Chapter 6: Examination and Evaluation of Neuromotor Systems

Chapter Objectives

Upon completion of this chapter, the learner should be able to:

1. Describe the normal physiology that underlies the functioning of the neuromotor system.

2. List and define the specific subcategories of muscle performance within a neuromotor examination.

3. List and define the specific subcategories of motor function within a neuromotor examination.

4. Describe the key performance-related aspects of the specific tests for each subcategory of the neuromotor examination.

5. Describe expected abnormal motor examination results in the context of specific neurological conditions.

Introduction

Human movement is essential for the performance of functional activities and must be measured by the physical and occupational therapist across the continuum of care in any rehabilitation setting. The control of movement includes both conscious and unconscious processing utilizing a vast and complex array of neurological structures. The purposes of this chapter are to review the neuromotor concepts of human movement that underlie the motor examination in a patient with neurological pathology, focusing on motor manifestations of the nervous system, and to describe specific neuromotor examination tests/measures organized according to the Guide to Physical Therapist Practice, including range of motion, muscle performance, and motor function (APTA, 2015).

Range of motion is the ability of a joint to be moved passively or actively, and it can be restricted by abnormalities of joint capsule or ligaments as well as decreased muscle length. Muscle performance includes aspects of muscle strength or force generation, power, endurance, and length or muscle extensibility (APTA, 2015). Examination of motor function includes tests and measures for motor control and motor learning. Normal functions of the neurological and musculoskeletal systems enable voluntary controlled movement. Impairments of these neuromotor functions frequently contribute to limitations in functional activity. Therefore, they must be carefully examined and are often addressed in the treatment plan.

Neuromotor System Function: Anatomical Perspectives

Areas of the Motor Cortex

This brief review of the motor components of the nervous system is only meant to emphasize key neurological concepts for the clinical neuromotor examination. The motor cortex, with a key role in voluntary movement, includes three portions: the primary, premotor, and supplemental areas. The primary motor cortex, located in the most posterior gyrus of the frontal lobe (precentral gyrus), houses a representation of the different muscle groups of the body organized regionally (Figure 6-1A: Where Is It?). The specific organization of the primary motor cortex is known as the motor homunculus and illustrates the idea that body regions over which the brain exerts more motor control, including hands and face, are represented as shown in the right half (motor cortex) of Figure 6-1B by disproportionately larger areas of cortex. Areas with less motor control are disproportionately smaller in the homunculus. A larger representation in the homunculus shape, with a larger number of cortex cells, allows for more selective activation of ...