The document discusses the examination of the motor system, covering muscle bulk, tone, strength, reflexes, coordination, and involuntary movements. It outlines assessment methods for muscle tone, strength, and coordination, and describes various types of gait abnormalities. Additionally, it details conditions such as atrophy, hypertonia, and involuntary movements like tics and tremors, along with their assessment techniques.

2. The examination of the motor system includes:
 Bulk of muscles
 Tone of muscles
 Strength (or power) of muscles
 Reflexes
 Coordination of movements
 Gait
 Presence or absence of involuntary movements

3. This is estimated by inspection an palpation. Measure the circumference of the
arm, forearm, thigh and leg at an identical level on both sides. The level should be
decided in relation to some fixed, subcutaneous bony landmark. Judgment
regarding the presence of muscular wasting or otherwise depends most often on a
comparison of the two sides.
 Wasted or Atrophic muscles are smaller, softer and more flabby (loose) than
normal when they contract.
 Muscle wasting associated with fibrosis is called contracture. The muscle
feels hard, inelastic and shortened. Therefore, it is not possible to stretch them
passively to a normal degree.

4.  The bulk of muscle decreases in:
(a) injury or disease of a muscle/joint, such as inflamed
muscles or during prolonged hypertonia in a group of
muscles;
(b) neurological disorders;
(c) cachexia of any cause
 The bulk of muscle increases in : athletic training,
continued excessive workload in certain occupations
like carpenters, labourers, etc. myotonic disorders

5.  Definition: Certain amount of tension present in the
resting muscle due to low frequency and asynchronous
discharge of gama- motor neuron which produces the
resistance of a muscle to stretch . This is referred to as
the ‘tone’ of a muscle..
 How to assess muscle tone: Clinically, muscle tone is
assessed by moving the muscles passively at their
various joints and feel for resistance is normal, low or
high.

6. Hypotonia : Decrease in resting muscle tone. Such
muscle offer little or no resistance to stretching.
Causes are:
 During sleep
 Lower motor neuron lesion, i.e. destruction of local
reflex arc anywhere in its pathway. For example,
(a) Destruction of efferent (motor) nerve to a muscle
by injury or poliomyelitis;
(b) Destruction of afferent (sensory) nerve as seen in
syphilis (tabes dorsalis).

7. Hypertonia: Increase in resting muscle tone. Such muscles offer
high resistance to stretch.
It is commonly seen in upper motor neuron lesion.
In brain diseases which cause increase in muscle tone if
hypertonia is confined to only one group of muscles, it is called
spasticity. However, when hypertonia involves both groups of
muscles, extensor as well as flexor, equally, it is referred to as
rigidity. For example, the lesions of internal capsule produce
spasticity, whereas basal ganglia lesions lead to rigidity

8.  How to Test:
(a) Each movement made during this assessment is tested by
comparison with the examiner’s own to be normal in a person of
comparable build to the patient.
(b) Testing for the strength of individual muscle :
Muscles of upper limb
(i) Abductor pollicis brevis: abduct the thumb in a plan at right angles to
the palmar , against the examiner’ s own thumb
(ii) Interossei and lumbericals: Flex the metacarpophalangeal joint and
to extend the distal inter-phalangeal joints.
(iii) Flexors of the finger: squeeze your fingers
(iv) Flexors the wrist : Bring the fingers towards the front of forearm.
(v) Extensors of the wrist: Forcibly to flex the wrist against his effort to
maintain his posture.
(vi) Brachioradialis: Place the forearm in mid-prone position . Then
flex it against résistance

9. (vii) Biceps: Place the forearm in full supination and then flex it against
résistance . The muscle stand out clearly.
(viii) Triceps : Place the forearm fully flexed against the chest and then ask him
to straighten it out against resistance.
(ix) Supraspinatus and Deltoid: Ask the subject to lift his arm straight out at right
angles to his side against resistance. The first 30 degree of his movement
carried out by the supraspinatus .and the remaining 60 degree is product by
deltoid.

10.  (i) Abdomen muscles: Babinski’s rising up sign. The Weakness of these
muscles is shown by the inability to sit up in bed from the supine position
without the aid of his arms.
 (ii) Diaphragm: In a healthy individual, inspiration is associated with
bulging and expiration with the fall of abdominal wall. Opposite occurs in
the paralysis of the diaphragm.
 (iii) Trapezius: (a) upper part ask the subject to shrug his shoulders against
the examiner’s resistance.
 (b) lower part ask him to approximate the shoulder blades.

11.  (i) Dorsiflexion and planter flexion of the feet and toes.
 (ii) Extensors of the knee. Ask the subject to flex his knee and then
pressing with your hand on his shin. Ask him to try to straighten it out
again.
 (iii) Flexors of the knee. Raise the leg up from the bed. Support the thigh
with your left hand and hold the ankle with your right hand. Then ask the
subject to bend his knee.

