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1. Motor Structures
Course-specific learning outcomes + references
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After this course, you should make sure that you can:
• List and describe the major structures involved in motor function
• Outline the principal properties, relations and functional interactions of these structures
• Assess the status of the motor peripheral nervous system via case history and observation
• Assess the status of major CNS motor structures via case history and observation
• Demonstrate key psychomotor skills relevant to your examination of motor structures
• Apply the above to a novel theoretical clinical situation, testing hypotheses generated
• Explicitly analyse your diagnostic process, reflecting on its strengths and weaknesses
• Evaluate the bearing of these processes on your subsequent physiotherapeutic care
NB the above may be the subject of formative or summative assessment, in line with prevailing professional bodies' guidelines
References
Visit as many of the references shown below as possible prior to your course. These are drawn from a variety of texts and take a range of forms (pictorial, textual and tabular). Our intention is to provide you with an assortment of information sources that you can choose from - and that you can match to your own learning style.
Detailed guidance on motor examination context and procedure: Ref 1 pp 299-309, Ref 7. pp 1344-1351, Ref 8 from p111
Interpretation of observable and other changes in the hands: Ref 4 pp 194-195
Weakness: what you find and what it means: Ref 8 pp 151-157; also table 15.1
Reflexes: context and procedure: Ref 1 pp 353-356; Ref 8 pp 141-150
Comparison between upper and lower motor neurone features: Ref 8 p 111, 112, 151
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1. Motor Structures
Indicative content – related theory and skills
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You'll need to bring your own: ‘Queen Square’ tendon hammer / percussor or equivalent
• The Neurological History:
Indications: alteration of use, perception or control of part of the body
• The Previous Medical History
Examples: Stroke, multiple sclerosis, cardiac abnormalities, hypertension, diabetes mellitus. The Family History such as inheritable disorders of the nervous system, hyper-cholesterolaemia, hypertension, cardiovascular disease and strokes. Social History: exercise pattern, previous trauma, cigarette smoking, alcohol and diet
• Observation
Examples: Gait, posture, gesticulation, facial expression, voice, handwriting
• Specific Observation
Examples: Hands looking for distribution of wasting, nicotine stains. Eyes for pupil size. Tremor type. Analysis of gait abnormality (e.g. ‘footdrop type’)
The ‘Hands - on’ examination:
• Muscle Tone (Tonus)
Increased, decreased or normal? Techniques of assessment. Interpretation
• Clonus
Physiological vs. pathological types - presentation, differentiation + causation
• Power
Linking the distribution of power loss to underlying structural - functional change. For example - common peripheral nerve and nerve root injuries; central nervous system damage in the spinal cord and the brainstem
• Reflexes
(Are these, strictly speaking, motor or sensory tests?)
Deep (or tendon) reflexes. Superficial (or skin) reflexes. Hyper-, hypo- and normo- reflexia. Accurate technique / interpreting underlying neural integrity
• UMNL versus other CNS conditions versus LMNL
Comparison of the overall features of upper and lower motor neurone lesions
Making the correct decisions regarding the site and severity of lesion
• Use of the preceding to inform subsequent patient management
© Crawford & Cook 2005-9
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