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Motor Skills
Motor skills or coordination is the product of a complex set of cognitive and physical processes. Smooth, targeted, and accurate movements, both gross and fine, require the harmonious functioning of sensory input, central processing of the information in the brain and coordination with the high executive cerebral functions, such as volition, motivation, motor planning of an activity. The performance of a certain motor pattern is also important. All of these elements must work in a coordinated and rapid way to enable complex movements involving different parts of the body.

Motor Skill

Gross Motor Skills

Includes lifting one's head, rolling over, sitting up, balancing, crawling, and walking. Gross motor development usually follows a pattern. Generally large muscles develop before smaller ones, thus, gross motor development is the foundation for developing skills in other areas like fine motor skills. Development generally moves from the top of the body down to the bottom.

Fine Motor Skills

Includes the ability to manipulate small objects, transfer objects from hand to hand, and various hand-eye coordination tasks. Fine motor skills may involve the use of very precise motor movement in order to achieve an especially delicate task, for example, the pincer grasp using the thumb and forefinger to pick up small objects, cutting, coloring, or writing. Fine motor development refers to the development of skills involving the smaller muscle groups.


Is a specialized skill in which there is no dominance between body symmetries, so tasks requiring fine motor skills can be performed with the left or right extremities. The most common example of ambidexterity is the ability to write with the left or right hand, rather than one dominant side.

Motor skill dysfunction has many causes, such as the demyelination of motor neurons. While fatigue or weariness may lead to temporary short-term deterioration of fine motor skills observed as visible shaking, serious nervous disorders may result in a loss of both gross and fine motor skills due to the hampering of muscular control.

Motor Symptoms

Motor symptoms have to deal with the muscular movement of any part of the body. This movement refers to something that produces or refers to motion. An example being a motor neuron is a nerve cell that conveys an impulse to a muscle causing it to contract. Multiple sclerosis (MS) motor symptoms typically involve weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, or a lack of coordination. It's associated with muscle tightness and weakness that limit a limb's range of movements.

Muscle-related symptoms most often occur in the arms and legs and at times, these symptoms may impair walking. Spasticity, which is the involuntary tightening of a muscle, can manifest as stiffness, pain or spasms. Some may experience an intention tremor causing difficulty in making small or complex movements and notice their hands shake when trying to pick something up, write, or button their shirt.

Muscle-Related Symptoms may include:
Loss of balance
Numbness or abnormal sensation in any area
Pain because of muscle spasms
Pain in the arms or legs
Problems moving arms or legs
Problems walking
Problems with coordination and making small movements
Slurred or difficult-to-understand speech
Tremor in one or more arms or legs
Uncontrollable spasm of muscle groups (muscle spasticity)
Weakness in one or more arms or legs
A cramp is a sudden, brief, unintended (involuntary), and usually painful contraction of a muscle or group of muscles.

Muscle cramps (also called charley horses) often occur in healthy people, usually in middle-aged and older people but sometimes in younger people. Cramps tend to occur during or after vigorous exercise but sometimes occur during rest. Some people have leg cramps during sleep and usually affect the calf and foot muscles, causing the foot and toes to curl downward. Although painful, these cramps are usually not serious and are thus called benign leg cramps.

Having tight calf muscles is a common cause of leg cramps. Muscles become tight when they are not stretched, when people are inactive, or sometimes when fluid repeatedly accumulates (called edema) in the lower leg.

Low levels of electrolytes (such as potassium, magnesium, or calcium) in the blood can also cause cramps. Low electrolyte levels may result from use of some diuretics, alcoholism, certain endocrine disorders, vitamin D deficiency, or conditions that cause loss of fluids (and thus electrolytes).

Spasticity is a condition in which certain muscles are continuously contracted. This contraction causes spasms, stiffness or tightness of the muscles and may interfere with movement, speech, and manner of walking. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement.

You might feel spasticity either as stiffness that doesn’t go away or as movements you can’t control that come and go, especially at night. Spasticity also can make you ache or feel tight in and around your joints and low back. How you feel can vary depending on your position, posture, and how relaxed you are.

Symptoms may include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs), and fixed joints. The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. Spasticity can interfere with rehabilitation in patients with certain disorders, and often interferes with daily activities.

