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  <head>
    <title>028-02 Motor-unit physiology, lesion localisation, and adaptive movement control</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Motor units, localisation, and adaptive control">
      <outline text="Hierarchical force recruitment">
        <outline text="Units differ in size, speed, fatigue, threshold"/>
        <outline text="Size principle: small fatigue-resistant first">
          <outline text="Smooth economical output, reserve preserved"/>
        </outline>
        <outline text="Rate coding fuses twitches"/>
        <outline text="Fatigue: more units and drive, more effort"/>
        <outline text="Surface EMG records summed activity, not force"/>
        <outline text="Needle examination samples single units">
          <outline text="Denervation gives fibrillation potentials"/>
          <outline text="Reinnervation gives larger longer units"/>
        </outline>
      </outline>
      <outline text="Neuromuscular safety margin">
        <outline text="Each impulse releases surplus acetylcholine"/>
        <outline text="Postsynaptic receptor loss: fatigable weakness"/>
        <outline text="Presynaptic failure may improve with repetition">
          <outline text="Calcium accumulates with activation"/>
        </outline>
        <outline text="Myasthenia: ocular, bulbar, neck, proximal">
          <outline text="Sensation and pupils spared"/>
          <outline text="Respiratory and swallowing crises"/>
        </outline>
        <outline text="Botulinum toxin blocks acetylcholine release">
          <outline text="Local use for dystonia and spasticity"/>
        </outline>
      </outline>
      <outline text="Localising weakness">
        <outline text="Upper motor neuron: pyramidal pattern">
          <outline text="Acute lesions may show low tone first"/>
        </outline>
        <outline text="Lower motor neuron: root, plexus, nerve pattern">
          <outline text="Root lesions add radicular pain"/>
        </outline>
        <outline text="Junction disease: fatigability, no early atrophy"/>
        <outline text="Myopathy: symmetric proximal weakness"/>
        <outline text="Functional weakness: positive inconsistency">
          <outline text="Genuine, treatable, uses preserved pathways"/>
        </outline>
      </outline>
      <outline text="Tone and reflex physiology">
        <outline text="Tone: mechanics, activation, reflex gain, state"/>
        <outline text="Spasticity rises with velocity and direction"/>
        <outline text="Rigidity uniform, smooth or ratcheting"/>
        <outline text="Paratonia varies with attention"/>
        <outline text="Hyperreflexia: raised gain, not strong muscle"/>
        <outline text="Clonus: self-sustaining stretch cycle"/>
        <outline text="Reinforcement can reveal a present reflex"/>
        <outline text="Asymmetry with weakness localises"/>
      </outline>
      <outline text="Spinal networks and pattern generation">
        <outline text="Withdrawal recruits by stimulus location"/>
        <outline text="Reflex effects are task dependent"/>
        <outline text="Pattern generators need supraspinal start">
          <outline text="Load, hip position, skin input adapt gait"/>
        </outline>
        <outline text="Cord lesion: segmental at, long-tract below"/>
        <outline text="Hemicord: ipsilateral motor, contralateral pain"/>
        <outline text="Central cervical lesion: arms more than legs"/>
      </outline>
      <outline text="Cerebellar prediction and error">
        <outline text="Compares command copy with feedback"/>
        <outline text="Feed-forward learning outruns slow feedback"/>
        <outline text="Climbing fibres teach, mossy fibres give context"/>
        <outline text="Plasticity updates internal models"/>
        <outline text="Signs worsen near the target">
          <outline text="Predictive braking and scaling fail"/>
          <outline text="Dysmetria, decomposition, intention tremor"/>
        </outline>
        <outline text="Midline: stance, trunk, gait"/>
        <outline text="Drugs, stroke, immune, nutritional causes"/>
      </outline>
      <outline text="Basal-ganglia selection and reinforcement">
        <outline text="Output tonically inhibits thalamus, brainstem"/>
        <outline text="Selection releases desired, holds competitors"/>
        <outline text="Hyperdirect pathway speeds global stopping"/>
        <outline text="Dopamine loss slows initiation and scaling">
          <outline text="Strength retained, starting impaired"/>
          <outline text="External cues bypass automatic control"/>
        </outline>
        <outline text="Bradykinesia decrements with repetition"/>
        <outline text="Levodopa fluctuates as buffering declines"/>
        <outline text="Deep-brain stimulation does not cure"/>
        <outline text="Phenomenology determines cause and treatment"/>
      </outline>
      <outline text="Posture, gait, and dual-task reserve">
        <outline text="Balance integrates many systems"/>
        <outline text="Compensation fails in dark or on uneven ground">
          <outline text="Recreate fall conditions safely"/>
        </outline>
        <outline text="Gait begins with weight shift"/>
        <outline text="Freezing at doorways, turns, competing demands"/>
        <outline text="Dual-task slowing predicts reduced reserve"/>
        <outline text="Devices help only when fitted and used"/>
      </outline>
      <outline text="Rehabilitation and adaptive control">
        <outline text="Restitution, compensation, prevention, adaptation"/>
        <outline text="Careless repetition is insufficient"/>
        <outline text="Error size must be tolerable">
          <outline text="Too little: no teaching signal"/>
          <outline text="Too much: fear and compensatory habits"/>
        </outline>
        <outline text="Variable practice improves transfer"/>
        <outline text="Rest and sleep consolidate learning"/>
        <outline text="Spasticity treatment targets specific goals"/>
        <outline text="Formulation beyond a single strength grade"/>
      </outline>
    </outline>
  </body>
</opml>
