Examination for signs of proximal muscle weakness includes:

• Watching for abdominal breathing or accessory muscle use
• Evaluating for head lag when pulled to sit (also note biceps resistance- failure of child pulling back when pulled to sit)- or inability to voluntarily flex neck when supine
• Evaluating whether child “slips through the hands” when held suspended (examiner’s hands under the armpits)
• Stimulating foot and evaluate force of withdrawal movement
• Watching for difficulty rising from floor (including Gowers maneuver, full or modified)

On exam, look for muscle hypertrophy or atrophy, particularly calves and tongue (calves may also feel abnormally full).

See the “Motor Assessment by Age” surveillance aid for more information.

Other physical findings may help distinguish neuromuscular disease (peripheral cause, such as Duchenne muscular dystrophy) from diseases of the brain (central cause, such as cerebral palsy), as shown in the table that follows. The table that follows shows general guidelines, though evaluation requires use of clinical judgment related to the child’s overall developmental history.

      To view Peripheral signs of weakness click here.