the patient in the grade 3 position with
    the hip in neutral rotation neutral adductionabduction and the hip
    and knee flexed to 15°
    Examiner Position Support the thigh to eliminate friction while
    palpating the superficial hip flexors just distal to the anterior
    superior iliac spine
    Instructions to Patient Ask the patient to lift your knee towards
    your chest as far as you can
    Action The patient attempts to flex the hip
    Note For Grade 1 the examiner is actually palpating the more
    superficial hip flexors ie sartorius and rectus femoris rather than
    the iliopsoas The insertion of the iliopsoas is too deep to be
    seen or felt when it possesses only Grade 1 strength When
    examining a patient with an acute traumatic lesion below T8 the
    hip should not be allowed to flex passively or actively beyond 90°
    Flexion beyond 90° may place too great a kyphotic stress on the
    lumbar spine
    L2 Common Muscle Substitution
    Any muscle of the trunk that can elevate or rotate the pelvis can trick the examiner into thinking that the hip flexor
    muscles are active This could include the rectus abdominus the adductor muscles obliques or the quadratus
    lumborum With accurate palpation correct patient instructions and observation of any trunk movement this
    substitution can be avoided
    L3 Knee Extensors | Quadriceps
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction and 15° of flexion The knee is in 30°
    of flexion
    Examiner Position Place the arm under the tested knee and
    rest the hand on the patient’s distal thigh This causes the tested
    knee to flex to approximately 30°
    Instructions to Patient Straighten your knee
    Action The patient attempts to straighten the knee through the
    full range of motion in extension首医科学宣武医院神外科脊柱组
    26
    部旋转中立位收外展中立位15 度屈膝关
    节 30 度屈
    • 检查者体位: 手臂放检查膝盖面
    手放患者腿远侧样保持检查
    膝关节屈接 30 度
    • 指令:您膝盖伸直
    • 动作:患者尝试膝盖伸直活动角度

    45 级
    • 患者体位:
    3 级肌力查体
    膝盖 15 度

    • 检查者体位:
    手臂放检查膝盖方手搭患者
    侧腿抓住检查侧腕关节端
    • 指令:保持住姿势您膝盖掰

    • 动作:检查者施加指屈膝力患者
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 11
    Grades 4 & 5
    Patient position Same as grade 3 except the knee is in 15°
    of flexion
    Examiner Position Place the arm under the tested knee and
    rest the hand on the patient’s opposite thigh Grasp the leg to be
    tested just proximal to the ankle
    Instructions to Patient Hold this position Don’t let me bend
    your knee
    Action Examiner exerts downward force into knee flexion while
    the patient attempts to hold the knee in 15 degrees of flexion
    Grade 2
    Patient Position The hip is in external rotation and 45°of flexion
    The knee is flexed at 90°
    Examiner position Support the distal thigh and leg
    Instructions to Patient Straighten your knee
    Action The patient attempts to move through the full range
    of motion
    Grades 0 & 1
    Patient Position Place the patient with the hip in neutral
    rotation neutral adductionabduction with both the hip and knee
    in 15° of flexion
    Examiner Position Support the leg Palpate the patellar tendon
    or the belly of the quadriceps muscle for trace function The
    muscle belly may also be observed for movement
    Instructions to Patient Straighten your knee
    Note In this position asking the patient to push the back of the
    knee downward toward the exam table may be better to elicit
    trace contraction in the quadriceps
    Action The patient attempts to straighten the knee首医科学宣武医院神外科脊柱组
    27
    尝试保持膝盖 15 度屈

    2 级
    • 患者体位: 髋关
    节外旋45 度屈
    膝关节 90 度屈
    • 检查者体位: 支
    撑患者腿远端
    • 指令:膝盖伸

