| 250 | Unit ts Human Experiments NO PY 10.11] (C) Examination of the Motor System tl ] or system The examination of the motor system inchices 1. Bul 2 Tag of muscles Strength (or per) of muscles 4, Reflexes 5. Coordination of movements 7. Prese r absence of involuntary movements BULK OF MUSCLES 1. This is estimated by inspection and palpation. Measure the circumference of the arp, forearm, thigh and leg at an identical level on both sides The level should be decided in relation to some fixed, subcutaneous bony landmark. Judgement regarding the presence of muscular wasting or otherwise depends most often on a comparison of the two sides. [ Note Occasionally, both sides may show wasting. Therefore, ‘Common sense about what should be normal muscle mass fora given person should also he employed. 2 Wasted or Atrophic muscles are smaller, softer nd more labby (oose) than normal when they contract. 3. Muscle wasting associated with 4s “called contracture. | muscle feels hard, inelastic and shortened. Thefefore, it is not possible TONE OF MUSCLES: 1. Definition: Certain amount of in the resting muscle due fo jog wo? Present asynchronous discharge Of motor , ie ANUS. It dept lex Which stn How to assess muscle tone Cli is assessed by moving the their various joints and feel by a moving muscle. This, Whether such resistance is nical my ee pa stance of comes by ope : normal, eg 3. Hypotona, ic: decense in resting macy Such muscles offer litle or no wage stretching. Causes are » (i) During sleep (i) Lower motor neuron lesion, i, ds example, (a) destruction of efferent (motor nerve yy muscle by injury ot poliomyelitis (b) destruction of afferent (sensor) ene seen in syphilis (abes dorsalis). 4. Hypertonia, ie. increase in resting muse te Such muscles offer high resistance ose hs commonly seen in upper motor neuron lta, In brain diseases which cause increase in mace tone if hypertonia is confined to only an rsp of muscles, itis called spasticity, Howeve nha hypertonia involves both groups of muss extensor as well as flexor, equal i rm! to as rigidity. For example, the lesions oir capsule produce spasticity, whereas basal gang lesions lead to rigidity (Fig. $3.20) Fig 53.20 (A) Spastity and (@) RB STRENGTH (POWER) OF MUSCLES 1. How to Test (@ The strength of muscles varies with the build of the Subject and its assessment requires practice and (Muscles of the Trunk ext experience The Seneral ral sty ag group of muscles which one wishast ™ fhe eaminer offers passive sen tefon. The muscle, if heathy, fe fond out prominently rach movement made during this a, ) Be by comparison with io essen ig suength oF by comparison with; tobe normal in a person of eony the patient 's own What he judges ‘Parable build to 1 Testing for the Strength of Indivs \uscles of Upper Limb () Abdul plics brevis. Ask the subject ab hsthumb ina plane aright angles tothe saat aspect of the index finger, against the nchewe, ofthe examiner's own thumb, The muscle ems seen and felt to contract. (Intros andLumbricals. Test the subject's ability to flex his metacarpophalangeal joint and. to extend the distal inter-phalangeal joints. Interosse also adduct and abduct the fingers. This action sauld also be tested. idual Muscle (a) lerors of the fingers. Ask the subject to squceze your fingers (a) Fleors ofthe wrist. Ask the subject toring the ips of his fingers towards the front of the forearm, (0) Extensors of the wrist, Ask the subject to make a fist (this results in a firm contraction. the flexors and extensors of the wrist), and try forcibly to flex the wrist against his effort to maintain his posture. oe (/*) Brachioradialis. Place the subject's forearm in mid- Prone position. Then ask him to flex it agaist resistance. (vi) Biceps. Place the subject’s forearm in full and then ask him to flex it against ‘muscle stands out clearly. (vi Triceps. Place the subject's against the chest and then ask hi it out against resistance. (") Suprespinatus and deltoid. Ask carried out by the ‘is produced by the deltoid (Fig. 5320 sng oH \) Muscles ofthe abdomen: Babinski's rising ¥P The weakne hee ae shown By BS | inspiration is (b) Lower shou Atk Nt approximate the Muscles of the Lower Limb ( Poriecion and pata flexion of the et and es Ask the Subject to elevate or depress the part ey ist iste i) Extensors of the knee. Ask the lex his knee ae ey ‘Support the thigh with your left hand and hold the ankle with your right hand. Then ask the Subject to bend his knee, Using the general principe (page 250, test the flexors and extensors of the