EXPERIMENT No.

Date:

EXAMINATIONOF MOTORSYSTEM

Aim: To assess the functional status of the motor system of the given subject.

Requirement:Tape for measurement.

Procedure: The bio-data findings , general examination including higher functions are noted. Then the motor
system is examined under the following headings.
I. Bulk of muscle
II. Tone of muscle
III. Strength of muscle
IV. Reflexes (Dealt separately)
V. Co-ordination of movements
VI. Involuntary movements
VII. Gait
I. Bulk of Muscle
By just observing the subject, any significant difference in the bulk of muscle between both sides of
the body can be assessed. A tape is used to measure the circumference of the limb at the same distance
from a nonmovable bony prominence, on both sides. The size or bulk of voluntary muscle varies with age,
sex, body build, state of nutrition and muscular exercise.
Abnormalities include:
(a) Atrophy: In atrophy or wasting, the muscle becomes small in size. This can occur due
to disuse, neurological disorders, joint injury or joint diseases.
(b) Hypertrophy: Here the bulk of the muscle increases eg. Muscular dystrophies. In
pseudo-muscular dystrophy due to pathological changes in the muscles, the
muscle bulk increases, but these enlarged muscles are weak inspite of their size.
II. Toneof Muscle
The mild degree of tension or partial state of contraction found in normal healthy muscle is referred to
as muscle tone. The tone is assessed by asking the subject to relax completely and then passively moving
the joints of the upper and lower extremities. The resistance offered by the muscle during passive
movement represents the degree of muscle tone.
Abnormalities:
(1) Hypertonia: Increase in muscle tone.
a) Spasticity - Seen in upper motor neuron lesions. The muscle tone is increased and is of
clasp knife’ type. As the joint is passively flexed or extended, there is increased resistance
to begin with, but as the movement is continued the resistance suddenly decreases.
 b) Rigidity
i) Lead pipe rigidity - Characteristic feature of extrapyramidal lesions. Resistance is felt
uniformly throughout the movement. Here both agonists and antagonists muscles contract.
ii) Cog-wheelrigidity - Here the agonists and antagonists muscles contract alternately and
regularly during the passive movement. As there is alternate increase and decrease in
resistance the passive movement will be jerky, like the movements of a cog wheel. This is
seen in extrapyramidal diseases.
iii) DecorticateandDecerebraterigidity - In decorticate position the upper limb is flexed and
the lower limb extended - due to cerebral cortical lesions. In decerebrate rigidity there is
extension of all limbs with internal rotation of the upper limb and plantar flexion of the feet.

