Pemeriksaan Motorik

dan
Serebelum

Mudjiani Basuki
Dep. Neurologi, FKUA-Surabaya
PEMERIKSAAN MOTORIK.
INDIKASI?

KAPAN MELAKUKAN
PEMERIKSAAN OTOT ?

KELUHAN : KELEMAHAN/ WEAKNESS:

1. EKSTREMITAS
2. OTOT WAJAH
3. OTOT PERNAFASAN
Pemeriksaan Motorik
• Inspeksi
• Kekuatan Motorik
• Tonus otot
• Perkusi otot
INSPEKSI OTOT:

Atropfi otot
tungkai

Hypertrophy

Atropfi otot lidah

Kekuatan Motorik:
• Untuk membantu menegakkan diagnose klinis dan topis
• Persyaratan Pemeriksaan:
• Penderita sadar baik
• Penderita kooperatif
• Perlu di tentukan:
• Tingkat kelemahan nya : phlegia / paresis?
• Pola kelemahannya : mono / hemi / para / tetra ?
• Tipe kelemahan : UMN/ LMN?
Tingkat keparahan kelemahan otot
• Sesuai Medical Research Council
Nilai
5 Mampu melawan tahanan optimal
4 Hanya mampu melawan tahanan minimal
3 Hanya mampu melakukan gerakan melawan gaya gravitasi
2 Hanya mampu melalukan gerakan tanpa pengaruh gaya
gravitas
1 Hanya mampu melakukan kontraksi otot
0 Tidak mampu melakukan gerakan sama sekali

• Phlegia : kekuatan < 3

• Paresis : kekuatan ≥ 3
Pola dan Tipe kelemahan otot
UMN LMN
hemi- paresis/ phlegia Hemisfer cerebri kontralateral
Brainstem kontralateral
tetra-paresis/ phlegia Medula spinalis Cervikal – thorakal Saraf tepi
1 Otot
Para – paresis/ phlegia Medula spinalis Thorakal- Lumbal Saraf tepi tungkai bawah
Mono – paresis/ phlegia Saraf tepi (mono)
Pemeriksaan m. Deltideus

m. Deltoideus:

- Abduksi sendi bahu

- Radix C5-6
- N. Aksilaris

lis is innervated by C5-C6 through the radial nerve.
It acts as an elbow flexor when the forearm is held
midway between pronation and supination (thumb
up). The brachioradialis acts as a supinator when the
forearm is extended and pronated, but as a pronator
Pemeriksaan m. biceps brachii
when the forearm is flexed and supinated.
Biceps and brachialis functions are tested by
having the patient attempt to flex the elbow against
resistance. The biceps contraction can be seen and
felt, but the brachialis is buried (Figure 27.14). The
m. Biceps Brachii
Campbell_Chap27.indd 431
- Fleksi sendi siku pada
posisi tangan supinasi
- Radiks C5, C6
- N. muskulokutan
attempt to either extend the elbow or to hold posi-
tion against the examiner’s resistance (Figure 27.16).
The triceps muscle is less powerful when the elbow
is fully flexed, and slight weakness may be more eas-
ily detected with testing in this position. With mild
triceps weakness, the examiner may be able to pin the
triceps in extreme flexion using one or two fingers on
the involved but not the normal side.
Supination of the forearm is done primarily by
the supinator muscle, assisted by stronger muscles,
432 SECTION E | THE MOTOR SYSTEM
especially the biceps, for movements requiring power.
FIGURE 27.14 Examination of the biceps brachii. On attempts
to flex the forearm against resistance, the contracting biceps
muscle can be seen and palpated.
m. Brachio Radialis
FIGURE 27.15 Examination of the brachioradialis. On flexion of the semipronated forearm (thumb up) against resistance, the
contracting muscle can be seen and palpated.
7/12/2012 12:27:00 PM
- Fleksi sendi siku posisi
mid pronasi-supinasi
- Radiks C6
- N. Radialis
FIGURE 27.15 Examination of the brachioradialis. On flexion of the semipronated forearm (thumb up) against resistance, the
contracting muscle can be seen and palpated.

M. Triceps Brachii
m. Triceps Brachii:

- Ekstensi sendi siku

- Radiks C7
- N. radialis

FIGURE 27.16 Extension of the forearm. On attempts to extend the partially flexed forearm against resistance, contraction of the
triceps can be seen and palpated.
FIGURE 27.45 Examination of flexion at the knee. The prone patient attempts to maintain flexion of the leg while the examiner

m. Hamstring
attempts to extend it; the tendon of the biceps femoris can be palpated laterally and the tendons of the semimembranosus and
semitendinosus, medially.

m. Hamstring:

- Fleksi sendi lutut

- Radiks L3, 4, 5
- N. obturator

FIGURE 27.46 Examination of the sartorius. With the thigh flexed and rotated laterally and the knee moderately flexed, the
patient attempts further flexion of the knee against resistance.
 M. Quadriceps Femoris
CHAPTER 27 | MOTOR STRENGTH AND POWER 455

m. Quadriceps Femoris:

- Ekstensi sendi lutut

- Radiks L 2, 3, 4
- N. Femoralis

FIGURE 27.47 Examination of extension of the leg at the knee. The supine patient attempts to extend the leg at the knee against
resistance; contraction of the quadriceps femoris can be seen and palpated.

as a knee extensor. The vastus medialis is sometimes force by allowing the rectus femoris to contract across
 FIGURE 27.48 The “barkeeper’s hold,” a powerful move against the quadriceps. (Reprinted from Wolfe JK. Segmental Neurology.
Baltimore: University Park Press, 1981, with permission.)