Almost everyone with MS will have some loss of mobility, which may take the form of impaired (lessened) motor control, muscle weakness, impaired balance, and spasticity. Spasticity is one of the primary symptoms of MS and is characterized by weakness, loss of dexterity, and the inability to control specific movements. It's usually more severe in the legs and torso. Mobility can also be affected by many non-physical factors including mental well-being, social networks, fatigue, and even the weather.

The Cause

Spasticity occurs as a result of an imbalance between the excitatory and inhibitory signals from the brain and/or spinal cord. Excitatory signals send messages to other neurons, firing them into action, whereas inhibitory signals stop neurons firing and suppress a response, such as stopping a full bladder from spontaneously emptying itself. It's thought that there is an interruption of the inhibitory signals along the spinal cord and in the brain which results in an increased excitation and therefore an imbalance.

Spasticity can be complicated by dystonia where the problem is not only increased muscle tone but odd postures such as neck twisting to one side or the other. Dystonia can also exist alone as an isolated movement disorder in MS. One or more muscles or muscle groups can be involved in spasticity or dystonia. Muscle spasticity, or excessive tightness, is common and may be more disabling than weakness.

It can get worse when it's too hot or cold, when you have an infection, or if you're wearing tight clothing. It can also be present at any point of the disease (early or late onset) and the symptoms can vary from mild to severe. In severe cases, spasticity can even cause a limb to become "frozen" in a bent position, requiring immediate medical attention.

It's important that the person with spasticity is positioned correctly when sitting and lying down to prevent limbs becoming fixed in an inappropriate position. They should be able to lie flat every day in order to stretch the muscles involved. Lying on the side and standing are also useful for stretching muscles in spasm. Posture when sitting needs to be well balanced and stable. Special seating systems are available to help with this. The person should be moved regularly to avoid damage to skin and help in joint mobility. Design of the wheelchair is also important, as it's essential that it provides support for the upper body and limbs.

Spasticity affects body functions and can cause activity limitations and participation restrictions, primarily due to its effect on functional movement.

Detrimental Consequences Associated with Spasticity:
Interference with mobility, ability to exercise and the range of motion in joints
Negative impact on endurance and energy expenditure
Interference with the activities of daily living
Discomfort or pain
Sleep disturbance

Treating MS Spasticity

Physical therapy, medications, surgery, or a mix of these treatments can ease spasticity when you have MS. To decide the best way to help you, your doctors will think about your overall health, how severe your symptoms are. Other considerations that need to be looked at range from pain level, cost, side effects, and so on.

Physical and Occupational Therapy
Most of the time, a physical therapist can treat MS spasticity with a basic physical therapy stretching program. The goal is to lengthen your muscles which should ease the condition. An occupational therapist may recommend different tools, like splints, casts, or braces, to keep up your range of motion and flexibility. If physical and occupational therapy don’t help, your doctor may want to try medications.

The most common medications to treat the condition include the muscle relaxants baclofen (Gablofen, Kemstro, Lioresal) and tizanidine (Zanaflex). Another option is diazepam (Valium), which can help you sleep if nighttime spasms keep you awake. If pills don’t work, your doctor might be able to put a pump inside your body to deliver the medication directly to your spinal fluid like with a baclofen pump. You can also get shots of botulinum toxin (such as Botox or Myobloc) to relax your muscles.

When other treatments don't work, there are two types of surgery that can treat spasticity:

Rhizotomy is where a surgeon cuts away part of the spinal nerve. The goal is to relieve pain or ease muscle tension.
Tenotomy is where a surgeon cuts severely tight tendons away from the muscles. It may make spasticity happen less often and make it less severe, depending on how old you are. Over time, you may need to have the surgery again.

These surgeries can help, but they’re usually only for extreme cases of spasticity and are rarely performed in patients with MS.

It's important to approach spasticity management from an interdisciplinary team approach with everyone involved so they can better identify goals and make the adjustments necessary to attain optimal spasticity management. Goals of spasticity management should be orientated towards the improvement of function and improved comfort, and an individual's response to interventions such as medications, rehabilitation or surgery needs to be closely monitored.