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LEARNING OBJECTIVES
Identify the purposes and components of the examination of motor structure and function: motor control and motor learning.
Discuss potential constraining factors that can affect an examination of motor function, including sensory, perceptual, cognitive, and communication deficits.
Describe the examination of activities and participation.
Describe the examination of the movement system.
Describe the examination of impairments of body structure and function of the movement system and the implication of common deficits for function.
Describe the measures used in the assessment of motor learning.
Discuss the importance of examining and promoting patient involvement in decision-making and assessment of problem-solving skills.
Compare and contrast the advantages, disadvantages, and utilization of imaging tests, including radiography, computed tomography (CT) scan, magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), spectrum photon emission computed tomography (SPECT), and positron emission tomography (PET).
Compare and contrast the advantages, disadvantages, and utilization of electrophysiologic neuromuscular assessments to include nerve conduction studies (NCS), electromyography (EMG), electroencephalography (EEG), and transmagnetic stimulation (TMS).
Discuss factors that influence determination of the physical therapy diagnosis with disorders of motor function.
Analyze and interpret patient data, formulate realistic goals and expected outcomes, and identify appropriate interventions when presented with a clinical case study.
Compare and contrast the clinical examination findings associated with various central nervous health conditions (see Table 5.14).
Compare and contrast the clinical examination findings associated with various neuromuscular diseases (see Table 5.15).
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OVERVIEW OF MOTOR STRUCTURE AND FUNCTION
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Motor Control and Motor Learning
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Motor control evolves from a complex set of neural, physical, and behavioral processes that govern posture and movement. Some movements have a genetic basis and emerge through processes of normal growth and development. Examples of these include the largely reactive reflex patterns that predominate during much of early life and in some patients with brain damage. Other movements, termed motor skills, are learned through practice and interaction with the environment. Practice and feedback are important variables in defining motor learning and motor skill development. A motor program is defined as “a prestructured set of movement commands that defines the essential details of skilled action, with minimal or no involvement of sensory feedback.” An example is the complex neural circuitry in the spinal cord known as central pattern generators that control locomotion and gait.
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Generalized motor programs (GMPs) are higher level motor programs, defined as “a motor program whose output can vary along certain dimensions to produce novelty and generalizability in movement.”1 GMPs contain information about the order of events, the timing of events (temporal structure), the overall force of contractions, and the muscle(s) or limb(s) used in the movements. Motor memory (procedural memory) involves the recall of motor programs or subroutines and includes information on (1) initial movement conditions; (2) sensory parameters (how the movement felt, looked, and sounded); (3) specific ...