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MOTOR CONTROL TEST (MCT)

NeuroCom, a division of Natus: NeuroCom Protocols: Motor Impairment Assessments: Motor Control Test (MCT)

Description
The MCT assesses the ability of the automatic motor system to quickly recover following an unexpected external disturbance. Sequences of small, medium or large platform translations (scaled to the patient's height) in forward and backward directions elicit automatic postural responses. Translation of the surface in one horizontal direction results in displacement of the COG away from center in the opposite direction relative to the base of support. To restore normal balance, a quick movement of the COG back to the center position is required.

MCT Comprehensive Report

1. Weight Symmetry quantifies the relative distribution of weight on each leg. Accurate interpretation of the latency and amplitude scaling measures requires weight-bearing symmetry within the normal limits (automatic responses may be suppressed in a leg not carrying weight). 2. Latency quantifies the time between translation (stimulus) onset and initiation of the patient's active response (force response in each leg). The composite latency score is an average of the individual scores for the two legs. Latency scores are displayed only for the medium and large translations. Latencies for large translations are typically shorter than for medium translations in normal subjects. 3. Amplitude Scaling quantifies the strength of responses for both legs and for the three translation sizes. Strengths are typically similar for both legs and increase with increasing translation size.

Functional Implications
Automatic postural responses are the first line of defense against a fall following unexpected external disturbances to balance. To be effective in this capacity, responses must be timely and well coordinated between the two legs. As response latencies increase and/or amplitudes decrease outside normal ranges, effectiveness is reduced and patients tend to sway farther in response to disturbances. Patients with abnormally strong responses tend to over-correct and oscillate back and forth. When responses are asymmetrical between the two legs, patients are at increased risk for instability during tasks such as walking and reaching when the less effective leg is the primary means of postural support. When combined with the Sensory Organization Test (SOT), the MCT results are very useful in differentiating among normal responses, true pathological conditions, and exaggerated sway responses. Because they are not under conscious control, automatic responses are initiated very rapidly and are highly repeatable across trials. Exaggerated responses are volitional, take longer to initiate, and tend to vary widely from one trial to the next. Thus, automatic and (exaggerated) volitional responses can be readily distinguished within the MCT data set. Automatic response latency information is also of significance in the diagnostic process. Prolonged latencies are strong evidence of musculoskeletal/biomechanical problems and/or pathology within the long loop pathways including the peripheral nerves, ascending and descending spinal pathways, and brain structures. When prolonged latencies are documented by the MCT, the EMG component is useful in further localizing the deficit within the peripheral nerves or central pathways.

http://www.archives-pmr.org/article/S0003-9993%2800%2984942-4/abstract

Motor control testing of upper limb function after botulinum toxin injection: A case study
Abstract
Hurvitz EA, Conti GE, Flansburg EL, Brown SH. Motor control testing of upper limb function after botulinum toxin injection: a case study. Arch Phys Med Rehabil 2000;81:1408-15. Objective: To evaluate changes in upper extremity function in a hemiparetic patient after treatment with botulinum toxin (BTX) using motor-control testing (MCT) techniques. Design: Interventional with longitudinal study, open label. Setting: A children's hospital and a motor-control laboratory at a major academic center. Participants: A 16-year-old male with right hemiparetic cerebral palsy and a healthy 12-year-old control subject. Interventions: BTX injections to the elbow and wrist flexors. Main Outcome Measures: MCT was used to examine 4 upper extremity movements: forward reach, bilateral rhythmic movements (both muscle homologous and direction homologous), isometric pinch, and hand tapping. The patient was tested before treatment and at 2, 4, 6, 12, 18, and 24 weeks after treatment. In addition, range of motion (ROM), the Ashworth scale of spasticity, Functional Independence Measure, and the mobility and activities of daily living (ADL) sections of the Pediatric Evaluation of the Disability Inventory were performed. Results: Forward reach demonstrated little change initially despite patient reports of feeling looser. Improvement was noted after 18 weeks, but returned to baseline level at 24 weeks. Bilateral rhythmic movements also showed slight improvement at 18 weeks. Pinch force increased significantly after 2 weeks, but declined again at 6 weeks. Improvements occurred in ROM and the Ashworth rating of spasticity, but were not temporally associated with each other or with MCT results. Functional assessment data did not change during the study period. Conclusions: Improvements in more complex motor tasks were noted after significant delay from the time of treatment, while simpler tasks demonstrated a more rapid improvement, followed by a rapid return to baseline levels. This case suggests that MCT techniques can provide quantitative and qualitative data, which can add new information about upper extremity motor disability and the outcome of treatment. 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Keywords: Botulinum toxin type A, Muscle spasticity, Arm, Case report, Cerebral palsy, Functional assessment, Rehabilitation

http://www.nap.edu/openbook.php?record_id=4563&page=118 Evaluation of Physical Performance James A.Vogel1

Neuromotor Control
The second physiological determinant of physical performance is neuromotor control of the initiation, coordination, and maintenance of muscular activity. This is composed of central nervous system processing of afferent signals, transmission of efferent signals to the muscle, and the subsequent depolarization of the muscle myofibril to bring about muscle contraction. Neuromotor control is typically assessed by measuring reaction time, agility, and coordination. Even though these measures are more commonly applied to tasks that are not physically demanding, they can be used to assess performance of tasks that are complex and demanding, such as the repeated loading and firing of a howitzer. Total reaction time, or the time from the recognition of a signal until a motor action takes place, can be fractionated into its components with the use of electromyography (Kroll, 1974), thereby allowing evaluation of the efficiency of each of the subcomponents of neuromotor control. Premotor time corresponds to the central processing component, while motor time represents the muscle contractile component. A typical procedure involves the presentation of a sudden visual signal to which the subject responds by hitting a target. The activity of the involved muscle is measured electromyographically (Clarkson, 1978.) A laboratory test of gross motor agility and coordination has been reported by Fitzgerald et al. (1986). For this test, a subject stands between two sets of shelves. During a 1-min time interval, the subject removes a 7.3-kg sliding drawer from a shelf at a 150-cm height on the left side, rotates 180 degrees and inserts the drawer into a shelf at a 50-cm height on the right side. The subject repeats this pattern by removing a second sliding drawer from the shelf on the upper right side and inserting this into a shelf on the lower left side. The process is then reversed, moving the shelves from the lower positions back to the upper ones. The motion is repeated as many times as possible
within the 1-min period.

Examples of fine motor control tests that assess eye-hand coordination and steadiness include the arm-hand steadiness task (Kobrick et al., 1988, p. 6), the cord and cylinder manipulation test (Johnson, 1981, pp. 166167), and marksmanship. Marksmanship can now be quantified in the laboratory by the use of laser marksmanship systems (Noptel ST-1000, Oulu, Findland) (Tharion et al., 1992)