    • 动作:患者尝试
    膝盖伸直活动范围

    01 级
    • 患者体位: 髋
    部中立旋转位
    中立收外展
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 11
    Grades 4 & 5
    Patient position Same as grade 3 except the knee is in 15°
    of flexion
    Examiner Position Place the arm under the tested knee and
    rest the hand on the patient’s opposite thigh Grasp the leg to be
    tested just proximal to the ankle
    Instructions to Patient Hold this position Don’t let me bend
    your knee
    Action Examiner exerts downward force into knee flexion while
    the patient attempts to hold the knee in 15 degrees of flexion
    Grade 2
    Patient Position The hip is in external rotation and 45°of flexion
    The knee is flexed at 90°
    Examiner position Support the distal thigh and leg
    Instructions to Patient Straighten your knee
    Action The patient attempts to move through the full range
    of motion
    Grades 0 & 1
    Patient Position Place the patient with the hip in neutral
    rotation neutral adductionabduction with both the hip and knee
    in 15° of flexion
    Examiner Position Support the leg Palpate the patellar tendon
    or the belly of the quadriceps muscle for trace function The
    muscle belly may also be observed for movement
    Instructions to Patient Straighten your knee
    Note In this position asking the patient to push the back of the
    knee downward toward the exam table may be better to elicit
    trace contraction in the quadriceps
    Action The patient attempts to straighten the knee
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 11
    Grades 4 & 5
    Patient position Same as grade 3 except the knee is in 15°
    of flexion
    Examiner Position Place the arm under the tested knee and
    rest the hand on the patient’s opposite thigh Grasp the leg to be
    tested just proximal to the ankle
    Instructions to Patient Hold this position Don’t let me bend
    your knee
    Action Examiner exerts downward force into knee flexion while
    the patient attempts to hold the knee in 15 degrees of flexion
    Grade 2
    Patient Position The hip is in external rotation and 45°of flexion
    The knee is flexed at 90°
    Examiner position Support the distal thigh and leg
    Instructions to Patient Straighten your knee
    Action The patient attempts to move through the full range
    of motion
    Grades 0 & 1
    Patient Position Place the patient with the hip in neutral
    rotation neutral adductionabduction with both the hip and knee
    in 15° of flexion
    Examiner Position Support the leg Palpate the patellar tendon
    or the belly of the quadriceps muscle for trace function The
    muscle belly may also be observed for movement
    Instructions to Patient Straighten your knee
    Note In this position asking the patient to push the back of the
    knee downward toward the exam table may be better to elicit
    trace contraction in the quadriceps
    Action The patient attempts to straighten the knee首医科学宣武医院神外科脊柱组
    28
    位髋膝关节均屈 15 度
    • 检查者体位: 扶住患者腿触膝肌腱
    股四头肌肌腹判断肌肉收缩观察
    股四头肌肌腹遵嘱活动时收缩
    • 指令:伸直您膝盖 注意:体位
    患者膝盖侧(检查床方)力
    更容易引出股四头肌收缩
    • 动作:患者尝试伸直膝关节

    L4 踝关节背伸肌群(胫前肌)
    3 级
    • 患者体位: 髋
    部中立旋转位
    中立收外展
    位 检查者
    手放膝关节
    腿方
    髋膝关节轻度屈曲踝关节跖屈
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 12
    L4 Ankle Dorsiflexors | Tibialis Anterior
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction with the hip and knee slightly flexed The
    hand may be placed under the knee of the tested leg to
    incorporate slight flexion The ankle is plantarflexed
    Examiner Position At the patient’s side Support the leg
    Instructions to Patient Pull your toes upward toward your
    head letting your ankle bend
    Action The patient attempts to dorsiflex ankle through a full
    range of motion
    Grades 4 & 5
    Patient Position Same as grade 3 except the ankle is
    fully dorsiflexed
    Examiner Position In the grade 3 position place
    the hand on the dorsum of the foot and apply pressure downward
    in the direction of plantarflexion
    Instructions to Patient Hold your ankle in this position Don’t
    let me push it down
    Action The patient attempts to resist the examiner and maintain
    the ankle in full dorsiflexion
    Grade 2
    Patient Position The hip is in external rotation and 45° of
    abduction The knee is flexed and the ankle is fully
    plantar flexed
    Examiner Position Support the leg
    Instruction to Patient Lift the toes upward toward the head
    allowing the ankle to bend
    Action The patient attempts to dorsiflex ankle through the full
    range of motion首医科学宣武医院神外科脊柱组
    29
    • 检查者体位: 检查侧扶住腿
    • 指令:脚趾力指您头部脚
    踝弯曲
    • 动作:患者尝试背伸脚踝活动范围

