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  "text": "Hi, my name is [PERSON_NAME] [PERSON_NAME]. I'm a [OCCUPATION] [OCCUPATION] [OCCUPATION]. Can I get [MEDICAL_PROCESS] first and last name and birth date? [PERSON_NAME] [PERSON_NAME] [DATE_OF_BIRTH]. Okay. I'm going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] medical record number. It matches. I'm going to wash my hands. And we're here for a [MEDICAL_PROCESS] [MEDICAL_PROCESS] today. Okay? So first we're going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] muscle strength. So I'm going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] biceps. First, [MEDICAL_PROCESS] elbows are going to be in flexion, and I'm going to have you pull against my hands. Now, I'm going to be pushing against my hands, checking [MEDICAL_PROCESS] triceps and extending extension at the elbow. Next, we're going to do wrist extension. You're going to make a fist and you're going to resist me pushing down on [MEDICAL_PROCESS] wrist. Okay, good. Next, we're going to do palms flat, fingers spread. This also works on the ulnar nerve. You're going to resist me pushing [MEDICAL_PROCESS] fingers together. Next, we're going to do thumb opposition. You're going to try to touch [MEDICAL_PROCESS] thumb to [MEDICAL_PROCESS] pinky, the distal part, and resist me pulling it apart. That works on the median nerve. Now I'm going to have you lay down. I'm going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So first we're going to check flexion. I'm going to have you lift up against my hand on [MEDICAL_PROCESS] thigh. Okay. I'm going to have you push down on [MEDICAL_PROCESS] posterior thigh of my hand. That's checking extension of [MEDICAL_PROCESS] hip. Now we're going to do abduction of the hips. I'm going to place my hands on [MEDICAL_PROCESS] outer knee and actually ask you to spread [MEDICAL_PROCESS] legs. I'm going to place my hands on [MEDICAL_PROCESS] inner knee and ask you to push them together. That's checking abduction. Now we're going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] knee. I'm going to support it in a flexed position, and I want you to make a straight leg and I expect a forceful response. So this involves [MEDICAL_PROCESS] quadriceps. Now I want you to resist me, straightening [MEDICAL_PROCESS] leg and keeping [MEDICAL_PROCESS] foot on the table. And I'm checking flexion of the knee. Okay. Now I'm going to dorsiflexion. So I'm going to have you pull up against my hand. And I'm going to check plantar flexion. I'm going to be pushed down against my hands. Okay. So I'm going to have you touch [MEDICAL_PROCESS] thumb, [MEDICAL_PROCESS] index finger, to the distal joint of [MEDICAL_PROCESS] thumb as fast as you can. I'm looking for smoothness, rhythm and speed. And we'll have you do the other side. Okay, good. Now I'm going to have you kind of hit [MEDICAL_PROCESS] thigh with [MEDICAL_PROCESS] palm and then the back of [MEDICAL_PROCESS] hand, making sure to lift up as fast as you can [INJURY] [INJURY] same spot. And I'd observe the other side as well. And now I'm going to have you hit my hand with the ball of [MEDICAL_PROCESS] foot. And I'm going to check the other side, observing rhythm and coordination. Okay, so now we're going to do port point to point movements. We'll start with finger to nose. So I want you to touch my index finger with [MEDICAL_PROCESS] index finger and then touch [MEDICAL_PROCESS] nose, making sure [MEDICAL_PROCESS] arm is fully extended. Okay, good. Now we're going to do finger to finger movements. So you're going to start with [MEDICAL_PROCESS] hand above [MEDICAL_PROCESS] head and you're going to come down and touch my index finger with [MEDICAL_PROCESS] eyes open. Good. Now you can close [MEDICAL_PROCESS] eyes. I'm going to watch that for a few times. Good. So now we're going to do knee to shin to toe cuff. So what I'm going to have you do is you're going to place [MEDICAL_PROCESS] heel below [MEDICAL_PROCESS] knee and slide it down to [MEDICAL_PROCESS] big toe and back up with [MEDICAL_PROCESS] eyes closed. And I'd have you do that on both sides. Okay, so we did muscle, nothing, alternating these legs. So now we are going to work on [MEDICAL_PROCESS] gait and as you walk across the room and turn around, just normal. I'm observing smoothness of the turn, arms swaying and balance. And now we're going to do tandem walking. So it's going to heel to toe in a straight line. I'm observing for any ataxic gaze, which you don't have. So good. And then we're going to do heel and toe walking. So you're going to walk on [MEDICAL_PROCESS] toes and then on [MEDICAL_PROCESS] heels, which show plantar flexion, dorsiflexion, the strength of her distal muscles and coordination