The Motor Examination

Abstract

Because of the nature of development, with its dependence on sensorimotor interaction, an assessment of motor functioning is critical to a meaningful evaluation of the cognitive control system. In this regard, a motor examination should be considered critical to neuropsychological evaluation, particularly within the developing pediatric population since cognition is grounded sensorimotor behavior. Results of motor examinations, as reported above, are predictive of later cognitive control. Motor examinations should be systematic, and unfortunately, most commercially available neuropsychological assessment tools do not include systematic motor assessment. Many commercially available exams are multiple-component subtests that are organized idiosyncratically, instead of respecting the way in which motor behavior is organized within the human brain. Certain existing motor exams typically focus on aspects of unimanual and bimanual motor programming tasks which are clearly extremely useful. Abilities to perform these types of tasks emerge at around the age of 5 years, while the motor system stabilizes, with adult levels of performance expected sometime between the ages of 10 and 12 years [183, 290]. These tasks are difficult to norm, as inter-rater reliability can be difficult to achieve (Goldberg and Podell, independent personal communications, circa 2007). However, as a general rule, the three brain regions participate in motor activity in different ways, and this has potential localizing significance. Programming motor sequences is the property of frontal lobes [64, 165]. Intention programs, such as starting, perseverating, and stopping behaviors, as well as the lack of inhibition over voluntary movement, is basal ganglia governed [111, 195, 291]. Managing the coordination, or the rate, rhythm, and force of movements, in other words, the quality of movement, is under cerebellar control. In this regard, qualitative observations can be extremely important in interpreting the data obtained from motor examinations. A neurologist routinely relies upon this type of information. Why can’t a neuropsychologist do the same?