WHERE ARE THE MEASURES FOR MOTOR CONTROL FOLLOWING CEREBRAL PATHOLOGY? - STABILITY AND MOVEMENT MEASURES INCLUDING SMARTPHONE TECHNOLOGY

¹University of South Alabama, Department of Physical Therapy, Mobile, AL, United States

Background: A variety of definitions have been used to describe motor control, emphasizing the ability of the brain to regulate movement. The various descriptions include the ability of the brain both to keep the joint from moving (motor control-stability) when it is not supposed to move and the ability to move with refinement when the part is supposed to move (motor control-movement). Impairments of motor control are particularly common following cerebral pathologies like cerebrovascular accident, traumatic brain injury, and cerebral palsy. Impaired movement control may be observed as a lack of smooth, continuous movement and lack of isolated or selective control, e.g., abnormal synergies of movement. Impaired stability control may be observed in a weight-bearing joint that gives way, or inability to grasp. However, there is a lack of consistent terminology in the literature to describe and measure these aspects. There are very few standardized measures, especially for motor control-stability, and no clinically available objective measures.

Purpose: Motor control-stability and Motor control-movement will be described in concept, along with clinical examples of each that could be observed and current clinical measures, with a focus on techniques described in the literature, mentioning areas that lack specific measures.

Methods: First, it is important to clarify the distinction between weakness, a deficit in force generation, and impaired motor control with the lack of regulation of movement, as described earlier. A literature review was conducted to determine methods described to measure motor control for stability and movement.

Results: The literature review revealed a progressive attention over decades to motor control-movement, advancing from general subjective descriptions (Brunnstrom stages), to more standardized but still subjective ratings. Subjective ratings of selective control noted by absent/impaired/normal (Fugl-Meyer) then were advanced to three-point scales addressing selective control, which can be applied to any joint and considering which portion of the movement excursion loses selective control (Trost, 2004; Voorman, 2007). More specific development has used a standardized five-point scale that considers the proportion of excursion with normal control, along with observation of the extent of unwanted synergistic muscles used to assist the primary intended movement, e.g., degree to which long toe extensors and tibialis anterior are used for ankle dorsiflexion (Boyd & Graham, 1999). The Selective Control Assessment of the Lower Extremity (SCALE) considers selective control, extraneous movements, timing and speed of movement and excursion (Fowler, 2009). The next generation of outcome measures may include use of 2-D slow motion video and accelerometry, both clinically available through smartphone technology, to measure selective motor control (Fell & Dale, 2017). No specific measures for motor control-stability have yet to be described, but possible options will be described.

Conclusion(s): More definitive, valid and objective measures of motor control-stability and motor control-movement are needed. Possible options will be discussed.

Implications: With improved measures of motor control, physical therapists will be better able to measure improvement of motor control following specific therapeutic interventions.

Funding acknowledgements: None

Topic: Neurology: stroke

Ethics approval: This is a special interest topic and no human subjects were studied. Therefore no ethics approval was needed.

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