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Neurosurgery
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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?
Figure 21-1. p. 688.
Chapter 21
• Cerebral Cortex
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
• ADL’s affected
– Weakness• Where? When? Why?
Subjective Data
• Incoordination• Balance, falling,
• Legs give out
• Clumsy
• Numbness/ Tingling• Describe ( pins and needles)
• Significant past history • TIA’s, 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
