The motor system examination includes assessing body position, gait, muscle inspection and palpation, tone, strength and reflexes. Central motor system disorders cause spastic paralysis with hypertonia, hyperreflexia and pathological reflexes. Peripheral disorders cause flaccid paralysis with hypotonia, hyporeflexia and muscle atrophy. Lesions in different parts of the motor system result in specific patterns of weakness, such as hemiplegia from internal capsule lesions or paraplegia from thoracic spinal cord lesions.

1. • Motorparamidal system{ CNS}

2. The first neuron is located in
cortex.
The second neuron is located
in the anterior horn on the
spinal cord

3. THE EXAMINATION OF THE MOTOR
SYSTEM
• body pose
• gait
• involuntary movements
• inspection and palpation of muscles
• normal reflexes
• muscle tone
• muscle strength (force)

4. BODY POSITION

5. GAIT

6. INSPECTION AND PALPATION OF MUSCLES

7. MUSCLE TONE

8. MUSCLE FORCE

9. THE AFFECTION OF THE MOTOR SYSTEM
Total absence of any movements is called as a paralysis or palsy
The restriction of volume of movements and decrease in force is paresis
Kinds of the paralysis (paresis)
monoplegia diplegia triplegia tetraplegia
(monoparesis) (diparesis) (triparesis) (tetraparesis)
paraplegia
(paraparesis)
hemiplegia
(hemiparesis)

10. THE SYMPTOMS OF THE CENTRAL PARESIS
• muscular hypertension
• decrease of muscular force
• hyperreflexia
• clonus
• pathological reflexes
• protective reflexes
• decrease or absence of skin reflexes
• the dysfunction of the urination and dejection

11. MUSCULAR HYPERTENSION (RIGIDITY)
The tone is raised on spastic type and muscular resistance is
felt at the beginning of movement (a clasp-knife sign). The
tone raises in flexors of hands and extensors of legs (the
Wernicke-Mann’s pose)

12. MUSCULAR HYPERTENSION
The slight paresis recognizes with help Barre’s test. A patient
must raise extremities and hold their at closed eyes. On a side
of a lesion extremity falls down.

13. DECREASE OF MUSCULAR FORCE
GRADING OF FORCE:
0 numbers No muscle contraction visible, complete paralysis.
1 number Muscle contraction visible, but no movement of joint.
2 numbers Movement is possible when gravity is excluded i.e. patient ' can
move limb horizontally on bed but unable to elevate.
3 numbers Movement possible against gravity but not against resistance
i.e. when patient is asked to elevate the limb he is able to
elevate, however not able to move the limb if further resistance-
is added.
4 numbers Movement, is possible against gravity and some, resistance.
5 numbers Normal power.

14. CLONUS
Clonus is the term applied to a rhythmic series of involuntary muscle contractions
evoked by sudden stretch of the muscle. Clonus can be evoked on ankle and knee as
following:
Ankle clonus
Support the flexed knee with one hand in the popliteal fossa so that the ankle rests
gently, on the bed. Using the other hand arid briskly dorsiflex the foot and sustain
the pressure, there will be a rhythmical beating (alternate plantar, flexion and
dorsiflexion) of the foot for as long as the pressure is maintained.
Knee clonus
Sharply push the patella towards the foot while the patient lies supine and relaxed
and the knee extended. Following the initial jerk, exert sustained pressure with the
thumb and index finger in a downward direction on the patella, the patella will jerk
up and down.

15. PATHOLOGICAL REFLEXES
Pathological reflexes
Carpal pathological reflexes are
characterized by slow bending
fingers of a hand:
- Rossolimo’s reflex
- Zhukovsky's reflex
- Bechterew-Mendel’s reflex
- Jakobson-Lask’s feflex
Plantar pathological reflexes are
divided on flexor and extensor ones.
Flexor reflexes are
characterized by slow flexion of
foot fingers:
- Rossolimo’s reflex
- Zhukovsky's reflex
- Bechterew’s reflex
Extensor reflexes are characterized
by occurrence extension of the big
finger and a fanlike divergence of other
fingers:
- Babinski's reflex
- Oppenheim's reflex
- Gordon's reflex
- Schäffer's reflex
- Puusepp's reflex

16. CARPAL PATHOLOGICAL REFLEXES
Rossolimo’s reflex - flexion
of 2-5 fingers of a hand at
short, fast impacts on
finger-cushion.
Zhukovsky's reflex –
impact at the middle of a
palm of the patient.
Bechterew-Mendel’s reflex
– impact by the dorsal part
of a wrist of the patient.
Jakobson-Lask’s feflex -
percussion on styloid process of
ulna.

