Voluntary Motor Control

Use of Voluntary Motor Control

In case of hemiplegia, cerebral palsy, etc severe spasticity will make movements impossible, these movements can be graded with voluntary motor control. While moderate spasticity will allow some slow movements but they will be performed with too much effort and abnormal coordination but fine movements of the limbs especially involving the distal portion will be difficult or impossible.

VOLUNTARY MOTOR CONTROL GRADING

In hemiparesis there are some muscles which are always involved and which finally give rise to a peculiar abnormal mass movement pattern and attitude that is characteristic of many hemiparesis patient.The spasticity invariably affects the anti-gravity muscle for reasons not clearly understood.It is however presumed that this anti-gravity muscles are relatively more stretched than pro-gravity muscles in neutral position hence stimulating the stretch reflex giving rise to spasticity.

ABNORMAL SYNERGY IN UPPER AND LOWER LIMBS :

• Flexion synergy for upper limbs :Shoulder girdle retraction and elevation ,shoulder abduction external rotation,supination,flexion of elbow,wrist and finger flexion.
• Flexion synergy for lowr limbs :Hip flexion abduction and lateral rotation , knee felxion,dorsiflexion and inversion.
• Extension synergy - For upper limbs :Shoulder girdle protraction and depression,shoulder adduction,internal rotation,elbow extension,pronation,wrist and finger flexion.
• Extension synergy - For lower limbs :Hip extension,adduction,internal rotation,knee extension,ankle plantar flexion,inversion,and plantar flexion.

Thus is can observed that the following muscles does not take part in either of the synergies :

• 1)Lat dorsi
• 2)Teres major
• 3)Serratus anterior
• 4)Wrist and finger extensors
• 5)Ankle evertors

It is highly essential to understand that synergies are different from the abnormal attitude seen in a hemiparesis patient.The abnormal hemiplegic attitude is due to the combination of strongest component of the flexor and extensor synergy in both upper and lower limbs.

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