and balance. And next I'm going to have you, you're going to hop on one foot and then the other foot. So is that. That can tell me if she has two [MEDICAL_CONDITION] that shows muscle strength in both the distal and proximal extremities and position of stance. And then the last one, you're going to do a shallow knee bend. And that shows me strength of her quadriceps, her proximal muscles. And if she wasn't able to do that, some alternatives she could do is stand from a sitting position without using her arms or step up onto a stool without Using her arms. Okay, so now we're going to do some [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So we're going to start with a [MEDICAL_PROCESS] [MEDICAL_PROCESS]. You're going to have [MEDICAL_PROCESS] feet together with [MEDICAL_PROCESS] eyes open. And then I'm going to have you close [MEDICAL_PROCESS] eyes. I'm going to watch this for [DURATION] [DURATION] [DURATION] [DURATION]. I'm going to stand by her just in case she might fall in normal swelling or not swelling. Swaying might be normal. So you're set with that. Now we're going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] pronator drift. So I'm going to have you stand with [MEDICAL_PROCESS] eyes closed with [MEDICAL_PROCESS] arms out like this. And a positive pronator drift would be dropping of the arm and then pronation, which she doesn't have. And now I'm going to push down on her arms and I'm going to ask you to return them back to where they were. And that shows good core coordination, balance, and function. So that finishes that. So you can have a seat. So now we're going into [INJURY] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So first we're going to do a [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So you're going to feel a dull touch and then a sharp touch. And I'm going to do this kind of on the proximal and distal portions of the [MEDICAL_PROCESS] upper and lower extremities and [MEDICAL_PROCESS] abdomen and chest. So I'm going to close [MEDICAL_PROCESS] eyes and tell me what you feel. Dope sharp. Dope sharp. And I would do here, but she's wearing a shirt. So let's get that sharp. Dope. Dope sharp. Okay, good. Next we're going to do light touch. So I'm just going to kind of touch you with this cotton swab. And you're going to tell me when you feel it. Okay. So you can close [MEDICAL_PROCESS] eyes. No, no, no, no. And I'd be going through upper extremities, lower extremities, and the same the abdomen. And I've compared sides. Did they feel the same on both sides? Okay, so now I'm going to do [MEDICAL_PROCESS] [MEDICAL_PROCESS] so I can have you lay down for this one. So first thing we're going to is just going to be see if you can feel vibration [INJURY] [INJURY] distal joint of [MEDICAL_PROCESS] big toe. So tell me when it stops. No. Okay. And then I've got the tuning fork. And now we're going to do [MEDICAL_PROCESS], which is position of sense. I'm going to move [MEDICAL_PROCESS] big toe either up, down, in, or out. And I'm going to move [MEDICAL_PROCESS] little other toes aside. And you're going to tell me which direct it is. Up, down, in, out. Okay, good. So now we're going to do [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So I'm going to do the [MEDICAL_PROCESS] [MEDICAL_PROCESS]. I'm going to stroke from the heel of the foot to the ball of the foot and the lateral aspect of the foot and then move medially. And a normal response would be plantar flexion of the big toe. The positive response would be fanning out of the little toes and dorsiflexion of the big toe. Okay, so normal, definitely. So next we're going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So outward from the umbilicus, I'm going to [MEDICAL_PROCESS] inward from both below and above. And the normal reaction would be contraction. And then the umbilicus would deviate towards the stimulus. And then the anal reflex, I would stroke outward in all four quadrants and look for contraction of the anus. So the next thing I'm going to do is I'm going to do discriminatory sensations so you can sit up. So the first one is sterongosis. So I'm going to place an item in [MEDICAL_PROCESS] hand with [MEDICAL_PROCESS] eyes closed and you're going to tell me what it is. And this can tell me if there's a [INJURY] [INJURY] [INJURY] [INJURY] [INJURY]. Okay? Okay. So the next one is grastesthesia. I can do this if she has [MEDICAL_CONDITION] or motor weakness in her hand. So what I'm going to do is I'm going to draw a number in [MEDICAL_PROCESS] palm, facing you with [MEDICAL_PROCESS] eyes closed and you're going to tell me what it is. Three? Yep. And then I do the other tongue. And if she was unable to tell me what it was, that'd be [MEDICAL_PROCESS], which