De Letter et al describe a clinical protocol for the examination of patients in the Intensive Care Unit (ICU) for critical illness polyneuropathy and myopathy (CIPNM). The clinical findings are used to derive a motor sumscore (summation of individual motor findings) which is used as on of the criteria for the diagnosis of CIPNM. The authors are from three hospitals in the Netherlands.


Clinical examination:

(1) motor weakness (motor deficit)

(2) muscle wasting

(3) sensory loss

(4) tendon reflexes


Motor weakness is scored from 0 (no strength) to 5 (normal). The precise scale for scoring is not described; for the implementation I will use the MRC scale for muscle power.

Muscle Strength


no contractions


flicker or trace of contractures


active movement with gravity eliminated


active movement against gravity (but not resistance)


active movement against gravity and resistance


normal power



If the muscle weakness is asymmetric, then the more affected side is graded.


For a cooperative patient 6 muscle groups are evaluated:

(1) deltoid

(2) biceps

(3) wrist

(4) iliopsoas

(5) quadriceps

(6) foot


For an uncooperative (not able to cooperate) patient 2 muscle groups are evaluated:

(1) flexion at the elbow

(2) flexion in the hip


motor sumscore =

= SUM(points for all motor groups evaluated)


Tendon reflexes are described based on the global assessment:

(1) increased

(2) normal

(3) decreased

(4) absent


The authors also performed electrophysiologic testing, which will be included in the next section.



• minimum motor sumscore: 0

• maximum motor sumscore for a cooperative patient: 30

• maximum motor sumscore for an uncooperative/unconscious patient: 10


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