Motor control: spinal and cortical mechanisms

There is extensive machinery at cerebral and spinal levels to support voluntary movement, but spinal mechanisms are often ignored by clinicians and researchers. For movements of the upper and lower limbs, what the brain commands can be modified or even suppressed completely at spinal level. The corticospinal system is the executive pathway for movement arising largely from primary motor cortex, but movement is not initiated there, and other pathways normally contribute to movement. Greater use of these pathways can allow movement to be restored when the corticospinal system is damaged by, e.g. stroke, but there can be unwanted consequences of this ‘plasticity’. There is an extensive literature on cerebral mechanisms in the control of movement, and an equally large literature on spinal reflex function and the changes that occur during movement, and when pathology results in weakness and/or spasticity.