| Course | PA 528 Comprehensive Clinical Module Neurology |
|---|---|
| Week | 4 |
| Paper type | Motor neuron brief |
| Length | About 660 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 528 Week 4
Motor Neuron Brief: An Upper Motor Neuron Pattern in B.T.'s Left Limbs Despite Low Tone on Day 2, With Brisk Reflexes, an Upgoing Toe, No Wasting and Face and Arm Weaker Than Leg
Student Name
Chamberlain University
PA 528: Comprehensive Clinical Module Neurology
Instructor Name
Month Day, Year
Motor Neuron Brief: An Upper Motor Neuron Pattern in B.T.'s Left Limbs Despite Low Tone on Day 2, With Brisk Reflexes, an Upgoing Toe, No Wasting and Face and Arm Weaker Than Leg
Verdict: Upper Motor Neuron, Acute Phase
Tone
On day 2, tone in the left arm and leg is reduced: the arm falls loosely when lifted and released, and passive movement meets little resistance. On its own, low tone suggests a lower motor neuron problem. In an acute lesion of the upper motor neuron, however, tone is often low for days to weeks before spasticity develops, a phase sometimes called cerebral shock. This finding favors neither pattern alone and is read in light of the others.
Reflexes
Biceps and knee jerks are brisker on the left than on the right, graded 3+ against 2+, and the left plantar response is upgoing. An upgoing plantar response is a sign of corticospinal tract dysfunction and does not occur with peripheral nerve or muscle disease. These favor the upper motor neuron pattern.
Bulk and Twitching
No wasting of the left arm, hand or leg compared with the right, measured at the forearm and calf. No fasciculations seen over five minutes of observation. Wasting and fasciculations are features of the lower motor neuron, and their absence favors the upper pattern, although wasting would not have had time to appear in two days in either case.
Pattern Across Limbs and Segments
Weakness affects face, arm and leg on one side, with the arm weaker than the leg, and within the arm the extensors weaker than the flexors, the pyramidal distribution. A lower motor neuron lesion would follow a nerve root or peripheral nerve, affecting a few muscles, not a whole side from face to foot. This favors the upper pattern strongly.
The Finding That Disagrees
Low tone is the only finding that seems to point the other way, and it is explained by the timing. In the first days after a stroke, the loss of descending input can leave muscles slack before the stretch reflexes become overactive. Brisk reflexes and an upgoing toe, already present, show the reflex arc is released from control even while tone is still low. Spasticity is expected to develop over the coming weeks, and its arrival will be recorded.
Sensory Findings in a Motor Brief
B.T. also has reduced pinprick and position sense on the left side of face, arm and leg. A brief about motor neurons might leave this out, but it helps: sensory loss on the same side as the weakness, including the face, points to a lesion above the brainstem, where motor and sensory pathways run close together. It argues against a pure motor neuron disease, which spares sensation.
From Pattern to Possibilities
An upper motor neuron pattern of sudden onset in a 67-year-old with vascular risk factors is most likely an ischemic stroke, which the CT angiography supported with an occluded branch of the right middle cerebral artery. Other causes of the same pattern include a bleed, excluded by CT; a tumor, unlikely given the sudden onset; and a postictal weakness after an unwitnessed seizure, unlikely because the weakness has not resolved. The secondary prevention guideline frames the workup that now follows, including heart rhythm monitoring and carotid imaging (Kleindorfer et al., 2021).
Measurement for Follow-Up
Strength by the Medical Research Council scale and tone by the modified Ashworth scale will be recorded at day 7 and at discharge, so the change from low tone to spasticity, and any recovery of strength, can be tracked. The guideline supports early, structured rehabilitation once the patient is stable (Powers et al., 2019).