hip and adductor, abductors and rotators ofthe thigh 3. Grading of the Muscle Strength "Grade 0 : Complete paralysis (flaceid muscle Grade 1: Muscle just shows a flicker of ‘contraction only. Grade 2 : Muscle movement is possible only when the force of gravity is excluded : bby appropriate postural adjustment. Grade 3 : Muscle movement is possible egninst the force of gravity. Therefore, a limb can be held against the force of gravity but not against the examiner's resistance.be made against the exarin REFLEXES COORDINATION OF MOVEMENTS result of appropriate regula time tera (exten), fore and direction of musculat activity 3A disturbance: in the coordination of ‘muscle movement is called Ata, Its of two types atest. This results from defective sensory information and is usually found in the injury dlisease of the dorsal column such as tabes dorsalis (i) Corbeitr atari, This results de to cerebelhim dysfunctions 4. The sensory ataxia may be compensated for by vision; therefore, the disturbance of movements ‘may become apparent only when the eyes are closed or the person i inthe dark. In the Upper Limb 1. Finger-mose test: Ask the subject to fist touch his nose with his own index finger and then the ‘examiner's index finger. I he performs these ‘movements without making errors, coordination 's normal. He is then asked to perform the sane action with his eyes close. Iregulaity indicates the impairment of position sense inthe limb. ig Ask the person to describe a ice inthe aie with his index fingee, frst with it . yes open and then 4 All normal persona ean druve a le smoothly and accurately Whether te en oF closed. nb FingerNove Test ‘otha Adlndchtinst Te pen nd yg ot rally aerate and oppose see For Samp, pit supe of fora Ts Ba gi “iat or Mop mawenets ue a thelr mot ae slow an eg ‘pec and very uel pn oh ea A moana enone cn sagt ‘When the movements are so inp wh pt shythm, and often become imps eo fe a this is refered 1 as Dysdadechakinsa In the Lower Limb 1 fh person ae owl ask in wa 4 sin corn pra soon deviate to ae side othe oe 2. If he cannot walk, perform, Heel Kn Eich {eyes open. Ask him to plc he he ol on the oppite knee and then tse ong the shin of the bin ear tha cerebellar ataxia, a characters torside series of errors in the speed and ain? ‘of movement occurs (ig: 8824) oar requirements described as u 1. Spastic ( is a char with pyr Person w difsculty drags his the d ground b leg is the foot may along the 2 Stamping to strike with the character his feet abnormal them for {he grou And ote be may Place of } becomes" of cerebellar atagia 10 this very reply if ion Supination fg. 5224 Coordination of muscle move in the lower limb * Hea. a I-Knee Test bery’s Sign. Refer to page 243 cat mt_means the manner of wal ruiements should be fulfilled before ofl penn. These are ng. Certain ‘examining the “legs should be fully exposed, 2. fet should be bare 3. Bamine the bone ind joints to exclude local diseases like the osteoarthritis of the hip; leat injury (or pain) in the knee, leg or pelvis tance in diagnosis. Some mmmon abnormal types of gait recognised ane decribed as under: 1 Spastic (or He Gait is of major import esic) Gait, This isa characteristic feature of persons with pyramidal tract lesions, ‘The Person walks on a narrow base, has dificult in bending his knees and diags his feet as if they are glued to the Boor. The foot is raised from the ‘round by tilting the pelvis, and the igs then put forward so that the ‘fot may tend to describe an arc, the toes scraping long the floor, 2 Stumping Gait. Stamping means "0 ‘strike the ground heavily With the sole of the foot. This is characteristic of a person’ with ory ataxia, The person rales Ns feet very suddenly, often ‘normally high, and then Jerks te forward, bringing them to * sound again with a stamp, ret ees fist. fhe watches the ground |™AY be fairly steady, as he can use his eyes pice of his position sense, However, the person Somes severely ataxie when his eyes are closed “rif he walks in the dark. 0 main ining at ga a Pe cl dra Pe Oe a 8 He ed aes stain Es equally severe 2 ing 5, Modding Cat dng meas gqye—s to walk wih sep ik aioe due The ypialy fai pee vat pool mc wes yop cat ycpio) Thos fe dy mann Sees ne Pelee cress. ns (su Fi ease! yap on ta Gye ou oo. ao The heel and os td be rgb a simulta. INVOLUNTARY MOVEMENTS 1. Epilepsy eee faylunary movement ill of te body oF 1 ore inhi sind corona (ii) Movement is ~ erate! whi (iii) Tt may be increased ee touching the link2, Tremors al sretn clans (vibrating) character