Examinations
The motor system examination allows to quantify the degree of motor function impairment and often to differentiate between central and peripheral lesions. The motor examination involves examining the following and comparing both sides to note abnormalities:
- Bulk and nutrition of muscles.
- Tone of muscles.
- Power of muscles.
- Reflexes.
- Coordination of movements.
- Involuntary movements.
- Gait.
Wash your hands
- Introduce yourself to the patient and clarify their identity.
- Explain the procedure you about to perform and obtain consent.
- The upper body should be exposed for this examination.
- Initially, observe the patient’s arms, look for any muscle wasting, fasciculations or asymmetry.
Motor Function
UMNs Transmit impulses from cortical nerve bodies to:
- motor nuclei in brainstem (CNs)
- Anterior horn cells of spinal cord
LMNs Transmit impulses from anterior horn cells through anterior root into peripheral nerves
- Terminate at the neuromuscular junction
The assessment of motor system is considered under following headings.
- Inspection and palpation of muscles
- Assessment of tones
- Examination of reflexes
- Testing movement and power
- Testing co-ordination
Motor Function
Inspection
- symmetry
- muscle bulk
- size and contours
- flat or concave; unilateral or bilateral; proximal or distal
- atrophy
Palpation
- muscle tone
Percussion
- ? fasciculations; Looks likes irregular ripples or twitches under the skin overlying muscles at rest commonly seen in LMN lesions. Â They may be benign (physiologic) or drug induced (cholinergic). Â Check motor strength
Body position
- during movement and at rest
Involuntary movements
- location, quality, rate, rhythm, amplitude
- relation to posture, activity, fatigue, or emotions
Causes of atrophy
- motor neuron diseases
- disuse of muscles
- rheumatoid arthritis
- protein-calorie malnutrition
Causes of decreased muscle tone
- disease of PNS
- cerebellum dysfunction
- acute spinal cord injury
Other Videos
fasciculations
Abnormal Movements
