MOTOR EXAMINATION OF THE LOWER LIMB• Inspection - Ask the child to lie down on the bed and expose him to the pants with the legs and thighs fully exposed. Place a towel over the groin and inspect the lower extremity. o Posture – Note the resting posture. Look for abnormal flexion or extension, unusual rotation, clawing of the foot, or shortening of the limb. Always compare with the other side for more symmetry. o Muscle mass - Look for muscle wasting in the quadriceps and anterior tibialis and hypertrophy of the calf muscles. Compare one side with the other and proximal with distal (asymmetry). o Involuntary movements - Inspect for abnormal involuntary motor activity such as fasciculations, tremors, etc. catheter• Gait examinationThe functional assessment of the lower extremities is a very important part of the neurological examination. In some cases, this area alone is presented as an individual case during the exam. It is important to remember that normal stance and gait depend on the integrity of the visual, proprioceptive, corticospinal, extrapyramidal, cerebellar, and motor systems. The normal gait cycle has two phases: the stance phase, when the foot is on the ground; and the oscillating phase, when it advances. When assessing gait, both stance and gait (with various maneuvers) should be assessed. Before assessment, ask the child to remove socks and shoes and examine the shoe. o Position: Make sure the legs and thighs are clearly visible. Look for shortening of the limbs Position of the foot and knee – valgus/varus Stance width Romberg sign (refer to cerebellar examination) o Walking: ...... middle of paper ...... sole of heel upwards and curves inward across the sole of the foot medially before it reaches the toes. In children over one year of age, flexion of the big toe at the metatarsophalangeal joint is the normal response. The abnormal response, also called positive Babinski sign, is characterized by extension of the big toe and fanning of the other toes and is seen in an upper motor neuron lesion. Cremasteric reflex (L1-2): This reflex is NEVER caused in the review and is only mentioned here for the sake of completion. Ask the child to lie on their back, abduct and rotate the thigh outward. With a blunt object, stroke the upper and medial side of the thigh downward. The normal response is contraction of the cremaster muscle which moves up the testicle on the brightly stimulated side. • Functional gait assessment – ​​see above