    45 级
    • 患者体位:
    3 级肌力检查相
    踝关节
    完全背伸
    • 检查者体位:
    3 级肌力检
    查位置手
    放足背施加
    跖屈方力
    • 指令:保持您脚踝位置压

    • 动作:患者试图抗检查者力量保持踝关节
    完全背伸
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 12
    L4 Ankle Dorsiflexors | Tibialis Anterior
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction with the hip and knee slightly flexed The
    hand may be placed under the knee of the tested leg to
    incorporate slight flexion The ankle is plantarflexed
    Examiner Position At the patient’s side Support the leg
    Instructions to Patient Pull your toes upward toward your
    head letting your ankle bend
    Action The patient attempts to dorsiflex ankle through a full
    range of motion
    Grades 4 & 5
    Patient Position Same as grade 3 except the ankle is
    fully dorsiflexed
    Examiner Position In the grade 3 position place
    the hand on the dorsum of the foot and apply pressure downward
    in the direction of plantarflexion
    Instructions to Patient Hold your ankle in this position Don’t
    let me push it down
    Action The patient attempts to resist the examiner and maintain
    the ankle in full dorsiflexion
    Grade 2
    Patient Position The hip is in external rotation and 45° of
    abduction The knee is flexed and the ankle is fully
    plantar flexed
    Examiner Position Support the leg
    Instruction to Patient Lift the toes upward toward the head
    allowing the ankle to bend
    Action The patient attempts to dorsiflex ankle through the full
    range of motion首医科学宣武医院神外科脊柱组
    30

    2 级
    • 患者体位: 髋
    部外旋45 度外
    展膝关节屈
    足踝完全跖屈
    • 检查者体位:
    扶住患者腿
    • 指令:您脚趾力指头部踝
    关节弯曲
    • 动作:患者试图做踝关节背伸动作活动范


    01 级
    • 患者体位:髋关
    节中立旋转位
    中立收外展
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 12
    L4 Ankle Dorsiflexors | Tibialis Anterior
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction with the hip and knee slightly flexed The
    hand may be placed under the knee of the tested leg to
    incorporate slight flexion The ankle is plantarflexed
    Examiner Position At the patient’s side Support the leg
    Instructions to Patient Pull your toes upward toward your
    head letting your ankle bend
    Action The patient attempts to dorsiflex ankle through a full
    range of motion
    Grades 4 & 5
    Patient Position Same as grade 3 except the ankle is
    fully dorsiflexed
    Examiner Position In the grade 3 position place
    the hand on the dorsum of the foot and apply pressure downward
    in the direction of plantarflexion
    Instructions to Patient Hold your ankle in this position Don’t
    let me push it down
    Action The patient attempts to resist the examiner and maintain
    the ankle in full dorsiflexion
    Grade 2
    Patient Position The hip is in external rotation and 45° of
    abduction The knee is flexed and the ankle is fully
    plantar flexed
    Examiner Position Support the leg
    Instruction to Patient Lift the toes upward toward the head
    allowing the ankle to bend
    Action The patient attempts to dorsiflex ankle through the full
    range of motion
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 13
    Grades 0 & 1
    Patient Position Place the hip in neutral rotation neutral
    adductionabduction and neutral flexionextension The knee is
    fully extended and the ankle slightly plantarflexed
    Examiner Position Palpate the proximal lower leg over the
    tibialis anterior muscle belly or on the tendon of the tibialis
    anterior muscle as it crosses the anterior ankle Observe the
    muscle belly for movement
    Instructions to Patient Bring your toes upward toward your
    head letting your ankle bend
    Action The patient attempts to dorsiflex the ankle
    L4 Common Muscle Substitution
    Ankle dorsiflexion can be mimicked by the long toe extensors particularly the extensor hallucis longus Correct
    stabilization and observation along with proper patient instruction and palpation can eliminate this substitution
    L5 Long Toe Extensors | Extensor Hallucis Longus
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction and neutral flexionextension The knee is
    fully extended
    Examiner Position At the patient’s side Support the foot
    Instructions to Patient Lift your big toe upwards toward
    your knee
    Action The patient attempts to move the great toe through the
    full range of motion首医科学宣武医院神外科脊柱组
    31
    位中立屈伸位膝关节完全伸直踝关节轻度
    跖屈
    • 检查者体位: 触胫前肌肢端肌腹
    胫前肌肌腱跨踝关节前方位置观察做动作
    时肌腹活动
    • 指令:您脚趾力指头部踝
    关节弯曲
    • 动作:患者试图背伸脚踝