arereteredas | tremor. Clinically th aie (Fine and rp 4 and thyrotow iregulae tremors. They typcallyocear both at rest ar creased by te | b) Hysterical tremors; inere rearerl weed Seth (a) Resting tremors of Parkinson's disease. Iconssts of regular, thythmic,altemate contraction of | antagonist and agonist musdes at a rate of 63 LSS times/sc. Its frequent presence can be seen a3 ing mocenent, i. rythm contraction of ee b) Ha, $3.25 (A) Retin tremors ah) thumb over fist two fingers. (Fig $325 A and B rotenet fh fe gl lig meri gers hand, Ups or tongue parent bende fad dha mpnataet Movement ponaton and Neu td key i a supination, therefore, popularly called as resting (static) tremors ((») Intentional tremors of cerebellar dysfunction, The tremors are coarse which occur at the rate of 4-6 times/sec. and can clearly be seen when the part 4s used in voluntary movement (Fig. 83.25 C) Itis present at rest but disappears during activity, oo fe Alm: Tb ase the tone of muses ine Upraee | oF the sbjecr heck ist 1 Esplin the test procadre othe aj 2. Makes the sbjectcomfriably sete lenacuar | 3: Asis the mares pasielya ie tang ivitng mores rae! by continuous, sow. | td feds forthe alan afd twisting movements (one phase of movement ueleg ae aoe 4 Compares the muscle tone in the sin ain 6 the oppose side forthe intial mule 4. Chorea itd 1s mini det the involve and is characterized by. ape movements of short dation deceased muscle tne and cm: ‘Chore is sen fe of eum fever 3. Athetosis It is primarily due to the lesion of the etting nt of caudate nucleus irregular involuntary eet assoc with ssess the strength of muscles in the up wusculae weakness, arm of the subject provided Checklist 1. Explains the test procedure to the subjet esl 2. Makes the subject comfortably seated, (ie 5 Asks the subject to throw into action the pact ‘muscle/group of muscles and he appl past resistance to that action. 4 Compares the movement/strength of exch mie veil in children the complication 5. Ties These are simple, normal movements w hich become repeated unnecessarily to the point that thes Becca ‘on the opposite side or with his own must) an emburasament OF ious of eine 5 strength, Psychiatric problem. It commonly involves the face. . St ahoulders and usualy deeop early pet om ’ also called habit spasm, For example, head, Rodding, blinking, cheek/lips/nail biting, laryngeal tic, ete RPS canbe led fog usc in any of the mb we To te [aimee upper © check list t Make 1 plains | Bp [oe f first wil in Fe Finger ri Desa y cary + impo 4. Gio the Ana, Page 25 2 How wi Ans. Page 25 3. Menton Reflex is an | stimulus whict ervous pathy APPARATUS, Patella (or kne torchx lst ic In upper limb (@ Finger = 1a Deseribing a circle nthe sr with his index fing Kinson dean nd (8) Pi uncon (0 tetoad ndicate tr remors)) | lf carying out rapidly stemate and opposite a "muscles in the Upper arm PET 01. Gi bulk of the muscles getter, a2 8 the bulk of sce? ure to the subject, (esNo) co nrtably seated. — ew/Ne) @ sun andr wh he cmiton of wely at thei various joints arid ot ance offered by moving reso) ein the similar fashion the individual muscle (eso) hs an involuntary (automatic) response to a Souls which depends on the integrity ofa particular vous pathivay, ie. the reflex art cof muscles in the Uppet ranarus ms - "(or knee) hammer, examination couch, subject, ¢ to the subject testNO? tably seated, CieuN0) no action the land he applies passive * devs its name. from. its — ston as an instrument 1 ose (or patella) rfl ‘ttn fe to become "lr part of the neuclgia! amination "cuss of a lng metalic handle at one fwhich a triangular shaped soft rabber ple S stashed (Fig 5336). Tis piece 1 wed 1 Bride sharp blow toa tendon ode © nse saen stretching of ts mele Hoke te st cme a a | s thes or any eror in the movement nN Bt 9 ope and ten yn ee chink te sec mtn, el oe a dE He ifn or ame pty ee Ao. Page 25” "A ered 2a say and {ie Adlets ond rds Ai tig oi rma athetosis oe ss P5229 pz rapt Pagers 8 Wa Roi i cea Ans. Page 2a tS aes QU etn onstage of clinical segniicunce, fF nw ge 12 Ho ot ony pon dag ‘Ans. Page 253, : E Inlay mene [PY 10.11] (D) The Reflexes 2. The rubber piece has two ends: broad end and 4 poined end. The broader end ised when ‘muscle tenon bell is boa and thin (s ofthe tendon of triceps muscle) while the pointed end is used when the tendon is stout and narrow {as of biceps muscle) “The boy ofthe hand is also provided with 2 ‘rush with nylon fair and pointer. These are used fr the sensory component of reucogial ‘examination. as : a 6 Ahi!