Neuro UL & LL Examination Tutorial Recording



This on-demand teaching session is perfect for medical professionals looking to enhance their understanding of tonicity, reflexes and sensation tests, as well as patient-driven bed movements and power tests. With step-by-step instruction, this session will equip you with the know-how to accurately assess tone, reflexes, and sensation while improving patient comfort. This session will guide you through the different types of tonicity and the lesions that each cause. Additionally, you will gain knowledge on the biomechanics of power tests, including those of the upper and lower limbs. With practice questions included, this teaching session is sure to provide you with the skills needed to assess and evaluate patients.
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Learning objectives

Learning Objectives: 1. Describe the basics of an examination of muscular tone, power and sensation. 2. Demonstrate the proper hand positioning when assessing the upper and lower limb for tone, power and sensation. 3. Explain the difference between upper and lower motor neuron lesions. 4. Demonstrate the ability to compare the findings between one limb and the other to identify abnormalities caused by pathological lesions. 5. Demonstrate the ability to identify patterns of abnormal muscle tone, power and sensation in patients with neurological pathology.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

so the structure of your limits, Um, so you'll be asked to do the tone power reflexes sensation on. Then afterwards, you'll have two minutes off follow up questions. So that's when we'll go through the MRI's and everything else on this is again ck's or promise that example. So you won't need to know the exact border of everything. But you will need to know how to do it within on the little prompt you to do certain things. So your introduction. So this is the same as all your other CP A stations. Your introduction is really important on the easiest way to just pick up a lot of marks. So you want to start off by making sure you've got the ppd and washing hands. You know, introduce yourselves to say your name, your roll on what you're gonna be doing today, and then you want to check the patient details. So that's their name and date of birth gain consent. So here you want to make sure that you tell them what you're going to be doing, So this is a limit exam, so you'll need to be manipulating their arms, asking them to move against resistance, Then you're going to be tapping on them to test your reflexes and then using a constable to test the sensation of the end. So I made sure that you tell them that on then they can give you proper consent, just all skin of third cable. So for the exposure, as I said, there's gonna be sensation and this, so you need to make sure that that bad from the shoulders down or for the legs and that they're wearing shorts just let you Kentucky their legs on. Then the position of off the bed needs to be a 45 degrees on. Then at the end, just ask for the patient comfort, and it's important to ask if they're in any pain, because when you're moving them about, you don't want to cause any discomfort so toned. So what is tone? Well, your muscles are constantly in a state of partial contraction, even at rest on. This is what we call tone. So it was to assess your tone. You need to passively move the patient on. You want to get them to completely relax so that you can completely move their muscles for them on as you go from one home, so the other one leg to the other, and you just want to constantly compare. And then this way you can tell if one has more or less tone compared to the others in your upper limb. You'll need to test that three points. So the first one is the shoulder on this, where you want to move the metal plate single emotion and then, once he got on for months, older goes to the next. The same with Albert, So it's a flexion and extension, so you just wanna carefully bend on, extend the arms so off gently and just you know what you're doing and then just go for a few times and then you'll get a feel for what the tone is like in your lung on then in the wrist, you want a deflection extension, and then you also want to twist at the rest. It's not still pronation on Super Nation, and if there's increased tone or hyper Tonia, then the joints will feel stiffer on don't feel a bit more rigid and hard to move on. If there's decreased tone or Hypo Tonia in the Joints would be much more free, and she'll feel like there's very little resistance. So which move about really easily in the lower limb? You want to test the hip by doing the leg roll, so you want to roll their leg from the upper leg around the knee, and you should see that for also begin to roll with but independently on just a little bit point. So if there's increased tone, then the foot will seem really rigid on. I'll move more or less. At the same time, there won't be any delay. And if there's decreased own than foot, will move much more freely and or pretty much flap about, start taking self This hypotonia with all of these, the way you really get a feel for how much tone is, and that is by just doing on multiple patients. And then you can really get a feel for what normal tone is like ongoing for the knee you want to solve. Make sure that the knees nice and loose, so just put up a little bit on. Then you want to quickly pull up the whole night, and you see that the hell