    L4 肌力误判
    踝关节背伸趾长伸肌尤拇长伸肌收缩
    混淆正确固定观察准确指令触诊
    消种误判

    L5 趾长伸肌 (拇长伸肌) 首医科学宣武医院神外科脊柱组
    32
    3 级
    • 患者体位: 髋
    关节中立旋
    转位中立
    收外展位中
    立屈伸位膝
    关节完全伸

    • 检查者体位: 患者侧扶住患者足部
    • 指令:脚趾翘起膝盖方力
    • 动作:患者试图脚趾背伸活动范围

    45 级
    • 患者体位: 3 肌力查体相拇趾完
    全背伸
    • 检查者体位: 站患者侧拇指放患者
    拇趾远端指节前方施加指足趾跖屈方
    压力
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 13
    Grades 0 & 1
    Patient Position Place the hip in neutral rotation neutral
    adductionabduction and neutral flexionextension The knee is
    fully extended and the ankle slightly plantarflexed
    Examiner Position Palpate the proximal lower leg over the
    tibialis anterior muscle belly or on the tendon of the tibialis
    anterior muscle as it crosses the anterior ankle Observe the
    muscle belly for movement
    Instructions to Patient Bring your toes upward toward your
    head letting your ankle bend
    Action The patient attempts to dorsiflex the ankle
    L4 Common Muscle Substitution
    Ankle dorsiflexion can be mimicked by the long toe extensors particularly the extensor hallucis longus Correct
    stabilization and observation along with proper patient instruction and palpation can eliminate this substitution
    L5 Long Toe Extensors | Extensor Hallucis Longus
    Grade 3
    Patient Position The hip is in neutral rotation neutral
    adductionabduction and neutral flexionextension The knee is
    fully extended
    Examiner Position At the patient’s side Support the foot
    Instructions to Patient Lift your big toe upwards toward
    your knee
    Action The patient attempts to move the great toe through the
    full range of motion首医科学宣武医院神外科脊柱组
    33
    • 指令:保持您
    脚趾勾


