ABSTRACT
First-degree relatives with relevant familial diseases – Muscular dystrophy, spinocerebellar degeneration, Huntington's chorea and diabetes mellitus. Walking – Initiation, gait symmetrical, size of paces, posture, arms swing, turning, speed, fluency of stepping, stride length, distance between feet (base), inspect the patient's knees, pelvis and shoulders. The peripheral nervous system examination includes: Have the patient sitting up in the examination couch or chair. Expose the patient's upper and lower limbs. Ask the patient whether they have any pain. Remember the anatomy of the spinal cord tracts: Descending pyramidal tract – Corticospinal tract (i.e. arm/leg weakness [UMN]) Descending extra-pyramidal tract – Rubrospinal/Vestibulospinal (i.e. ataxia) Spinothalamic tract – Pain and temperature sensation, Dorsal columns – Light touch, proprioception and vibration sense, Autonomic pathways – Bladder and sexual function. And remember the spinal nerve is a mixed nerve: Sensory root Specific dermatome sensory deficit (pain, temperature, light touch, joint position sense [JPS], vibration and co-ordination).
