The Motor System Examination

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THE MOTOR SYSTEM THE MOTOR SYSTEM(APPLIED ANATOMY)(APPLIED ANATOMY)

AN INTRODUCTION TO THEAN INTRODUCTION TO THEPHYSICAL EXAMINATIONPHYSICAL EXAMINATION

DR HAMIADJIDR HAMIADJI



THE MOTOR SYSTEM(APPLIED ANATOMY)

AN INTRODUCTION TO THEPHYSICAL EXAMINATION

DR HAMIADJI





ExtrapyramidalSystm

Pyramidal Systm Cr!llar Systm

Gross, Automatic, Voluntary Movements

Precise, Skilled, Voluntary Movements

Monitoring, Modulating Movements

1. Corticospinal

2. Corticobulbar

(Upper Motor Neuron)

Ri"idity

#rady$i%sia & Hypr$i%sia

(A!%'rmal M'm%ts)

Spastiity

Parsis & Paralysis

(A!%'rmal R*xs)

Hyp't'%ia & Ast+%ia

Asy%r"ia

(A!%'rmal C''rdi%ati'%)

- Resting tremor

- Chorea- Athetose

- Hemibalism etc.

- Hofmann

- Tromner - Babinski

- Openheim etc.

- Intention tremor

- Dysmetria- Adiadochokinesia

- Dysarthria etc.

N,l,s & A%tri'r +'r%

(L'-r M't'r N,r'%)

.laid para&parsis

Hyp'&Ar*xia

Atr'p+y

.asi,lati'%

T+ M't'r Systm '%sists '/ t+'s parts '/ t+ #rai% a%d Spi%al C'rd t+at '%tr'l S$ltalM,sls

T+r ar 0 /,%ti'%al 'mp'%%ts (Pyramidal1 Extrapyramidal1 Cr!llar systms) a%d aC'mm'% M't'r Pat+-ay (M't'r %,r'%s i% %,li '/ ra%ial %rs a%d a%tri'r +'r% '/ spi%al'rd 2 L'-r M't'r %,r'%s)



THE PYRAMIDAL SYSTEM

COMMON MOTORPATH3AY



THE PYRAMIDAL SYSTEM

C'rti'!,l!ar



The corticospinal tract originates, as the name implies,from cerebral cortex: primary

motor cortex, but also severala!acent, functionally relateareas" The axons cross the milineat the !unction bet#een meullaan spinal cor" They synapseupon spinal cor motoneurons, but

also upon spinal interneurons inorsal as #ell as ventral horns"The fibers in the tract are lai outin an orerly map, both inbrainstem, as you #ill learn later,an in spinal cor" In both

structures, fibers controlling thearm are locate more meially,fibers controlling the leg arelocate more laterally $see #iringiagram that follo#s%"



The pyramidal motor system $corticospinal plus corticobulbar

tracts% originates from more than !ust primary motor cortex, an

synapses on more than !ust lo#er

motor neurons"The pyramial motor system is the only

"straight-line" descending pathway "

T+ 4xtrapyramidal4 m't'rsystm1 that is, the sum total of all

parts of the motor system other thanthe pyramial $an also excluing

the r!ll,m, #hich is a thingunto itself% escens in stages, #ith

several synaptic #ay stations orintermeiate integrating structures

on the #ay o#n"Many escening path#ays from

cerebral cortex o not !oin thepyramial system, but influence the

activity of the extrapyramial systemby synapsing upon its intermeiate

integrating structures"The human extrapyramidal system

exerts its effect on voluntarymovement primarily by influencing

the activity of the pyramial system&



The cerebellum is an importantpart of the higher orer motor

system" Ho#ever, unli'e the parts ofthe motor system #e have alreayescribe, the cerebellum does not

itself initiate any movements.

Instead, the cerebellum has apo#erful orering, regulating, an

patterning influence upon voluntarymovements initiate in the motorareas of the cerebral cortex" (e

infer this influence by observing ho#voluntary motor functions are

altere, impaire, or even lost, inspecific lesions of the cerebellum

an)or its connections"

*ommon motor

path#ay



MRC Scale for Grading MuscleStrength

Score Muscle Response

+ o Movement

- Muscle belly moves butthe !oint oes not move

. Joint moves #ithgravity eliminate

/ Joint moves againstgravity

0 Joint moves againstgravity an someresistance

1 2ull strength

Clasp-knife phenomenon5Dsripti'% '/ t+ a!%'rmal -ay t+atparaly6d lim! m,sls rsp'%d t'

passi strt+ a/tr pyramidal tratdama"5 C+aratristially1 t+

"ratr t+ l'ity '/ strt+1 t+

"ratr t+ rsista% '/ t+ m,sl5





Abnormal Reflexes on theAbnormal Reflexes on the

Upper Limb & Lower Limb:Upper Limb & Lower Limb:

- Tromner, Hoffmann

- Babinski, !addock,

"##en!eim





Levels of motor integration are ofclinical significance because injuryat levels 1! produces sharply

different patterns of reflex activity"

Level 1Spinal cord transection thatdisconnects all descending motortracts"

Level #$ontine transection that spares thevestibulospinal %&S' andreticulospinal %R(S' tracts"

Level !Transection rostral to the red

nucleus that spares therubrospinal %RS' tract as )ell"



C*+R(,

Dys/,%ti'%s t' t+ #asalN,li rs,lt i% A!%'rmal

M'm%ts



T*( C(R(-(LL,R S.ST(M



Ataxia an ysmetria can beemonstrate by the fingertonose an heeltoshin clinical

tests, #hich are easy for

neurologically normal patientsbut impaire or impossible ifcerebellar function is

compromise" 3uch patients areespecially impaire in the

performance of rapi alternatingmovements" The meical 4ree'

name for this isadiadocho/inesis or

dysdiadocho/inesis $a 5 lost6ys 5 impaire%" There may bescanning speech, i"e" ataxia ofthe complex movements of lipsan cheec's, tongue, larynx,an iaphragm involve in

speech"



Hemiplegic gait 3huffling gait

Ataxic gait





7AITS7AITS



THANK YOU

Ada t,!,+ s'r"a-i da% adat,!,+ d,%ia-i1 ttapi

$m,liaa% t,!,+ s'r"a-i lai%dari pada $m,liaa% t,!,+

d,%ia-i !orint"s #$%&.



Impulse

Presynaptic neuron

Vesicle

Transmitters

Synaptic cleft

Receptors

Postsynapticneuron

Postsynaptic activity



CELL BODY

AXON

Myelin sheath

Schwann cell

Node of Ranvier

Synaptic terminals

Dendrites Nucleus Synapses











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The Motor System Examination