will remain in constant on interaction with the bed, and if it does come off the bed, that means that there's increased tone or hyper Tonia. And then that is a sign on that something wrong. Or they could be a lesion. And then you want to meet the ankle so you want to move that ankle in a civil emotion again, similar to the shoulder just all around in a big circle on. Then, once you've gone from ankle goes on corn circular motion. You want to go straight to see if there's a clonus. So this is where once you're moving it, you want to suddenly stop and push it up. Um, they shouldn't be a clonus in the patient at all, but if there is, then the foot will spontaneously move up and down and so off flat in your hand, and so that again, that shouldn't be there in a healthy patient. But if there is a clonus, then is a sign that there's a lesion. So what? The different types off tone fine on what could be caused by these lesions. So hypotension is called bi lo. Most neuron lesion on this, basically, because you're limiting your on's create the the tension in the muscle. So if there's something wrong with those, then the muscle feel very relaxed on in Hypotonia, it's caused by an upper motor neuron lesion. Bliss is because your up most insurance will have a new inhibitory of bets on the low most neurons on. When this is gone, the muscles will feel much, much safer. And then your ankle clonus is also caused by an upper most neural Asian. On this is off the descending motor pathways. You got a few practice questions here just all about toe. So if you could put your answers in the chap, I'll be great and then I'll just have a look. Eso What type of lesion will cause a high degree of flexibility in the elbows? You could just put any answers in the chart, and then you can you're just see that. And I'm not going to you quickly. Yeah, I can see a low most in your allegiance. Anyone else? Does that sound agreeable? Disagree? Yeah, if you if you have been low most of your religion, so that is correct. What would cause the closest to be present? Yeah, it's a up, um, it's in your relation So now we move onto power. So here's where you basically want to move the patient on. Do you're gonna ask them, Teo, move their own muscle this side on this time, you're gonna have a bit of resistance just so you can see how strong their muscles are. Eso When you're doing this, it's really important that you stabilize their joints on that. You make sure they're only using those muscles being assessed. Otherwise, if they do have muscle weakness, that could be compensating for this using other muscles. So it's really important that you hand position is in the correct place for this Onda again compare both sides and then you can tell if there's any power loss. So on the left there's a table on. But it's all the palace for so 025 on. It is really important that you know this, but in your CPA, you should have healthy patients, so they should all have five hours five power on there. I put it in men so that you're aware that and if there is muscle weakness, you can sort of see the power school for this. So in the upper limit, you wanna do shoulder abduction on Adduction. So what you told the patient because you wanted to be very friendly, patient, friendly in terms of information. So you just say please arms up like a chicken like this. Then like in the picture there on, then don't be pushing down. Or if you're doing shoulder adoption, push down against me on a put the lives in there because it is important to know which muscles being innovative by which nerves. Because if there is a muscle weakness for shoulder abduction, for example, then you know that that could be something. Along with the exhilarating eso is important to know, you know as well for reflection on extension. So you want to tell the patient to put your arms in front of you like a boxer on. Then reflection pulled towards he from for extension away from you so he can see that reflection. You want to put your your other hand on their biceps. So this pretty reasons one you make sure that they are only contracting their biceps and not moving the whole shoulder up because if you're saying to pull them towards you, that could move the whole shoulder up towards you on the national test in the biceps. So you wanna make sure that he has that, not They're not completely running towards it. The other thing you want to do is put your hand on the biceps and so you can feel for the contraction the same. But opposite through the elbow extension, you want to put your hand on the triceps so they're not moving the whole shoulder down on. Then you also want to make sure you can feel the contraction and, again importance know the nerves so they don't know for elbow extension, because that's the triceps on muscular detainees on really knows the reflection. And then you need to do risk election know extension on the way you do. This is you just tell them to make a fist with their palms up, was in front of you, and then you want to use your fist to push down. And so it's important that you use, like, like so that you can tell that the rest are either week or stronger than yours. And again, just by doing more patients and more people in general, you'll get a feel for normal rescue actually, should be like, then on the lower limb you want to test for hip flexion and extension. So for him, for both these, you want to tell them to keep their leg straight on. Then you want to put your hand on