(2) Hypotonia: Decrease in muscle tone. There is decreased resistance to passive movement and
increased range of movements in the limbs. This is seen in lower motor neuron lesion and
cerebellar lesions.
III. Strengthof the muscle(Power)
The patient tries to contract the muscle against resistance offered by the examiner (active method).
May be described as poor, fair, moderate strength.
Gradingof musclepower
Grade 0 - Complete paralysis
Grade 1 - Flicker of contraction present
Grade 2 - Active movement with gravity eliminated
Grade 3 - Active movement against gravity
Grade 4 - Active movement against gravity and some resistance
Grade 5 - Normal power.
Musclesof upperlimb:
(1) Abductorpollicisbrevis: The patient is asked to abduct his thumb in a plane at right angles to
the palmar aspect of the index finger. The muscle can be seen and felt to contract.
(2) Opponenspollicis: Ask the person to touch the tip of his little finger with the point of his thumb
against resistance
(3) First dorsal interosseous: Ask the person to abduct his index finger against resistance.
(4) Interosseiand lumbricals: Test the patient’s ability to flex his metacarpophalangeal joints and to
extend the distal interphalangeal joints. In ulnar nerve palsy ‘claw hand’ deformity is seen.
(5) Flexorsof the fingers: Ask the person to squeeze the examiner’s middle and index fingers.
(6) Flexorsof the wrist: Ask the person to bring the tip of his fingers towards the front of the forearm.
(7) Extensorsof the wrist: Ask the person to make a fist and then try to forcibly flex the wrist
against his effort to extend the wrist. In radial nerve palsy, wrist drop occurs.
(8) Brachioradialis: Place the forearm midway between prone and supine position. Then ask the
person to flex the forearm at the elbow joint against resistance.
(9) Biceps: Ask the person to flex the forearm at the elbow joint against resistance in the supine
position.
(10) Triceps: Ask the person to straighten his forearm against resistance.
(11) Supraspinatus: Ask the person to lift his arm laterally. The first 30º of this movement is carried
out by the supraspinatus. The remaining 60º is produced by the deltoid.
(12) Deltoid: The anterior and posterior fibres help to draw the abducted arm forwards and backwards
respectively.
(13) Infraspinatus: The patient is asked to hold his elbow firmly to his side with the forearm flexed at
right angle. He is then asked to rotate the limb outwards against the examiner’s resistance. The
elbow is held against the side throughout.
(14) Pectoralis: Ask the person to stretch out his arms forwards and then to clap his hands against
resistance.
(15) Serratusanterior: When this muscle is paralysed the scapula is ‘Winged’, the vertebral border
projects out. Pushing forwards with the hands against a wall can also bring out this deformity.
(16) Latissimusdorsi - The person is asked to clasp his hands behind his back, while the examiner
standing behind the patient offers passive resistance to the downward and backward
movement.
Musclesof trunk:
(1) Musclesof abdomen: Weakness of abdomen is shown by the patient’s inability to sit up from the supine
position without the aid of his hands.
Beevor’ssign: paralysis of a portion of the anterior abdominal wall can be detected by displacement of
umbilicus when the patient attempts to lift up his head from the pillow against resistance. When the lower
segment is paralysed the umbilicus moves upwards, and when the upper segment is affected the umbilicus
is pulled downwards. It helps in localizing the level of spinal cord lesion.
(2) Erectorspinaeand musclesof the back- The person lies down in the prone position and he raises his head by
extending the neck and back.
(3) Trapezius:
a) Upperpart tested by asking him to shrug his shoulders against resistance.
b) Lowerpart tested by asking him to approximate the shoulder blades.
(4) Diaphragm: In paralysis paradoxical movement is seen i.e. when the patient coughs or sniffs the
diaphragm descends (instead of ascending)
Musclesof lowerlimb:
(1) Intrinsicmusclesof foot: cannot be easily tested. In paralysis of interossei ‘claw foot’ may develop.
(2) Flexorsand extensorsof toes and foot: Dorsiflexion and extension are tested against resistance
(3) Extensorsof knee: Bend the patient’s knee and then pressing with the examiner’s hand on the shin, ask
him to straighten it.
(4) Flexorsof the knee: The patient’s leg is raised up from the bed by supporting the thigh with the left hand
and ankle with the right hand. Ask the patient to bend the knee.
(5) Extensorsof the thigh: With the knee extended, try to lift the patient’s foot off the bed. The patient is asked
to resist the limb elevation.
(6) Flexorsof thigh: With the leg extended, ask the patient to raise his leg off the bed against resistance
(7) Adductorsof thigh: Abduct the lower limb and ask the patient to bring it back to the midline against
resistance.
(8) Abductorsof thigh: Place the patient’s legs together and ask him to separate them against resistance.
(9) Rotatorsof thigh - With the lower limbs extended on the bed, ask the patient to roll it outwards or inwards
against resistance.
ABNORMALITIES:
a) Hemiplegia: Paralysis of one side of the body (especially of the arm, leg and face)
b) Crossedhemiplegia:Here there is paralysis of the muscles of the arm and leg on one side, and the region
supplied by the motor cranial nerves of the other side.
c) Paraplegia: Paralysis of both legs.
d) Monoplegia: Paralysis of one limb.
1. Brachial monoplegia. [paralysis of one upper limb]
2. Caudal monoplegia [paralysis of one lower limb]
e) Quardriplegia: All four limbs are paralysed.