References
Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Jr., Turan, T. N., & Williams, L. S. (2021). 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke, 52(7), e364-e467. https://doi.org/10.1161/STR.0000000000000375
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344-e418. https://doi.org/10.1161/STR.0000000000000211
What the PA 528 Week 4 assignment asks for
The fourth week asks for a short, headed brief deciding between an upper and a lower motor neuron pattern. Put the verdict in the first heading as a phrase. Then give four short blocks: tone, reflexes, muscle bulk with any visible twitching, and the pattern of weakness across limbs and segments. Close each block by saying which pattern that finding favors, so the document reads as a tally. If one finding disagrees with your verdict, give it its own section and explain it rather than leaving it out. If the case includes sensory findings, explain what they add to a motor question. Finish by moving from the pattern to the likely causes, and say how the findings will be measured at follow-up. Cite the guidelines you rely on.
Inside the PA 528 Week 4 example
The verdict, upper motor neuron in the acute phase, sits in the first heading. The tone block reports a slack left arm on day 2 and explains why low tone alone favors neither pattern early on. The reflex block records 3+ reflexes on the left and an upgoing plantar response. The bulk block notes no wasting and no fasciculations over five minutes. The pattern block describes face, arm and leg on one side with pyramidal distribution in the arm. A disagreeing-finding section explains cerebral shock and expected spasticity. A sensory section uses same-side loss including the face to place the lesion above the brainstem. Causes are sorted, with stroke supported by the angiogram and the secondary prevention guideline cited, and follow-up measures use the Medical Research Council and modified Ashworth scales.
Reading the PA 528 Week 4 grading rubric
The marking on this brief begins with the verdict in the first line; a brief that withholds its conclusion until the end loses heavily. Each of the four blocks must end on the pattern it favors, and blocks that only describe are marked down. Faculty give significant credit for handling a disagreeing finding openly; hiding or ignoring it is a common and costly error. Sensory findings earn marks when used to refine the level rather than listed. The move from pattern to causes is graded on whether the causes fit the pattern and the time course. Follow-up measures should name recognized scales. Precision of terms, such as distinguishing fasciculations from tremor, matters. Cite sources for any clinical recommendations.
PA 528 Week 4 help: mistakes that cost points
Briefs like this often lose marks by burying the verdict or skipping the finding that does not fit. Send your examination findings and timing, and a brief built on them would lead with the verdict, then work through tone, reflexes, bulk and pattern, each closing on the side it favors. Any contradictory finding gets its own explanation. Sensory findings are used to sharpen the level. The causes that fit the pattern and onset are listed, with your case's test results applied. Follow-up measures use the scales your program teaches. If your patient's pattern is lower motor neuron or mixed, the tally reflects that. Make sure every finding in your brief comes from your own case before you submit.
Get a PA-528 Week 4 example written to your instructions
Send the case exactly as your classroom issues it, with the rubric, and a custom motor neuron brief written to it comes back inside 24-48h, the first at no cost. If the assignment is built on a patient you met during a rotation, send the wording of the task rather than anything identifying; the example is written on the described findings alone.
More PA 528 papers and MPAS samples
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PA 528 Week 4 questions, answered
The case gives reflexes but no comment on bulk. What does the example do?
It says so in writing and works with what it has. Recording a finding as not documented is different from leaving it out, and graders read the two differently. The example states which parts of the decision rest on missing data, then names bulk as the observation it would want next and what each possible result would settle.
Is a table of upper against lower motor neuron signs worth including?
Where your instructions call for one, yes, and even then it belongs beside the argument rather than instead of it. A table describing the two patterns in general is textbook material and earns little. A table filled with this patient's findings, one column per pattern and a tally at the bottom, is doing the work and is marked accordingly.
Can the brief name a specific disease?
Usually it can, at the end, and the order matters more than the name. A condition arrives as something the settled pattern makes possible, with a sentence saying what else would have to be true. Where your classroom wants a single answer, the example gives one and still shows the pattern work that produced it, because that reasoning is what the rubric rows tend to measure.
Where can I find a free PA 528 Week 4 sample paper?
The full PA 528 Week 4 motor neuron brief is on this page, an upper motor neuron verdict reached despite low tone on day 2.
Why is tone low in the PA 528 Week 4 sample if the lesion is upper motor neuron?
In the first days after a stroke, loss of descending input can leave muscles slack before spasticity develops, while brisk reflexes and an upgoing toe already show the tract is damaged.