Motor function involves complex physiologic processes and requires the integration of multiple systems, including neuromuscular, musculoskeletal, and cardiopulmonary, and neural motor and sensory-perceptual systems. Motor-functional status is indicative of current physical health status, burden of disease, and long-term health outcomes, and is integrally related to daily functioning and quality of life. Given its importance to overall neurologic health and function, motor function was identified as a key domain for inclusion in the NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox). We engaged in a 3-stage developmental process to: 1) identify key subdomains and candidate measures for inclusion in the NIH Toolbox, 2) pretest candidate measures for feasibility across the age span of people aged 3 to 85 years, and 3) validate candidate measures against criterion measures in a sample of healthy individuals aged 3 to 85 years (n 5 340). Based on extensive literature review and input from content experts, the 5 subdomains of dexterity, strength, balance, locomotion, and endurance were recommended for inclusion in the NIH Toolbox motor battery. Based on our validation testing, valid and reliable measures that are simultaneously low-cost and portable have been recommended to assess each subdomain, including the 9-hole peg board for dexterity, grip dynamometry for upper-extremity strength, standing balance test, 4-m walk test for gait speed, and a 2-minute walk test for endurance. Neurology Motor function, the ability to use and control muscles and movements, is integrally related to daily functioning and quality of life. Motor function is a complex physiologic process and requires the integration of multiple inputs and systems, including the neuromuscular, neurosensory, musculoskeletal, and cardiopulmonary systems. Impairments in motor function are often indicative of disorders of the central or peripheral nervous systems and can lead to increased risk of activity limitations, participation restrictions, and mortality in people across the lifespan.1,2 Accordingly, assessment of motor function was included as a major domain of the NIH Toolbox Assessment of Neurological and Behavioral Function (NIH Toolbox)-an initiative of the NIH Blueprint for Neuroscience Research that seeks to develop a brief but comprehensive set of standard measures of motor, cognitive, sensory, and emotional function across the age span from 3 to 85 years 3 for use in epidemiologic, longitudinal, and clinical research.Assessing change in motor function across the lifespan is a complex measurement task. Precise measures of motor function frequently require specialized testing environments and costly equipment. 4 Performance-based measures of motor function have demonstrated prognostic and diagnostic value at the individual and population levels 1,2,5 ; however, there is a lack of consistency in how motor function is measured across studies and across the age span that limits the generalizability of research fin...

1. Intracellular recording and stimulation techniques were used in anesthetized cats to study the interrelations between amplitudes of PSPs produced by electrical stimulation of several short-latency pathways to MG alpha motoneurons and the mechanical properties of muscle units innervated by the same cells. Motor-unit types were identified by muscle-unit properties.2. The maximum amplitudes of monosynaptic EPSPs produced in MG motoneurons by activation of homonymous (MG) and heteronymous (LGS) group Ia afferents were clearly related to motor-unit type, being, on the average, largest in type S units, somewhat smaller in type FR and F(int) units, and smallest in type FF units. Correspondingly, group Ia EPSP amplitudes were inversely correlated with muscle-unit tension production and directly correlated with resistance to fatigue. The same input distribution was true for disynaptic IPSPs produced by group Ia afferents from antagonist ankle flexors.3. The amplitudes of monosynaptic EPSPs produced by fibers descending in the ipsilateral ventral funiculi of the low thoracic cord were not clearly related to MG motor-unit type or (therefore) to muscle-unit properties.4. A quantitative input-output model of the MG motor-unit pool, based in part on the present results, suggests that overall characteristics of MG motor units, and their relative numbers in the MG pool, reflect functional specializations determined by specific mechanical demands placed on the MG muscle by the usual motor behavior of the animal.

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The physiological basis of flexion spasms in individuals after spinal cord injury (SCI) may involve alterations in the properties of spinal neurons in the flexion reflex pathways. We hypothesize that these changes would be manifested as progressive increases in reflex response with repetitive stimulus application (i.e., "windup") of the flexion reflexes. We investigated the windup of flexion reflex responses in 12 individuals with complete chronic SCI. Flexion reflexes were triggered using trains of electrical stimulation of plantar skin at variable intensities and inter-stimulus intervals. For threshold and suprathreshold stimulation, windup of both peak ankle and hip flexion torques and of integrated tibialis anterior electromyographic activity was observed consistently in all patients at inter-stimulus intervals < or =3 s. For subthreshold stimuli, facilitation of reflexes occurred only at intervals < or =1 s. Similarly, the latency of flexion reflexes decreased significantly at intervals < or =1 s. Patients that were receiving anti-spasticity medications (e.g., baclofen) had surprisingly larger windup of reflex responses than those who did not take such medications, although this difference may be related to differences of spasm frequency between the groups of subjects. The results indicate that the increase in spinal neuronal excitability following a train of electrical stimuli lasts for < or =3 s, similar to previous studies of nociceptive processing. Such long-lasting increases in flexion reflex responses suggest that cellular mechanisms such as plateau potentials in spinal motoneurons, interneurons, or both, may partially mediate spinal cord hyperexcitability in the absence of descending modulatory input.

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Study Design: Electromyographic study in complete and incomplete spinal cord injury (SCI). Objective: To examine the changes in the pattern of reciprocal inhibition between agonist and antagonist muscles in SCI. Settings: Sensory Motor Performance Program, Rehabilitation Institute of Chicago, IL, USA. Methods: Tendon taps were delivered manually with an instrumented hammer to the tendons of the tibialis anterior and soleus muscle in positions of full-ankle dorsiflexion and plantarflexion in eight subjects with complete SCI and eight subjects with incomplete SCI. Electromyographic activity (EMG) was recorded from ankle dorsiflexor and plantarflexor muscles. Tapping force was also recorded by a force sensor mounted to the tendon hammer, indicating the stimulus onset. Measures of reflex EMG magnitude and reflex latency were obtained for both agonist and antagonist muscles. The ratio of antagonist to agonist EMG was computed based on normalized EMG. Results: Substantial reflex responses occurred in both the stretched muscle and in its antagonist. The reflex in antagonist, which we term 'reciprocal facilitation (RF)', was most evident in subjects with incomplete SCI. The magnitude of RF was consistently greater than reflex responses in agonist muscles under all test conditions. The latency of the RF was comparable to that of monosynaptic reflex response. Conclusions: Following SCI, reciprocal organization of segmental reflexes at the ankle is often partially or completely suppressed, allowing reflex activation in antagonist muscles to be manifested. Possible mechanisms underlying these changes in neural organization are discussed.