their quadriceps reflection on acid to push up against you on them for extension. You want to tell them to keep your leg up on, then push down against my hand and it get hard. Position is really important here, So you want to put your hand on the quadriceps for hip flexion, and then that way you can tell when they're leaving up on Do you don't want to put it below the knee? Otherwise, it could be just using other muscles. Do you want to make sure that you're limiting their muscle movement to just the hip flexes again for extensive Put your hand on their hamstrings and then you can just feel for the hip extenders and the knee flexion and extension. So you wanna get your patients, you bend both the knees on. Then you want to make sure that you're pulling against, say day, Let me straighten your leg on. This is the knee flexion on you want to put your hands on the back of the thigh on? Because when they are trying to straighten your leg, that could be used in the head extenders to you wanna make sure that they're not using this on Get this is that it never began really important to me than it was in case example wants you to tell them at the end on then the extension, the same against. So you wanna put your hand on from on the front ship? I'm just say, kick your legs out towards me on. Then you want to make sure that you can feel the quadriceps contracting there. Then I'm called dorsiflexion Implants of action. So Dorsiflexion is when they moved there for up on. So you want a hand on top and saying, Can you move your foot into my hands on, then push you down? Push your foot down into my hand for plantar flexion again important to make sure the rest of their legs they're still in there just moving at the ankle. Otherwise it could be compensated for this unlearned. Most of yours were both present with weakness is quite hard to tell the difference. But there is a difference on that's that up. Most of your own lesions have what we call parameter, passing off weakness. So this means that you're a pill in the extensive will be weaker than the flex is, so your triceps will be week, then your biceps on the opposite is true in your lower limbs, so in your legs, your flexes will be weaker than your expenses. In Lomotil your allegiances much more simple, just walking called focal pass enough weakness, so only the offensive muscles that directly innovated will be affected. So, for example, there's an issue with one of the nerves. Only that must will be affected and not the other ones is. That's that it was low, most in your religion's. So a few more questions if you put your answers in the chapel, is so what nerve is tested, really assess for shoulder abduction, and the answer is any guesses. Yeah, I've got C five and exhilarating if you have both right senses. Eso Where did you place your hand? One assessment for hip flexion by a simple one. So if you want to test him flexion that in there like up So where money. But you hunt yet on the quarter subs on what nervous testimony assess for and called dorsiflexion. This one's a bit harder, but five s one. Yeah, deep peroneal. So not s one bizarre for self. I realize, like on beer, it's now we move onto reflexes. So reflexes, you're just gonna be using a tendon hammer on. Do you just want a top on their tendons? So for this, you just want to tell them that you're going to be tapping on the arms and legs on. Just need them to be completely relaxed if they are contracts, and then the muscles will be really hard to elicit any reflexes. And the other thing is, this is quite hard. So as long as you have the right technique that the examining can see that you're probably going for So the correct technique is making sure that you hold the tendon hammer at the end, and then you just want to use gravity so you don't need to put any force into each from lift up on the loud, the tendon Hamiti swing under gravity and on if you do felt to you a letter, any replaces that's absolutely fine we can do is reinforcement believer on So rather than being there for ages, just if you're If you're unsuccessful the first two times. Just tell them the reinforcement believer. So this is there's multiple ones that you can choose. What is tell the patient is on the count of three. Could he clench your jaw when you go? 321 A clench on the same time you had that tender Onda, Um, it's important that you ask them to do this if you don't let any reflexes. But again, if you do this and it's still there, a lesser anything, that's fine. Least the examining. Conceivably, you did try and you've got the correct technique. So in the upper leg and there's three. So the first one is the biceps reflex. So this is C five C six on. You want to ask them to put their home across the body so it's completely relaxed on that they're not using any muscles. Then one. Locate the biceps tendon, so that's just put your thumb on the inside of their elbow on. Then you can feel it there on. Then you just want to tap your thumb with the tendon hammer and you'll see that they're arms sort of contracts up, and the next one is the triceps. So, Lord, to do this again, they should be completely relaxed. And you want to take the weight with that arm. Just want to hold it out to the side at 90 degrees on. Then this way it will completely extend the triceps tendon. Making easier Teo hitter on this will just be an inch above the elbow. Eso not quite as high as in the picture, but that's the correct technique for holding out for