    • 动作:患者尝试
    抗检查者施
    加压力保持
    拇趾背
    伸范围

    2 级
    • 患者体位: 髋
    部外旋45 度
    外展膝关节屈
    曲足踝脚趾
    放松中立

    • 检查者体位: 扶住患者腿
    • 指令:脚趾勾膝盖方力
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 14
    Grades 4 & 5
    Patient Position Same as grade 3 except the toe is
    fully extended
    Examiner Position At the patient’s side Place the thumb on the
    distal phalanx of the great toe and apply pressure downward in
    the direction of toe flexion
    Instructions to Patient Keep your toe lifted upward Don’t let
    me push it down
    Action The patient attempts to resist the examiner and maintain
    the great toe in full extension
    Grade 2
    Patient Position The hip is in external rotation 45° abduction
    The knee is flexed The ankle and long toe are in a relaxed
    neutral position
    Examiner Position Support the leg
    Instructions to Patient Lift your big toe upwards toward
    the knee
    Action The patient attempts to extend the great toe through the
    full range of motion
    Grades 0 & 1
    Patient Position Place the patient in the grade 3 position
    Examiner Position Support the leg and palpate the extensor
    tendon of the long toe for trace function
    Instructions to Patient Lift your big toe upwards toward
    your knee
    Action The patient attempts to extend the great toe
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 14
    Grades 4 & 5
    Patient Position Same as grade 3 except the toe is
    fully extended
    Examiner Position At the patient’s side Place the thumb on the
    distal phalanx of the great toe and apply pressure downward in
    the direction of toe flexion
    Instructions to Patient Keep your toe lifted upward Don’t let
    me push it down
    Action The patient attempts to resist the examiner and maintain
    the great toe in full extension
    Grade 2
    Patient Position The hip is in external rotation 45° abduction
    The knee is flexed The ankle and long toe are in a relaxed
    neutral position
    Examiner Position Support the leg
    Instructions to Patient Lift your big toe upwards toward
    the knee
    Action The patient attempts to extend the great toe through the
    full range of motion
    Grades 0 & 1
    Patient Position Place the patient in the grade 3 position
    Examiner Position Support the leg and palpate the extensor
    tendon of the long toe for trace function
    Instructions to Patient Lift your big toe upwards toward
    your knee
    Action The patient attempts to extend the great toe首医科学宣武医院神外科脊柱组
    34
    • 动作:患者尝试拇趾背伸范围

    01 级
    • 患者体位: 3
    级肌力检查
    体位相
    • 检查者体位:
    扶住患者腿
    触趾长伸肌肌腱
    • 指令:脚趾勾膝盖方力
    • 动作:患者尝试拇趾背伸

    L5 肌力误判
    跖屈拇趾背伸更容易果患者动整足
    部跖屈程中会拇长伸肌动背伸
    肌腱固定原通适固定减少足部踝关
    节运动避免种误判
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 14
    Grades 4 & 5
    Patient Position Same as grade 3 except the toe is
    fully extended
    Examiner Position At the patient’s side Place the thumb on the
    distal phalanx of the great toe and apply pressure downward in
    the direction of toe flexion
    Instructions to Patient Keep your toe lifted upward Don’t let
    me push it down
    Action The patient attempts to resist the examiner and maintain
    the great toe in full extension
    Grade 2
    Patient Position The hip is in external rotation 45° abduction
    The knee is flexed The ankle and long toe are in a relaxed
    neutral position
    Examiner Position Support the leg
    Instructions to Patient Lift your big toe upwards toward
    the knee
    Action The patient attempts to extend the great toe through the
    full range of motion
    Grades 0 & 1
    Patient Position Place the patient in the grade 3 position
    Examiner Position Support the leg and palpate the extensor
    tendon of the long toe for trace function
    Instructions to Patient Lift your big toe upwards toward
    your knee
    Action The patient attempts to extend the great toe首医科学宣武医院神外科脊柱组
    35
    种误判患者动跖屈拇趾然放松
    动放松动作中立位错误判动
    背伸

    S1 踝跖屈肌群(腓肠肌目鱼肌)
    3 级
    注意:检查 35 级肌力标准教科书述肌肉查体
    评分中查体求患者仰卧位
    • 患者体位: 髋
    关节中立旋转
    位45 度屈
    膝关节完全屈
    踝关节完全背

    • 检查者体位:
    手放膝盖
    方支撑固定患者腿手放患者
    足底患者足部背伸患者足放检查床
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 15
    L5 Common Muscle Substitution
    Great toe extension can be facilitated by plantarflexion If a patient actively plantar flexes the entire foot passive
    extension of extensor hallucis longus can be achieved during the active plantarflexion of the foot This is a type of
    tenodesis for the foot and can be avoided by proper stabilization to eliminate foot and ankle movement
    Another possible muscle substitution for L5 can occur when the patient actively flexes the big toe and then relaxes
    Passive relaxation into a neutral position can be perceived as active extension
    S1 Ankle Plantarflexors | Gastrocnemius Soleus
    Grade 3
    Note Checking for Grades 35 is significantly different
    from what is described in standard manual muscle testing texts
    This departure is required for examining patients in the
    supine position
    Patient Position
    The hip is in neutral rotation and 45° of flexion with the knee fully
    flexed and ankle in full dorsiflexion
    Examiner Position Place one hand behind the knee to assist in
    stabilizing the leg The other hand is positioned under the sole of
    the patient’s foot pushing the foot into dorsiflexion The patient’s
    heel remains resting on the exam table
    Instructions to Patient Push your foot down into my hand and
    lift your heel off the table
    Action The patient pushes the forefoot downward into the
    examiner’s hand and raises the heel off the exam table through a
    full range of motion in plantarflexion首医科学宣武医院神外科脊柱组
    36