12. Grade 0 Complete paralysis
Grade 1 A flicker of contraction only
Grade 2 Power detectable only when gravity is
excluded by postural adjustment
Grade 3 Limb can be held against gravity but not
resistance
Grade 4 Limb can be held against gravity and some
resistance
Grade 5 Normal power

13. Definition: This means the smooth recruitment, interaction and
cooperation of separate muscles or group of muscles in order to
perform a definite motor act.
The coordination of muscle movement depends on:
(a) Sense of position of a limb or joint.
(b) Cerebellar functions
(c) The state of tone of muscles
Ataxia : A disturbance in the coordination of muscle movement. It is
of two type. (i) Sensory ataxia (ii) Cerebellar ataxia

14. TEST FOR CORDINATIONOF MOVEMENTS
In the upper limb
1.Finger-nose test – Ask the subject to first touch his nose with his
own index finger and then the examiner’s index finger. Then he is
asked to perform the same action with his eyes closed. If he
performs these movements without making errors, coordination is
normal. Irregularity indicates the impairment of position sense in
the limb.
Adiadochokinesia: The person is unable to carry out rapidly alternate
and opposite movements. For eg: Rapid supination and pronation
of the forearm.
Dysdiadochokinesia: When the movements are slow, incomplete with
irregular rhythm, and often become impossible after a few
attempts.

16. In the lower limb:
1. If the person is able to walk, Ask him to walk along a straight
line. If in coordination is present, he will soon deviate to one
side or the other.
2. If he cannot walk, perform Heel-Knee Test with the eyes open.
Ask him to place the heel of his leg on the opposite knee and
then to slide the heel along the shin of the tibia towards the
ankle.
3. Romberg’s Sign : The person is asked to stand with his feet close
together, and if he can do this, then ask him to close his eyes.
If Romberg’s sign is present, as soon as his eyes are closed. he
begins to sway about or may fall.

18.  Gait means manner of walking.
Requirements for examination of gait:
1.The legs should be fully exposed.
2.The feet should be bare.
3. Examine the bone and joints.
Spastic (Hemiplegic) Gait: The person has difficulty in bending
his knees and drags his feet as if they are glued to the floor.
 It is seen in pyramidal tract lesions.

19. Stamping gait: Stamping means to strike the ground
heavily.
 The person raises his feet very suddenly, often
abnormally, high, and the jerks them forward,
bringing them to the ground again with a stamp, and
often heel first.
 It is seen in sensory ataxia.

20. Drunken (Reeling) Gait: The person walks
awkwardly with the feet well apart. They have such
difficulty in maintaining balance, that it appears
drunken, called drunken gait.
 It is seen in cerebellar lesion.

21. Festinant gait: The person bends forward, and walks
quickly with short steps as if trying to catch up centre
of gravity or preventing himself from falling down.
 It is seen in Parkinson’s disease.

22. Waddling Gait: Waddling means to walk with short
steps like the gait of duck. The person plants his feet
widely apart and the body sways from side to side as
each step is taken.
 It is seen in proximal muscular weakness
(myopathies, muscular dystrophies).

23.  Involuntary movements limited to one side of the body
 Movement is usually complex, repetitive and stereotyped which last for
short duration
 It may be increased by arousal
 TICS: These are normal movements which become repeated
unnecessarily to the point that they become an embarrassment or a
source of, or reaction to, psychiatric problem.
 It commonly involves the face and shoulders and usually develops
early in life, also called habit spasm.
 Eg: Head nodding, blinking, cheek/lips/nail/ biting, laryngeal tic,
etc.

24.  Regular or irregular distal movements having an oscillatory
character are referred as tremors. Classification :
 Fine and Rapid tremors : seen in anxiety, thyrotoxicosis
 Coarse and Irregular tremors : eg.
a) Senile tremors: seen at rest and during movements
b) Hysterical tremors: increased when attempt to control it
 Resting tremors: consist of regular, rhythmic, alternate
movements of muscles@ 6-8/sec. seen as pin rolling
movements. Common site is fingers, hand, lips. As these
tremors are present at rest and disappears during activity , so
called as Resting tremors
 Intentional tremors: these tremors are coarse @4-6/sec and are
seen when the person tries to do some voluntary movement.
Seen in cerebellar dysfunction

25.  Athetosis: It is primarily due to the lesion of the lenticular nucleus and is
characterized by continuous, slow-twisting movements (one phase of
movement getting merged with the next).
 Chorea : It is mainly due to there involvement of caudate nucleus and is
characterized by:
 Rapid, irregular involuntary movements of short duration and is associated
with decreased muscle tone and muscular weakness.

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