the side, and then you'll just be able to see that um, swings out a little bit. The next one is the supinator reflex, so this is a little bit harder on. It's on the lateral side. Just blow the thumb, and so it's a couple of inches below and come out your fingers or your thumb over that on. This is a breaker radio this tendon on. Do you just want to hit the your fingers such thumb with your tendon hammer and you'll be able to see that their hand sort of rotates and it's a little bit and again is. Don't worry if you don't get this. I I know I didn't. That's absolutely fine. It is quite a hard reflexes trying a letter on then in the lower limb. So first one is the patella reflex, says the you cancel the classic knee jerk reflex. So here's the patella tendon on. This is lt to help for you on also patients at the end of the bed with the leg stand freely, Make sure they don't touch the four. Otherwise, your idea to see the new job on been an inch or so below the tell a tendon. You just one tablet with the tendon hammer and you'll see that, like kick out on you probably done it before. It's quite that simple, and Achilles reflects. This was quite a bit harder. So this is, uh, Swan's s two on the way you do that is you want to make sure that their knee is bent 90 degrees on. Do you want the list on? Do plant off sort of dorsiflex there for missile. Completely stress now the Achilles tendon. And once this is done, you want to make sure that your hands on the sole of that fear. And then you hit the Kellys standing and she just feel them. So plantar flex generated your hand and again really hot today. But if you have the correct technique, then the examine it cannot be so you know. So what the pathology is that you might find with reflexes? Well, if they are hyper reflexic or have no reflexes, all then this is a sign for lower most in your allegiance. So as you know, the low most urine's needed notes for a reflex arc. So if there's an issue with these lower most in your, um and low, most in your arms, then the reflex all just want to be there on the don't really have a reflex or one B s strong. And for hyper reflexing, this will be uppermost in your allegiance, Lesions said. There's a loss of habit inhibitory signals from the upmost in your lesions. This will cause them to be exaggerated. Reflex is so normally your up, most neurons will send inhibitory signals down. But if there's an issue with these than there will be exaggerating group flexes. So a few more questions answers on the chart. So what tendon do you tap When you're elicit in the seat next to reflux, any guesses on your answer is get the breaking really all this, then what nerve roots are assessment. Elicit the patella reflex to your cellphone on what type of lesion would cause more exaggerated reflex is yeah up most of your allegiance. Eso is You do need to know what No bruise. Your assessment for the reflex is something that I always remember is so s one book on my shoes. So that's your Achilles tendon reflex I'll to sell four. Kicked the door. So let's see. Patella reflex C five c six pick up sticks. So that's your biceps reflex on C 78 keeping straight. So I still triceps reflex on, then see connected C six pack and further than that. So sensation. So this is where you're going to be testing the different dermatomes on. It's important that you know this so that if there has been in there that's affected, you can more or less single out quite easily. Della Tums have pain, temperature and like touch. But the CPA or needs to know like touch on the way to test this is using a cotton ball. So you want to start off by demonstrating with normal sensations like And do you want to touch that stand and say this What feels like When I touch your arms or legs? Just tell me it's a just by saying yes on. Then you want to go from one homes the other on, then constantly compare, and then you wanna make sure that it feels the same on both sides Before you start, you wanna ask them to close the eyes. Otherwise, that tacitly invalid, they're just say yes when they see you touch them, just important that they're closing the eyes on that they only tell you when they are in. The upper limb is quite simple, so the dermatitis is more or less. It's me around in a circle, so you start with C five and then get T two. So C five is the upper lateral aspect of the A lot on there and see six is a lush lateral aspect of the forearm or in the thumb. C seven's The Middle finger. See a little finger, t one the middle aspect of forearm on T t the Exelon. And so again in the picture you can see the dermatology don't overlap people. But you do. You do want to make sure that you're not testing too damn turns at once. But there are the wrong. Do you want to make sure you're not testing to dermatomes at once? So you want to touch the middle of the's? Dermatomes is That's what's really important that you just know exactly where you touched him and then the examination. See that you're testing properly in the lower limbs, so it's a little bit more complicated. So it's lt to s to they need to test L2 is the lateral aspect of thigh or three. The lower medial aspect off the side, Um, or even the name out for is the medial aspect off the leg. Them all fives the lateral side of the leg or middle three toes. This one's a little toe on s use the back of the upper leg and die. So again, you want to make sure that you test in the middle of these dermatomes and to avoid confusion with