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  <head>
    <title>028-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Motor control foundations">
      <outline text="Distributed motor control">
        <outline text="Spinal circuits: reflexes and patterned output"/>
        <outline text="Brainstem: posture, balance, gaze, orientation"/>
        <outline text="Motor cortex specifies skilled action"/>
        <outline text="Basal nuclei select and scale actions"/>
        <outline text="Cerebellum predicts, compares, adapts"/>
        <outline text="Localise by weakness, tone, reflexes, gait"/>
      </outline>
      <outline text="Motor units and force">
        <outline text="Alpha motor neuron plus its muscle fibres">
          <outline text="Small units for fine control, large for power"/>
        </outline>
        <outline text="Force: faster firing, larger units recruited"/>
        <outline text="Asynchronous activation smooths contraction"/>
        <outline text="Neuromuscular transmission via acetylcholine">
          <outline text="Nicotinic end-plate potential, then sodium channels"/>
          <outline text="Safety factor can fail with receptor or release loss"/>
        </outline>
        <outline text="Lower motor-neuron loss: atrophy, fasciculations"/>
        <outline text="Junction disease: fatigable weakness, no sensory loss"/>
        <outline text="Muscle disease: symmetric proximal weakness"/>
      </outline>
      <outline text="Muscle spindles and tendon organs">
        <outline text="Spindles in parallel sense length and stretch rate">
          <outline text="Ia excites same muscle, inhibits antagonist"/>
          <outline text="Gamma drive preserves sensitivity in contraction"/>
        </outline>
        <outline text="Tendon organs in series sense tension via Ib">
          <outline text="Distribute load, flexible role in locomotion"/>
        </outline>
        <outline text="No receptor acts in isolation"/>
      </outline>
      <outline text="Spinal reflexes">
        <outline text="Stretch reflex resists sudden lengthening"/>
        <outline text="Tendon tap probes the whole reflex arc">
          <outline text="Amplitude varies with attention, age, technique"/>
          <outline text="Symmetry and other signs outweigh one grade"/>
        </outline>
        <outline text="Flexor withdrawal with crossed extension"/>
        <outline text="Renshaw recurrent and reciprocal inhibition"/>
        <outline text="Spinal shock, then exaggerated reflexes"/>
        <outline text="Pattern generators need descending initiation"/>
      </outline>
      <outline text="Descending pathways">
        <outline text="Corticospinal fibres cross in lower medulla">
          <outline text="Lateral tract: contralateral distal skill"/>
        </outline>
        <outline text="Corticobulbar input largely bilateral">
          <outline text="Lower face and tongue contralateral"/>
          <outline text="Central lesion spares forehead"/>
        </outline>
        <outline text="Reticulospinal: tone, posture, locomotion"/>
        <outline text="Vestibulospinal stabilises against gravity"/>
        <outline text="Tectospinal orients head to stimuli"/>
        <outline text="Upper motor-neuron lesion after shock resolves">
          <outline text="Hyperreflexia, clonus, extensor plantar"/>
          <outline text="Spasticity velocity-dependent, rigidity not"/>
        </outline>
      </outline>
      <outline text="Motor cortex and planning">
        <outline text="Primary motor: force direction, execution"/>
        <outline text="Premotor uses external cues"/>
        <outline text="Supplementary areas: sequences, bimanual"/>
        <outline text="Parietal cortex turns space into plans"/>
        <outline text="Maps overlap and change with learning"/>
        <outline text="Efference copy predicts sensory consequences"/>
        <outline text="Practice reduces attentional demand"/>
      </outline>
      <outline text="Cerebellar architecture and function">
        <outline text="Compares intended plans with performance"/>
        <outline text="Repeated cortical circuit">
          <outline text="Climbing fibres give teaching signals"/>
          <outline text="Purkinje cells inhibit deep nuclei"/>
        </outline>
        <outline text="Midline axial, lateral planning and timing"/>
        <outline text="Internal models support error-based learning"/>
        <outline text="Hemispheric lesions give ipsilateral signs"/>
        <outline text="Dysmetria, intention tremor, broad gait"/>
        <outline text="Sensory ataxia worsens with eyes closed"/>
      </outline>
      <outline text="Basal nuclei circuits">
        <outline text="Parallel motor, cognitive, limbic loops"/>
        <outline text="Inhibitory output selects cortical actions"/>
        <outline text="Direct pathway facilitates selected action"/>
        <outline text="Indirect pathway suppresses competitors"/>
        <outline text="Dopamine: D1 direct, D2 reduces indirect"/>
        <outline text="Parkinsonism from reduced dopamine">
          <outline text="Replacement helps but causes dyskinesia"/>
        </outline>
        <outline text="Chorea, dystonia, tics, ballism, myoclonus"/>
        <outline text="Dopamine blockers: dystonia, akathisia"/>
      </outline>
      <outline text="Posture, gait, and balance">
        <outline text="Quiet stance is active">
          <outline text="Ankle, hip, stepping strategies"/>
        </outline>
        <outline text="Anticipatory adjustments precede movement"/>
        <outline text="Ageing, neuropathy, sedatives reduce reserve"/>
        <outline text="Gait patterns localise the failure">
          <outline text="Parkinsonian short steps and freezing"/>
          <outline text="Frontal gait impairs initiation"/>
        </outline>
      </outline>
      <outline text="Motor learning and rehabilitation">
        <outline text="Restitution, compensation, practice, adaptation"/>
        <outline text="Task-specific, challenging, safe repetition"/>
        <outline text="Excess external correction impairs independence"/>
        <outline text="Treat spasticity for pain, contracture, function">
          <outline text="Stiffness may support transfers"/>
        </outline>
      </outline>
    </outline>
  </body>
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