Motor System

POSTURE Decorticate posture consists of abnormal flexor response in the arm at the elbow and wrist with extension of the leg. Fully developed, this pattern is referred to as decorticate rigidity. The arms are brought up over the chest with both the elbows and wrists flexed. Decerebrate posture consists of abnormal extensor response in the arm and the leg. Fully developed, this pattern is referred to as decerebrate rigidity and consists of opisthosthotonus with the teeth clenched, arms stiffly extended, adducted, and hyperpronated. The legs are stiffly extended and the feet are plantar flexed. Early in the development of an acute cerebral lesion, an abnormal posture may occur only in response to a noxious stimulus. Hemiparesis alone results in external rotation of the leg and foot on the affected side. The finding is not dissimilar to that seen with hip fracture, except that the leg is not foreshortened, and there is neither hip tenderness nor pain on hip movement. Seeing abnormalities in posture should be part of the initial observation of a patient. If a hemiparetic posture is suspected, one should look for evidence of facial flattening on the same side: wider palpebral fissure and flatter nasolabial fold, as well as an extensor plantar response or other indications of hemiparesis.

STRENGTH Motor strength is usually tested when focal or generalized weakness is either the presenting complaint or suspected by history or examination. ( Table...,, 2.18-2). Strength should be assessed in all four extremities. The earliest upper motor neuron weakness occurs in the dorsiflexors of the wrist and ankle. An adequate screening motor examination includes abduction of the shoulder, extension and flexion of the elbow, extension of the wrist and fingers, grip (testing with two fingers), flexion of the hip, extension of the knee, and dorsiflexion of the foot.

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