boundaries on the diagrams is out for you. Touch the big toe. I usually did. I just that you know that your big toe. Middle three on a little toe or L4 L5 s one, which is seven in your home on just literally spots rather than trying to get each time on. Then that way, you make sure they're going to test, um, a single damn term time. So this is a little summary on but nothing new on the slide. And just that you show what everything is. And so some more questions answers on the chat, as always. So what never is assessed when he touched the lateral aspect of four. Yeah. If you answer is coming in now. Yeah, C six Where you touched to you assess the as to you? Never. Yeah, but the upper leg on which never is assessment. He touched the hallux. Well, the big time. It's awful. We talked a lot about the uppermost in your lesions. Know, based on your own lesions, Caesar, Just a few examples and I'm not going to get into any detail about them, but is with just knowing some examples off them. In case at the end of three exam, they do ask you feel common causes or they give you a few signs and they ask you, What do you think could be the reason behind these on this is just the table which summarizes everything that we've gone through. So you could see up most of your lesions or cause their inspection. I don't think you're really Austin CPA to inspect the exam, but really do know, turn power and reflexes just cause. And you can get a lot of questions on these and it's important to just be able Teo know that in the backyard. So now we're going to move on to what? You could come up at the end of the exam. So is this a CT or MRI? Any guesses? Don't bit of the job on those of you that are observant of the beginning. They were gonna start talking about memorize. So, yeah, that was an MRI. So how can you tell the difference? Well, bone appears darker on an emery on fluid will appear lighter. Your memory is also a lot more detail than the CT. So here on the MRI, you can see indivisible Destin, everything and even the canal is on the CT. It's very basic. So how do they both work well and Emory uses magnets on this allies the protons, and then they get short waves off short radio with best of radio waves on bees. Just hit the protons out of alignment. Then, when these attend off, the protons jump back into alignment on, they send out the running radio waves which receiver picks up on. Then you can form in image Through this on. The different tissues will have different and realignment speeds and not produce different signals from each other. So that's how you can tell the difference between tissues and then CT's. Which one for your lot more familiar with there that was basically lows of factories from different angles or across the body. And then they can help create three D image, so em arise you do You get a lot more detail on that. Don't use radiation, but they're very expensive, and they take much longer today, so CT is usually a first line or is am arise will be used much more detailed things, or if there's pregnancy, then you don't want to give him radiation. You probably want to give them in them, right? So you guys reading Emery's so is just follow this especially spinal. Memorize so azo for alignment. So you want to look for any ligamentous injury, spondylolisthesis or spondylocladium spondylitis on? Do you want to look at the edges of Central Canal So unless you can see that it's nice and smooth. So this is a healthy Ameri. You can see it's nice and smooth, especially along the size of the canal, and that's what it should be like. He's for Bones. So, you know, look at the vegetable body, the pedic ALS laminate transverse processes, finds process is gonna have a look at all of that, and you can't see much of that list MRI. But if you're looking at it from different angles than you will be able to, unless you could just basically see if there's any sort of disease or any fractures or anything, which could be causing some issues, then for C is called, So you just wanna see if it's nice and it should basically looked like this. You want to assess for any lesions, edema, expansion of compression On day here, you can see that there's a spinal cord and you can see the CSF on either side, Which is that Brian White fluid that were on about on. So this is one should look like and then defeat disks. So you want to look and see if there's any sort of a bulge or herniation into the spinal canal on desk? They're usually what causes a no compression if you answer, but what pathology showed, um, any guesses that is already so slide right now. Noon. Just tell me. Just give you the answer. So it's a disc herniation. Um hum. Wears a lesion. Yes. Oh, spinal compression is correct. Is fine. A compression, but that's caused by just can initial about give you that. So where is the lesion? Um, quite hard to you. Count the vegetable level. Um, so C six last c seven I'll accept C five is quite a while to see exactly where it is. But according to the website, I found a C six slash seven. So we'll go on department, though. Will this patient have any upper or lower months in your allegiance symptoms? Which ones will they have? So a few people saying upper does anyone else would have the gas. Uh huh, Both actually. So they'll have lower most in your lesions in the upper limit on up most of your lesions in the lower lumbar. So this because, as we said so low, most of your lesions are everything the peripheral nervous system on upper