can mean a [INJURY] [INJURY] [INJURY] [INJURY] [INJURY]. So the next one I'm going to do, this is going to be a [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Normal is under 5 millimeters. If it's greater than that distance that you can distinguish, that could be a [INJURY] [INJURY] [INJURY]. So I'm going to show you one point. So that's what one point feels like. And this is what two points feels like. So I'm going to close [MEDICAL_PROCESS] eyes and tell me if you feel one or two points. Two. Two. One. Okay, so she is three millimeters, which is normal. Next we're going to do, I'm going to check to see if you can identify a touch reflex. I'm going to close [MEDICAL_PROCESS] eyes, I'm going to touch a point on [MEDICAL_PROCESS] body, Then you're going to open [MEDICAL_PROCESS] eyes and Tell me where I touched. Okay, good. So now we're going to go into [MEDICAL_PROCESS] deep tendon reflexes. So first we're going to check. I'm going to tell you how to reinforce them. We'd reinforce them if you had absent and diminished symmetric deep tendon reflexes. And then so to reinforce them, you're going to clench [MEDICAL_PROCESS] teeth before I [MEDICAL_PROCESS] [MEDICAL_PROCESS] upper extremity reflexes. And then [MEDICAL_PROCESS] lower extremity, I would have you interlock [MEDICAL_PROCESS] fingers and pull them apart before I [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] in [MEDICAL_PROCESS] lower extremities. So first we'll start with clonus. I'm going to be laying down. Clonus is used to show hyperactivity of reflexes. Normal reflexes, too. Clonus would be four. So I'm going to support [MEDICAL_PROCESS] knee [INJURY] [INJURY] flexed position with one hand. And I'm going to rapidly plantar flex and dorsiflex the foot. And I'm going to sharply dorsiflex and hold it there and feel for any oscillations, which I don't feel. We're going to start with [MEDICAL_PROCESS] triceps from [MEDICAL_PROCESS] bicep reflex. So first things first, I'm going to have [MEDICAL_PROCESS] palm down and [MEDICAL_PROCESS] arm flexed as it already is. I'm going to place my thumb on [MEDICAL_PROCESS] bicep tendon and I'm going to [MEDICAL_PROCESS] my digits. So I'm looking for contraction of the bicep muscle and flexion of the arm. So now the triceps. I'm going to kind of place [MEDICAL_PROCESS] arm towards [MEDICAL_PROCESS] body and [MEDICAL_PROCESS] chest. And I'm going to [MEDICAL_PROCESS] just above on the elbow at the triceps. So right there I'm looking for extension of the arm. And now we're going to do the [MEDICAL_PROCESS]. So with this one, [MEDICAL_PROCESS] arm is going to be slightly pronated. And I'm going to [MEDICAL_PROCESS] 1 to 2 inches above the wrist. So with that, I'm looking for supination and flexion of the forearm. So moving on, we are going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So I'm going to find the [MEDICAL_PROCESS] [MEDICAL_PROCESS]. I'm going to. For the tricep reflex, I want to make sure she's sitting. And also for the ankle reflex, she's going to be sitting. So moving on to the knee, I'm going to [MEDICAL_PROCESS] the [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Okay, so I'm looking for extreme extension of the knee and contraction of the quadriceps. And I would do all these reflexes on Both sides. Now the ankle reflex. I'm going to make sure the foot's relaxed. I'm going to dorsiflex the foot and I'm going to [MEDICAL_PROCESS] the Achilles tendon. And I'm looking for plantar flexion of the foot. So that finishes deep tendon reflexes. So now that we finished that, we're going to go to [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So I'm going to lay down. So the first one we're going to check is a nuchal rigidity. Normally the neck is supposed. Have you had any [INJURY] [INJURY] or anything like that? No. Patient too touched. So I'm going to lift [MEDICAL_PROCESS] head to you and see if [MEDICAL_PROCESS] chin can touch [MEDICAL_PROCESS] chest. Okay, good. Next we're going to do [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So a positive [MEDICAL_PROCESS] [MEDICAL_PROCESS] would be flexion of the hip and knees. Normally, when her neck is flexed, those muscles should be relaxed. I'm going to do that and I'm serving a. Okay, good. So lastly, we're going to check on Koenig's side. So I'm going to flex the knee and the hip. And normally it can be normal to have some discomfort behind the knee. And a positive kernic sign would be pain and resistance against extension of the knee. So let me know if there's any pain. And if there was pain bilaterally, that would be suggestive of meningeal irritation. So I'm all set. It was nice meeting you. Have a great day.",
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