EXAMINATION OF MOTOR SYSTEM Motor system examination is done under the following headings, i) ily iii) iy ” vi) vii) 1) 2) Bulk and nutrition of the muscle The state of muscle of muscle tone Power of the muscle Co-ordination of movement Presence of involuntary movement Reflexes Gait BULK AND NUTRITIO; OF THE MUSC LAND NUTRITION OF THE MUSCLE limbs for wasting & atrophy. Compare the two sides of the muscle of the Wasting may be: 1) Generalized 2) Localized Generalized wasting: this is present lower motor neuron lesion, cancers & tuberculosis ti jpoealized wasting: this is present due to injury or disease of joint, Group of muscles may show localize wasting duc to disease of muscle called myopathy In myopathy muscleg of calf, shoulder or buttock are particularly affected 's present in healthy muscles, Tone may be Tone is a state of tension or contraction th ied hypotonia, whereas , increased toneis increased or decreased. Decreased tone is cal called hypertonia. Causes of bypotonia or flaccidity Lower motor neuron lesion Unconsciousness Cerebellar lesion (08)Causes of hypertonia: Upper motor neuron lesion Lesion of basal Banglia(Parkinsonism © Hysteria In lower limb: passive fl joints, ®xion and extension is done at metatarso Phalangeal , ankle Thete are two principal types of hypertonia: i) Spasticity i) Rigidity ') Spasticty: itis a velocity. dependent to passive movement (itis detected with quick movements) & it is a feature of upper motor neuron lesion, It is usually accompanied — by weakness, hyperreflexia, an extensor plantar response & sometimes loaie Ieeuin forms it is detected as a “catch” at the beginning or end of passive movement Bria ah Severe cases it limits the range of movement possible & may be associated with, ray contractures. In upper limbs it is more obvious on attempted extension & in ower limbs. fe it is more evident on flexion, etc, ii) Rigidity: Its a sustained resistance throughout the range of movement is more detected when the limb is moved slowly. In Parkinson’s disease this is Aeseribed as “lead pipe” or “plastic rigidity”, In the presence of tremor thre may b regular interruption to movement giving it a jerky feel. This is “cog CLONUS f the museles. It Itis a rhythmic series of contractions evoked by a aia es. healthy individuals spontaneously when they are red of app When a upper motor neuron lesion and is accompanied by sP MUSCULAR POWER: age, occupation, whether or not the itty Power varies with ne Power is tested by asking the patent 9 DringThe following Movements will be performed in upper & lower limb to check the p Shoulder: abduction, adduction, flexion & extension. Elbow: lexion & extension Wrist: flexion & extension F abduction, adduction, flexion & extension. Thumb: extension, opposition In lower Ii Hip: abduction Knee: flexion & extension Ankle: dorsiflexion, plantar flexion, inversion & eversion of foot. Large toe: extension (i.e. dorsiflexion) GRADING OF POWER 0 No muscle contraction visible IT Flicker of contraction but no movement 2 _|_ joint movement when effect of gravity eliminated 3 _|_ Movement against gravity but not against examiners resistance 4 | _ Movement against resistance but weaker than normal 5__|_ Normal power DEFINITIONS OF PARALYSIS Paresis Weakness or Partial paralysis Complete paralysis Involvement of one limb Involvement of one half of the body Paralysis of the leg Paralysis of all four limbs (10)» CO-ORDINATION OF MOVEMENT Itis the ability to intact sensory ag well ar eames movement Smoothly and effi mr ‘ently. It depends Upon TEST IN UPPER LIMB 1) _Finger-nose test Ml) _Finger-finger test TM) Making a circle in air IN THE LOWER LIMB §) to walk ina straight line i) _heel- knee test i) Romberg’s sign Details are given in “Examination of cerebellum” PRESENCE OF INV¢ involuntary muscular contractions: The muscle may be in a state UNTARY MOVEMENT There are various types of spasm. The spasm may be tonic oF clonic. Tonic: when the contraction is continuous. Clonic: when the contraction is in series. Other involuntary movements are Tremors: these are rhythmical oscillations of a part or parts of limb: These are of following : i detected 9) Batman os ro thn ase ‘over the stretched extended fingers an if) Coarse tremors: these are presen! in parkinsonism. These are also called “pill rolling” movements. : in head, hand & legs. it id patients and are seen in iit) : these are present in © uy a ea inh cle ts eh aaa “Inlensity when one tis 10 s0P 2