are in the central nervous system. So they'll have Lomotil your allegiance in the upper lung because they'll have never compression never so appalled the PMS on then upper motor neuron, because it's still the spinal cord to CNS on the CNS is going down to the lower them at this point. So that shot both sides. Course you the other eso. Now we're gonna talk a bit more about disk and e a shin, so there's actually three types or brothers stages. Two disc an Asian, it's the first one is disc prolapse, and that's when the nucleus pulposus begins the former bulge, Um, but it still remains within the unless fibrous um, as you see their own image, then extrusion is a bit like once that further so the nucleus pulposus will break through. The annual is fibrous. They're still largely remain within the desk itself and Sechrest rations. It's basically gone away through, and it will completely separate, and sometimes it can and completely in the spinal canal on. That's where you'll see much more severe symptoms. What can actually cause herniations happen? Well, the main one is generative, so this is normal wear and tear. So as you get older ones, you do more wear or heavy lifting or cause analyst virus to weaken on. They're not making much easier. The nucleus pulposus to break through the second causes if there's sudden strain on the spine, and so this will allow the nucleus pulposus to break three down, inspire us on. This could be you're in a car crash or he left a heavy objects suddenly and then all of a sudden, you feel something or usually is both. So this degeneration so weak and man, it's fibrous. But then you have a sudden event which will then cause a lot of strain s so this could be triggered by sneezing. So usually that wouldn't cause anything. But if it's degenerated quite a bit, then it can it because a disc allegation. So now we just got a few questions at the end. Just test your knowledge. So what? Muscles are tested when the assess for Albert Flexion again just answers in the trap faster, right? Someone saying biceps? Any He knows this three. Yeah. Someone else said, break your less on a stick. Our your brachial. This is well and sounds for health reflection. Oh, can you stay two positive size that you'd find if you didn't up 11 examination on a patient, Most Parkinson's disease. It's a nice A few people have said Kabul Regency. You don't actually need to notice PCP. A beer. You're absolutely right. But while so what you find so out with the tone reflexes and power and sensation or well, from what you say, Yeah, so you'll see him hypotonia well increased tone that also be quite rigid when you move. No, um then hyper reflexive. So remember this and, uh, promoting your lesion and then weakness, eh? So they also have the parameter pattern off weakness be a year's. All right with that, Can you state three possible causes, often ankle clonus. Any other guess is once is eso Remember, ankle clonus is caused by up most of your lesions on, so these are just few. But there's a whole list. Yeah, you got You got quite a number of those. Yeah, And so now We've got a image. Latest place where no one that can tell me if this is an emery. A CT. Um, but the question is, what is your diagnosis? Yes, it's a CT. Um, what's your diagnosis? Yes, it's a estrogen. Um, extradural hemorrhage. So you can tell the difference between extra and subdural because extra drawers got the lemon shape on subdural banana tree. This is because it's yours are a arterial bleed. So we'll fill up much more quickly where a subdural is over a longer amount of time. So it's time to get around the inside the skull completely. See you guys a row with estradiol hemorrhage on the classic lemon shape here on what would be the associated symptoms? Eyes epidural. The same is extradural. Um, don't think so. No Sheriff of head of Napa. General hemorrhage. Um I mean, don't time away for it, but I don't think about head for natural hemorrhage. So, in terms of signs, what would be the associated symptoms if you're doing, like a CPA on them? So what? What would you say in their limbs? Yeah, So weakness. Still definitely weakness. Uh, yeah. Well, about the other bets off the exam. Yeah, someone's that left sided. So it's really important to distinguish. So as you can see on a CT, it's always taken from the foot up with a stiff. You're looking up the body. So this's this Bleeds on the right hand side so they have left sided symptoms. See, I did have weakness. Um, hyperten. Yeah. Onda, um hyper reflexive, remember, is hyper tone, you know, hypotonia because it's an up most new lesion. Then finally, on this an MRI just looked at them which off? The following signs would be seen in a patient with this MRI. So you can say, like, a B C D e r a. And on this most plans is so which one? Stephen there soon said, Oh, no, quite of not the lab. Someone said BNC is enormous in the nose. Got seeing a So I don't agree, Get form or answer and then I'll get through it and explain it. Last three. Okay, so they'll get muscle weakness in the arms and hyperreflexive. So you have said see, any is correct. Um so hypertension in the arms so they wouldn't get this because hypertensions and up most in your allegiance on down This spinal compression would cause a low most in your own lesion in the upper limbs. Um, hyper reflexing in the legs. So again, hyperreflexive is caused by a low mason. Your lesion on this is an up motion, your allegiance. So they wouldn't be hard. Perfect