Neurologic System

The Motor System and the Cerebellar Function

Motor Pathways & Type of Movements

Corticospinal or Pyramidal Tract
Voluntary, skilled, discrete, purposeful (writing)

Extrapyramidal Tracts
Maintain muscle tone and control body movements (walking)

Cerebellar System
Coordinates movement, maintains equilibrium and posture.Operates on subconsious level

Question for Thought

Describe 3 major motor pathways in the CNS including the type of movements mediated by each?

Chapter 21
Cerebral Cortex

Figure 21-1. p. 688.

Upper and Lower Motor Neurons

Upper motor neurons
All descending motor neurons that impact on the lower motor neurons Located in the CNS Convey impulses from motor areas of cerebral cortex to lower motor neurons in the cord Diseases = CVA, Cerebral palsy, Multiple sclerosis

Upper and Lower Motor Neurons

Lower motor neurons
In the peripheral nervous system
12 cranial nerves 31 pairs of spinal nerves and all branches

Final direct contact with the muscles Movement translated into action Reflex arc Examples = cranial nerves, spinal nerves Diseases = spinal cord lesions, poliomyelitis, ALS

Question for Thought

Differentiate an upper motor neuron from a lower motor neuron?

Subjective Data
In the Interview
Any shakes or tremors in the hands or face?
Worsen with anxiety, fatigue Relieved with activity, alcohol ADLs affected

Weakness
Where? When? Why?

Subjective Data
Incoordination
Balance, falling, Legs give out Clumsy

Numbness/ Tingling
Describe ( pins and needles)

Significant past history

TIAs, Atrial Fib.

Assessment of Motor System

Body position Involuntary movements Muscle size ( bulk) Muscle tone Muscle strength

Body Position
Observe during movement Observe at rest

Involuntary Movements
Tremors, tics, fasciculations, myoclonus Note:
Location Quality Rate Rhythm Amplitude

Involuntary Movements
Note the involuntary movement in relation to :
Posture Activity Fatigue Emotion Other factors

Terms to Describe Movement

Flexion Extension Abduction Adduction Pronation Supination

More Terms for Movement

Circumduction Inversion Eversion Rotation Protraction

Terms of Movement Continued

Retraction Elevation Depression

Muscle Size
Compare size and contour
Atrophy
Unilateral/bilateral Proximal/distal

Muscle Tone
A relaxed muscle maintains a slight residual tension referred to as muscle tone. Hypo tonic, Flaccidity. Spasticity. Lead-pipe rigidity.

Muscle Strength
Test muscle strength by asking the client to move actively against your resistance or to resist your movement. A muscle is strongest when shortest and weakest when longest.

Terms to Describe Strength

Weakness (paresis) Paralysis (plegia) Hemiparesis Hemiplegia Paraplegia Quadriplegia

Grading Muscle Strength

Scale 0-5 0 - no muscular contraction 1 slight contraction 2 Full ROM, gravity eliminated

Grading Muscle Strength

3 Full ROM against gravity 4 Full ROM against gravity, some resistance 5 Full ROM against gravity full resistance without evident fatigue = Normal Muscle Strength

Cerebellar Function
Balance tests
Gait
Observe normal walk Tandem Walking ( heel to- toe ) Romberg Test (stand, feet together, arms at side, close eyes) Shallow knee bend or hop on one leg

What findings would you expect to see when assessing gait and balance in an older adult?

Cerebellar Function
Coordination and Skilled Movements
RAM ( Rapid alternating movements)
Pat Knees Thumb to each finger Finger to finger Finger to nose Heel to shin

Question for Thought

List and describe 3 tests of cerebellar function?

Charting Sample
For Normal Muscle Strength (objective)
Able to maintain flexion against resistance and without tenderness

For Motor ( objective)

No atrophy, weakness or tremors. Gait smooth and coordinated, able to tandem walk, negative Romberg. RAM, finger-to-nose smoothly intact