IV Co-ordinationof movements:
Co-ordination refers to the recruitment, interaction and co-operation of separate groups of muscles in
order to accomplish a definite motor act. If co-ordination is affected, the motor performance becomes
difficult and ataxia occurs. Various factors like cerebellar function, muscle tone, and impulse production from
muscle spindles influence co-ordination.
Tests
(1) For upperlimb
a) Fingernose test: The person is asked to fully extend and abduct the arm, and then touch the tip of his
nose with the index finger. The test is repeated with the eyes closed.
Abnormalities - In cerebellar disease, the finger moves to the nose in a wavering manner. In sensory ataxia
(eg. tabes dorsalis) the movement is smooth with the eyes open, but when eyes are closed the finger
hesitates before touching the nose.
b) Fingerto fingertest: The person is asked to extend his arms to the side and then bring the tips of the index
fingers together through a forward arc.
c) Dysdiadochokinesia: Normally a person can supinate and pronate the flexed forearm rapidly. In cerebellar
ataxia there is impaired ability to rapidly execute such repeated movements.
(2) For lowerlimb
a) Straightline test: Ask the patient to walk on a straight line. If co-ordination is absent, he will soon deviate to
one side or the other.
b) Heel-kneetest: If the person is unable to walk, the heel knee test is done. Ask him, as he lies in bed to lift
one leg and place the heel of his leg on the opposite knee. Then slide the heel down the shin of the tibia
towards the ankle. In cerebellar disease, the heel is carried to overshoot the knee. As the heel is carried
downwards, it begins to execute a tremor like movement.
(3) Romberg’stest: The person stands with his feet close together and eyes open. After he has assumed a
stable position he is asked to close his eyes. When the test is positive the person begins to sway and may
even fall. Positive Romberg’s sign is seen in conditions with loss of position sense in the lower limbs
(sensory ataxia) - tabes dorsalis, subacute combined degeneration, sensory polyeuropathies.
V. Gait:
With the legs fully exposed, the person is asked to walk away from the examiner then to turn round at a
given point, and to walk back to the examiner.
ABNORMALITIES seen in
1) Spastic gait - Corticospinal lesions
2) Stamping gait - Tabes dorsalis
3) Drunken or Reeling gait - Cerebellar lesions
4) Festinant gait - Parkinson’s disease
5) Waddling gait - Myopathies and muscular dystrophies
6) High stepping gait - Common peroneal nerve palsy

VI. Test the motorcranial nerves.

VII. Involuntarymovements:
Involuntary unintended movements occur at rest or during voluntary movements in a number
of nervous system diseases. eg. are,
(1) Epilepsy: complex repetitive movements occur. In focal epilepsy the involuntary
movements are limited to one limb.
(2) Tremor- regular or irregular distal movements having an oscillatory character are seen in
thyrotoxicosis, Parkinson’s disease, cerebellar disease,
(3) Chorea- Huntington’s chorea is a familial disorder. Sydenham’s chorea is associated
with rheumatic fever.
(4) Athetosis- seen in basal ganglia lesions
(6) Metabolicflaps are regular, abrupt movements seen in the outstretched hand and
tongue. This may be seen in hepatic failure, uremia and respiratory failure.

Discussion:
The corticospinal system initiates voluntary and skilled actions especially fine distal movements. The
extra-pyramidal system is concerned with initiation of movement and control of posture. It includes the basal
ganglia, sub-thalamic nuclei, substantia nigra and red nuclei. The cerebellum maintains muscle tone and
co-ordination of movements. The lower motor neuron is the final common pathway for muscular movements.
Lower motor neuron lesions result in weakness, fasciculations, wasting, loss of tendon reflexes and
hypotonia. The skeletal muscle is the principal effector organ.

REPORT:

Questions:
1. Draw the pyramidal tracts.
2. Differences between UMN & LMN type lesions in a tabular form.