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The Importance of Motor Control in the Practice of Rehabilitation
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MOTOR CONTROL DISORDERS
+ .2O
THE IMPORTANCE OF MOTOR CONTROL IN THE PRACTICE OF REHABILITATION Bhagwan T. Shahani, MD, DPhil (Oxon)
Motor control may be defined as a "study of postures and movements as well as functions of mind and body that govern posture and movements."' If posture is considered as a static position of a part of a body at a given time, a movement represents transition from one posture to the other. Electromyography and electroneurography, in which electrical activity produced by skeletal muscles and peripheral nerves is studied, have proved to be very useful in investigation and understanding of human motor control. In most electrodiagnostic laboratories, however, electrophysiologic techniques are commonly used to help in the diagnosis of diseases that affect the peripheral nerves, neuromuscular junction, or skeletal muscles fibers. Although major advances in technology have made it possible to study, quantitate, and document voluntary and reflex activity in intact human subjects and patients with a variety of disorders, most physicians still rely on gross clinical observations, and most clinical neurophysiologists continue to use conventional electromyography and nerve conduction study techniques primarily to differentiate neuropathy from myopathy. Recent studies have shown that by using electrophysiological techniques it is possible to evaluate the motor system objectively as well as to perform sensory testing. Most reflexes (both proprioceptive and exteroceptive as well as long-loop reflexes) that are commonly studied in a clinical setting also can be evalu-
From the Department of Physical Medicine and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois
PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA --
VOLUME 4 NUMBER 4. NOVEMBER 1993
614
SHAHANI
ated by electrophysiologic techniques. These studies, in addition to providing an objective quantitative method for measuring function of the central and peripheral nervous system, give a better insight into the underlying pathophysiologic mechanisms responsible for the motor disorder. Motor control studies are of special interest to clinicians interested in the practice of rehabilitation medicine and restorative medical sciences. All definitions of medical rehabilitation and treatment of disabilities deal with the concept of maximizing the ability of a patient and his or her family to function to the best possible capability within our societal structure. Disability is synonymous with loss of function, and the role of the physiatrist is to improve function by using a team approach that includes participation of a physical therapist, occupational therapist, psychologist, rehabilitation nurse, social worker, speech pathologist (if there is a speech disorder), vocational counselor, and a biomedical engineer. In most instances, the practice of medical rehabilitation requires a scientific approach for improvement of function related to the motor system. Walking, dressing, driving, communication, feeding, employment, and interpersonal psychosocial interactions, to name a few, are all examples of motor function that are maximized in the rehabilitation medicine program. Furthermore, many of the therapies used in the practice of rehabilitation medicine, including physical therapy, occupational therapy, and biofeedback, require manipulation of motor, reflex, and sensory systems. It is possible that some of these methods (and other methods used in rehabilitation medicine) may in fact result in appropriate enhancement or curtailment of nerve fiber growth in the central nervous system of child and adult patients. Experiments documenting regeneration in the central nervous system, along with evidence of plasticity, have brought new hope and excitement to the field of rehabilitation medicine. A combination of neurophysiologic and neuropharmacologic approaches, along with a variety of other rehabilitation techniques, can lead to a better diagnosis and treatment of motor disabilities (produced by neurologic or nonneurologic disorders) and lead to a scientific basis of rehabilitation medicine. Reference 1. Brooks VB: Neural Basis of Motor Control. New York, Oxford University Press, 1986
Address reprint requests to Bhagwan T . Shahani, MD, DPhil (Oxon) Department of Physical Medicine and Rehabilitation (M/C 888) University of Illinois at Chicago 901 South Wolcott, Room W-130 Chicago, IL 60612
MOTOR CONTROL DISORDERS
+ .2O
THE IMPORTANCE OF MOTOR CONTROL IN THE PRACTICE OF REHABILITATION Bhagwan T. Shahani, MD, DPhil (Oxon)
Motor control may be defined as a "study of postures and movements as well as functions of mind and body that govern posture and movements."' If posture is considered as a static position of a part of a body at a given time, a movement represents transition from one posture to the other. Electromyography and electroneurography, in which electrical activity produced by skeletal muscles and peripheral nerves is studied, have proved to be very useful in investigation and understanding of human motor control. In most electrodiagnostic laboratories, however, electrophysiologic techniques are commonly used to help in the diagnosis of diseases that affect the peripheral nerves, neuromuscular junction, or skeletal muscles fibers. Although major advances in technology have made it possible to study, quantitate, and document voluntary and reflex activity in intact human subjects and patients with a variety of disorders, most physicians still rely on gross clinical observations, and most clinical neurophysiologists continue to use conventional electromyography and nerve conduction study techniques primarily to differentiate neuropathy from myopathy. Recent studies have shown that by using electrophysiological techniques it is possible to evaluate the motor system objectively as well as to perform sensory testing. Most reflexes (both proprioceptive and exteroceptive as well as long-loop reflexes) that are commonly studied in a clinical setting also can be evalu-
From the Department of Physical Medicine and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois
PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA --
VOLUME 4 NUMBER 4. NOVEMBER 1993
614
SHAHANI
ated by electrophysiologic techniques. These studies, in addition to providing an objective quantitative method for measuring function of the central and peripheral nervous system, give a better insight into the underlying pathophysiologic mechanisms responsible for the motor disorder. Motor control studies are of special interest to clinicians interested in the practice of rehabilitation medicine and restorative medical sciences. All definitions of medical rehabilitation and treatment of disabilities deal with the concept of maximizing the ability of a patient and his or her family to function to the best possible capability within our societal structure. Disability is synonymous with loss of function, and the role of the physiatrist is to improve function by using a team approach that includes participation of a physical therapist, occupational therapist, psychologist, rehabilitation nurse, social worker, speech pathologist (if there is a speech disorder), vocational counselor, and a biomedical engineer. In most instances, the practice of medical rehabilitation requires a scientific approach for improvement of function related to the motor system. Walking, dressing, driving, communication, feeding, employment, and interpersonal psychosocial interactions, to name a few, are all examples of motor function that are maximized in the rehabilitation medicine program. Furthermore, many of the therapies used in the practice of rehabilitation medicine, including physical therapy, occupational therapy, and biofeedback, require manipulation of motor, reflex, and sensory systems. It is possible that some of these methods (and other methods used in rehabilitation medicine) may in fact result in appropriate enhancement or curtailment of nerve fiber growth in the central nervous system of child and adult patients. Experiments documenting regeneration in the central nervous system, along with evidence of plasticity, have brought new hope and excitement to the field of rehabilitation medicine. A combination of neurophysiologic and neuropharmacologic approaches, along with a variety of other rehabilitation techniques, can lead to a better diagnosis and treatment of motor disabilities (produced by neurologic or nonneurologic disorders) and lead to a scientific basis of rehabilitation medicine. Reference 1. Brooks VB: Neural Basis of Motor Control. New York, Oxford University Press, 1986
Address reprint requests to Bhagwan T . Shahani, MD, DPhil (Oxon) Department of Physical Medicine and Rehabilitation (M/C 888) University of Illinois at Chicago 901 South Wolcott, Room W-130 Chicago, IL 60612