in their legs. They get hyper reflective muscle weakness in the arms. Yet they're definitely get that circulations in the legs. No, that's a low most in your lesion. But this spinal compression would cause an up most of your lesion in the legs so they wouldn't get fasciculation on hyper reflexing in the arms. Yeah, they would get up because hyper reflexive again is caused by low. Most in your religion on this one definitely goes along with the relation. So that's the end of the lecture. Um, I'm sure you guys have a lot of questions. Um, I'll just go with the cavity because I think you won't say them, But also here on, then, if you've got any questions at the end, do you let me know? All right. Thanks dot column. Um, So I'm just gonna put the links again for the feedback for this session. so if everyone could fill out those, um, feedback forms, um, for this session, that great on do? Yeah. If anyone has any questions, please feel free to put in the trap. Or if you prefer on you and ask the questions, Callum, you're all right with that, or would you prefer in the trap? No. No. Yeah, you can definitely on me or in the chat as well, either. Um great. Yeah. So, um, as soon as everyone's filled out the the feedback forms, Um, yeah. Please feel free to occur as soon as you feel that heat back forms. Um, well, the lecture be shed. So my understanding is we're going to share of I the metal platform on. Done. Um, definite is going to look into that. So mind standing is it will be should Yeah. I think you get a copy of that one. If you filled out the feedback for me, I could be wrong with that. And please do not. Yeah, yeah, yeah. And my experience, I think whenever we use metal, that's usually why we're using metal. Just that, Like, as soon as they get finished off the feedback, they can get access to it. I didn't cry. If anyone has in questions, please feel free to ask was Well, Kalam's more than happy to answer what I always Yeah, this is Would you explain? Especially again? Yeah, sure. Um, So here. So this is, um, what we're talking about before with the first MRI. So this is a spinal compression caused by desk herniation. And so this discrimination, this is in the survival spine on the nerve roots from here. Basically go to the upper limbs on. Do the rest of spine will go all the way down the body on also end up for the lower end. So when you get a spinal compression the nerve roots that gets the upper limbs because the never use our peripheral nervous system, they will get, um, thesis eyes of Flomax new lesion. The rest of spondylitis still been compressed on the spinal cord itself is in the, um, central nervous system. And so then the lower limbs will basically get up. Most neurologic signs. So here hypotonia in the arms. So hypotonia is caused by a low medicine so uppermost in urine lesion. So we said before that they would get low motive you're in size in the arm so hypotonia they will not get that. They'll get hypotonia, then hyper reflective in their legs. Again, Hyper flex is a sign off low most neuron lesions. There's a, uh, promoting your lesion in the legs so there won't be hyperreflexic here. They'll be hyperreflexic on. They'll get much more exaggerated on brief Lexus, and that likes muscle weakness in the arms. Yet they'll definitely get muscle weakness in the arms. Also, get muscle weakness in their legs because caused by both upper and lower, most in your allegiance and stick your Asians in the legs. So we set up for circulation. Is is a low, most in your allegiance. You definitely see that new CPA exam, but, um, by all means, just read the table before I'm just having no that again. It's very likely that you'll need to know about that if you see the exam. But it could definitely come up in your beer, so just know that anyway, on then, hyper flex in the arms. So he said, they won't be hyperreflexic in their legs, but that will be in the arms on. This is because the hyper flex here is caused by a low mason. You're a lesion on that will get low resting your relations in the arms. Um, merciful went through that secretly. Hopefully, that's helps. Um, if there's no, I've got my, you know, in the last side, he can, um, email me any further questions. Hours? Are there any other questions? I think we'll just We'll just stay on. It would just stay on for, like, another five minutes. Maybe they're just typing out the questions or something like, Yeah, absolutely. Also, if anyone for the for the next session is that the next section's going to be cranial nerves. Um, Andi, I'm digging that session. So there's a link. A swell for any questions for the next session. If there's specific unquestioned, like areas you'd like me to go through, please fill out that form. The link for that is also in the chart, so yeah. No, thank you. Thank you, guys. Thanks for coming. Do you have a link for the feed back for your, uh, um, feedback form should be on there. So the general CPA Serious feedback. The second link on the first link. Both our feedback warm. So the first Lincoln's feedback just specifically for this, and then the second is for everything. So the recordings will be made available later in, um so as, uh, as the feedback forms have been filled out will be making the recordings available. There's any further questions from please feel free to ask. I think that's all the questions Callum to know is I mean, you explained everything very well. So I'm going, I'm going to stop the recording, um