M. Gastroknemius
technique is to use the forearm as a lever by grasping
the patient’s heel with the hand and pushing against
the ball of the foot with the volar forearm. Normal
plantarflexors will hold fast even against this power
move. A better test of plantarflexor strength is to have
the patient stand on tiptoe. Normally, a patient can
easily support the entire body weight on one tiptoe,
hop on one foot, and even do multiple toe raises on

m. Gastroknemius

- Plantar fleksi sendi

ankle
- Radiks L5, S1
- N. tibialis posterior

FIGURE 27.49 Examination of plantarflexion of the foot. The patient attempts to plantarflex the foot at the ankle joint against
resistance; contraction of the gastrocnemius and associated muscles can be seen and palpated.
can be compared. Dorsiflexion may also be tested by nerve, L5–S1), the strongest invertor, is also a plan-
having the patient stand on the heels, raising the toes tarflexor, and is strongest as an invertor when the
as high as possible. The toes on the weak side cannot ankle is plantarflexed. The tibialis anterior functions
be lifted as far. The tibialis anterior is the major mus- as an invertor when the ankle is dorsiflexed. Inversion

M. Tibialis Anterior
cle innervated by the L5 myotome, and L5 radicu-
lopathy is the most common cause of weakness.
is tested by having the patient attempt to invert the
ankle against resistance (Figure 27.51). Weakness of

M. Tibialis Anterior

- Dorso fleksi sendi ankle

- Radiks L5, S1
- N. Peroneus

FIGURE 27.50 Examination of dorsiflexion (extension) of the foot. The patient attempts to dorsiflex the foot against resistance;
contraction of the tibialis anterior can be seen and palpated.
Pronator Drift CHAPTER 27 | MOTOR STRENGTH AND POWER 461

- Untuk melihat adanya

kelumpuhan ringan

- Kedua tangan dalam

posisi supinasi diangkat
keatas
- Tangan yang lumpuh
akan pronasi

FIGURE 27.56 Technique for testing for pronator drift. In the presence of a corticospinal tract (CST) lesion, the selectively
weakened muscles are the shoulder abductors and external rotators, the supinators, and the elbow extensors. These muscles are
overcome by their antagonists to cause pronation, elbow flexion, and downward drift. This is an illustration of mild pronator drift of
Pemeriksaan tonus otot
• Melakukan gerakan otot seperti pada pemeriksaan kekuatan otot
• Pemeriksa aktif melakukan gerakan, penderita pasif
• Syarat pemeriksaan:
• Pada kondisi sadar, harus disertai kooperatif dari penderita
• Dapat dilakukan pada penderita dengan kesadaran menurun
• Ada 3 tipe tonus otot:
• Normal
• Hipertonus
• Hipotonus
Kelainan tonus:

HIPERTONUS HIPOTONUS
• Spastisitas : • Kelainan serebelum
• Pada awal gerakan • Rebound phenomenon
• Lesi traktus piramidalis
• Fenomena pisau lipat/ clasp knife • Winging hand
• Rigiditas :
• Pada sepanjang gerakan
• Lesi traktus ekstrapiramidalis
àCogwheel
àLead pipe
HIPERTONUS

RIGIDITAS SPASTISITAS
MYOTONIA
KESIMPULAN PEMERIKSAAN OTOT.
• Monoparesis lengan kanan LMN, parese m. deltoideus kanan dengan
kekuatan MRC 3.
• Hemiparesis kiri UMN, dengan kekuatan MRC 4 pada otot:
• M. biceps brachii kiri
• M. extensor pergelangan tangan kiri
• M. kwadrisep femoris kiri
• M. tibialis anterior kiri
PEMERIKSAAN SEREBELUM.
INDIKASI?

KAPAN MELAKUKAN
PEMERIKSAAN SEREBELUM?

KELUHAN : GANGGUAN KESEIMBANGAN

(ATAXIA)
1. EKSTREMITAS ATAS
2. EKSTREMITAS BAWAH
Pemeriksaan Serebelum
• Syarat:
• Sadar baik
• Kooperatif
• Tidak ada kelumpuhan
• Terdiri dari:
1. Pemeriksaan tonus
2. Keseimbangan
3. Koordinasi
Pemeriksaan Tonus
• Hypotonus
• Test:
• Rebound Phenomena
Keseimbangan
• Tandem walking ROMBERG TEST:
• Romberg Test Kelainan serebelum à
mata buka jatuh kesisi
ipsilateral lesi.

Kelainan Proprioseptif à
- Mata buka dapat
mempertahankan
posisi
- Mata tutup jatuh ke
sisi ipsilateral lesi
Koordinasi
• Dismetria :
• Finger to finger
• Finger to nose
• Disdiadokinesia :
• Pekerjaan ulang alik
RINGKASAN
Pemeriksaan kekuatan otot lengan
Pemeriksaan otot tungkai
Pemeriksaan serebelum
Semoga bermanfaat,-