What motor level function has hip flexors, adductors, knee extensors, ankle dorsiflexors, and toe extension; may still need AFO but likely no AD?

• A. L4
• B. L5
• C. L3
• D. S1-S2

Answer: (C)

In motor level assessment, the level is defined by the most caudal key muscle group that has at least 3/5 strength (active movement against gravity). The relevant myotomes here are hip flexors and adductors (L2-L3), knee extensors (L3-L4), ankle dorsiflexors (L4-L5), and toe extension (L5). Among these, the lowest level that shows functional strength is the knee extensors at L3. Although ankle dorsiflexion and toe extension (L4-L5, L5) may be present, they do not move the motor level below L3 because the knee extensors at L3 are the most caudal key muscles with adequate strength. This is why the motor level is L3. In terms assistive devices, an ankle–foot orthosis may be needed to manage limited dorsiflexion and prevent foot drop, but a separate walking device (like a cane or crutch) is less likely to be required if knee and hip function are adequate for standing and gait with orthotics.