    • 指令:您脚踩手脚床
    抬起
    • 动作:患者足掌力踩检查者手足
    检查床抬起跖屈活动范围

    45 级
    • 患者体位:髋 部 中
    立旋转位中立屈
    伸位中立收外
    展位膝关节完全
    伸直踝关节完全
    跖屈
    • 检查者体位: 手扶住患者腿远端
    手跖侧握住足掌足底施加背伸压

    • 指令:脚踩推起
    • 动作:检查者跖侧施加指背伸方力患
    者尝试抵抗检查者施加力保持脚脚踝完全
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 16
    Grades 4 & 5
    Patient position The hip is in neutral rotation neutral flexion
    extension and neutral abductionadduction The knee is fully
    extended and the ankle is in full plantarflexion
    Examiner Position Place one hand on the distal lower leg while
    the other hand grasps the foot across the plantar surface of
    metatarsals Apply pressure on the bottom of the foot in the
    direction of dorsiflexion
    Instructions to patient Hold your foot pointed down Don’t let
    me push it up
    Action Examiner gives pressure on the plantar aspect of the
    metatarsals in the direction of dorsiflexion The patient attempts
    to resist the examiner by maintaining the foot and ankle in
    full plantarflexion
    Grades 0 1 & 2
    Patient Position The hip is in external rotation and 45° of flexion
    The knee is flexed
    Examiner Position Support the lower leg For trace function
    palpate either the gastrocnemius muscle belly or the achilles
    tendon or observe the muscle belly for movement
    Instructions to Patient Point your toes downward like a
    ballet dancer
    Action The patient attempts to plantar flex the foot through a full
    range of motion
    S1 Common muscle substitution
    Visually monitor the hip flexors to assure that these muscles are not being used to facilitate plantarflexion首医科学宣武医院神外科脊柱组
    37
    跖屈

    012 级
    • 患者体位: 髋
    关节外旋45
    度屈膝关节

    • 检查者体位:
    扶住患者腿
    部触腓肠肌肌腹腱观察肌腹运

    • 指令:跳芭蕾舞样脚尖指方
    • 动作:患者尝试做跖屈动作

    S1 肌力误判
    注意观察屈髋肌群确保肌群没参辅助跖屈
    动作
    International Standards for the Classification of Spinal Cord Injury
    Motor Exam Guide
    June 2008 page 16
    Grades 4 & 5
    Patient position The hip is in neutral rotation neutral flexion
    extension and neutral abductionadduction The knee is fully
    extended and the ankle is in full plantarflexion
    Examiner Position Place one hand on the distal lower leg while
    the other hand grasps the foot across the plantar surface of
    metatarsals Apply pressure on the bottom of the foot in the
    direction of dorsiflexion
    Instructions to patient Hold your foot pointed down Don’t let
    me push it up
    Action Examiner gives pressure on the plantar aspect of the
    metatarsals in the direction of dorsiflexion The patient attempts
    to resist the examiner by maintaining the foot and ankle in
    full plantarflexion
    Grades 0 1 & 2
    Patient Position The hip is in external rotation and 45° of flexion
    The knee is flexed
    Examiner Position Support the lower leg For trace function
    palpate either the gastrocnemius muscle belly or the achilles
    tendon or observe the muscle belly for movement
    Instructions to Patient Point your toes downward like a
    ballet dancer
    Action The patient attempts to plantar flex the foot through a full
    range of motion
    S1 Common muscle substitution
    Visually monitor the hip flexors to assure that these muscles are not being used to facilitate plantarflexion

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