12. DISEASE HISTORY STRENGTH DEEP TENDON REFLEX SENSATION WASTING Myelopathy Trauma, infection, cancer Normal to decreased Increased Normal to decreased No Motor neuron disease (ALS) Progressive difficulty swallowing, speaking, walking Decreased Increased Normal Yes Neuropathy Recent infection Ascending weakness Normal or decreased Distal > proximal Decreased Decreased Yes Neuromuscular junction disease Food (canned goods) Tick exposure Easy fatigability Normal to fatigue Normal Normal No Myopathy Thyroid disease Previous similar episodes Decreased Proximal > distal Normal Normal Yes