MOTOR PROBLEMS

PREPARED BY: ARIANE LAGERA

 PROBLEMS AFFECTING ACTIVATION AND COORDINATION OF
AGONIST

• Corticomotoneurons play an essential role in precision grip, and their loss due to
neural injury results in an inability to recruit distal muscles, particularly the intrinsic
hand muscles.
• Research on reaching behavior monkeys whose corticospinal system had been
lesioned at birth has shown that the distal component of the reach never matures
- Example: when area 4 of the motor cortex is lesioned in infancy, a precision grip
never develops.

• Remember from the chapter on development of upper extremity and manipulatory

control that precision grip usually develops in monkeys at about 8 months of age, at
the time that the pyramidial track matures.
• Research studies have examined recovery of upper extremity control in adult patients
who have had stroke, with primary damage to the motor cortex areas and the
pyramidial pathways. These studies have shown that movement in proximal joints
recovers first, with normal force returning in 4 to 6 weeks. However, isolated finger
movements were permanently lost in these patients.
• Other studies examining recovery of upper extremity function in adult stroke
patients have found that the shoulder-elbow synergery for transporting the
hand to the object showed recovery if the shoulder was passively supported
against gravity, but finger movements were always clumsy.
• Studies have examined the reaching behavior of developmentally disabled
children, including those with Hemiplegia or down syndrome. In some cases of
mild impairment, hemiplegia is not readily identified until about 40 weeks, when
the infant first begins to use the pincer grasp and manipulate objects.
In one child of 23 months, the hand with hemiplegia was
used only when the normal hand was immobilized, and
even then it was with greatly difficulty that the child grasped
objects.
Figure 17.3, Illustrates the child reaching for a prong from a
pegboard with the normal hand was immobilized, and even
then it was with great difficulty that the child grasped
objects.
And also its illustrates the child reaching for a prong from a
pegboard with the normal hand and the affected hand, with
a visual back. Note that the normal hand did not anticipate
the shape of the object well, but a finger extension/flexion
pattern was used. Also, contact of the hand with the object
caused the fingers to close around the object, giving an
accurate grasp. However, the hemiplegic hand showed an
exaggerated opening during the entire movement, with no
anticipatory grasp formation.
In a second child of 5 years of age, the hemiplegic
hand showed more normal reach and grasp
movements.
Figure 17.4 depicts film records of her reaching
movements with her normal hand (A) and her
hemiplegic hand (B,C,D). Note that reaching in the
hemiplegic hand was only affected in relation to the
pattern of grip formation. Finger shaping was
abnormal, with the index finger extended in an
exaggerated manner, and then the flexing only slightly,
if at all, before contacting the object.
INAPPROPRIATE ACTIVATION OF ANTAGONIST MUSCLES
 Abnormalities of upper extremity function can result from disturbances to the timing and amplitude
of contraction of antagonist muscles. In some patients, for example, those with athetoid cerebral
palsy, the antagonist muscle is inappropriately active.
• Antagonist Activation can occur prior to the agonist muscle, causing movement in the wrong
direction. Alternatively, antagonist activation can occur simultaneously with the agonist, resulting
decreased amplitude of movement.
• Surprisingly, in many patients who are neurologically impaired, abnormal coordination of muscles is
not found consistently in all types of upper extremity movements.
- For example, when patients with severe dystonia were asked to wave, muscle activation patterns
underlying the alternating wrist flexion and extension movements were normal.
SENSORY PROBLEMS
 Open – loop control or ballistic reaching movements are preprogrammed, and therefore do not
require sensory feedback to control the movement. Relatively normal ballistic upper extremity
movements have been found in patients with complete limb deafferentation.
 In contrast, closed-loop movements, such as precision hand movements, require continuous
sensory inputs, and are significantly impaired in patients with sensory loss.
 Tactile Input, is necessary to determine the appropriate grip force. If grip force is too tight, the
object can’t be manipulated; if it is too loose, the object will be dropped. In a precision grisp,
forces for gripping and lifting are generated simultaneously and appear to be very dependent on
cuntaneous input.
 What happens to eye-hand coordination skills in the patient with a neurological impairment with
loss of somatosensation?
 
 What happens to eye-hand coordination skills in the
patient with a neurological impairment with loss of
somatosensation?