17. PLANTAR PATHOLOGICAL REFLEXES
Flexor reflexes
Rossolimo’s reflex - flexion of
2-5 fingers of a hand at short,
fast impacts on finger-cushion.
Zhukovsky's reflex -
percussion on the middle of a
sole.
Bechterew’s reflex -
percussion on the dorsal
part of the foot.

18. PLANTAR PATHOLOGICAL REFLEXES
Extensor reflexes
Babinski's reflex -
irritation of the
external edge of a
sole.
Oppenheim's reflex –
pressing on an
anterior surface of a
tibia ridge.
Gordon's reflex –
compression of the
gastrocnemius muscle of
the patient.
Schäffer's reflex –
compression of the
Achilles' tendon.
Puusepp's reflex – a fan-
shaped divergence of 2-5
fingers at irritation of a
sole.

19. PROTECTIVE REFLEXES
At irritation of the paralysed extremity a patient
pulls aside this extremity to yourself (Mari – Fua’s
symptom).

20. THE SYMPTOMS OF THE PERIPHERAL PARESIS
• hypotonia (atonia)
• hyporeflexia (areflexia)
• hypotrophy (atrophy)
• fibrillation and fasciculation

21. LESION OF A CEREBRAL CORTEX
A lesion involving the cerebral
cortex, such as a tumor, an infarct or a
traumatic injury, causes weakness or
paresis on the opposite side. At
irritation lesion can be the cause focal
(jacksonian) seizures.
If focus is located in a
paracentral part of a cortex,
then a patient has weakness or
paresis in both legs.

22. LESION OF AN INTERNAL CAPSULE
If the internal capsule is involved, there will be a
contralateral spastic hemiplegia with the central paresis of
7th and 12th pairs of the cranial nerves and the Wernicke-
Mann’s pose.
+

23. LESION OF A BRAINSTEM
At affection of brainstem causes alternating (cross)
syndromes. That is the affection of the cranial nerves on
the affected side and hemiplegia on the opposite side.

24. LESION OF A PYRAMIDAL DECUSSATION
Affection of the pyramidal decussation leads to a
paralysis of a hand on the affected side and paralyses of
the leg - on the opposite one.

25. LESION OF A UPPER CERVICAL PART
At affection of a spinal cord at С1-С4 level develops
tetraparesis (tetraplegia) and paralysis of a diaphragm, the
central dysfunction of pelvic organs (the plunger symptom).

26. LESION OF A CERVICAL INTUMESCENCES
Affection of a spinal cord at С5-D1 level (cervical
intumescences) causes a peripheral paralysis of the upper
extremities and the central paralysis of the lower
extremities, the central dysfunction of pelvic organs.

27. LESION OF A THORACIC PART
At affection of a spinal cord at D3-D12 level appears a
spastic paresis of the lower extremities, the central
dysfunction of pelvic organs.

28. LESION OF A LUMBAR INTUMESCENCES
At affection of a spinal cord at level L1-2 - S1-2 develops a
flail paralysis of the legs, the central disorders of pelvic
organs.

29. LESION OF A CONE AND CAUDA EQUINA
At affection of
cauda equina the
peripheral
paralysis of the
lower extremities,
dysfunction of
pelvic organs on
peripheral type.
At affection of
medullar cone
a anal reflex
absents,
dysfunction of
pelvic organs
on peripheral
type.

30. LESION OF A LATERAL COLUMN
Affection lateral column of spinal cord develops the
central paralysis of muscles below a level of affection.

31. LESION OF A ANTERIOR HORNS
At affection of anterior horns causes a peripheral
paralysis in a zone of innervations of the given
segment and muscle fibrillation.

32. LESION OF A PERIPHERAL NERVE
At affection of a peripheral nerve causes a peripheral
paralysis in a zone of innervations of the given nerve.