From the Guidelines
Motor impersistence is a neurological condition that requires a comprehensive management approach, focusing on treating the underlying condition and providing supportive care, rather than a specific medication to directly address the condition. This condition is characterized by the inability to sustain simple motor activities, such as maintaining postures or actions, despite having the physical ability to perform them. It is commonly associated with damage to the frontal lobes of the brain, particularly the right hemisphere, and is often seen in patients with dementia, stroke, traumatic brain injury, or neurodegenerative disorders 1.
Clinical Presentation and Diagnosis
The clinical presentation of motor impersistence can vary, but it typically manifests as an inability to maintain postures or actions for more than a brief period. Clinicians diagnose motor impersistence through simple bedside tests, such as asking patients to maintain specific postures or actions. The neurological basis involves disruption of the brain's attention networks and motor control systems, affecting the ability to sustain voluntary movements despite preserved motor strength.
Management and Rehabilitation
Management of motor impersistence focuses on treating the underlying condition and providing supportive care. Rehabilitation strategies, including occupational therapy, can help patients develop compensatory techniques to improve their ability to perform daily activities. For example, patients with stroke may benefit from therapeutic interventions to improve sensorimotor performance, such as exercise programs and physical therapy 1.
Importance of Early Intervention
Early intervention is crucial in managing motor impersistence, as it can help prevent secondary complications, such as reduced cardiorespiratory fitness, muscle atrophy, and impaired circulation to the lower extremities. Additionally, motor impersistence can have a profound negative psychological impact, including diminished self-efficacy and greater dependence on others for activities of daily living. Therefore, a comprehensive management approach that addresses the underlying condition, provides supportive care, and promotes early intervention is essential in improving outcomes for patients with motor impersistence.
From the Research
Definition and Characteristics of Motor Impersistence
- Motor impersistence is the inability to sustain certain simple voluntary acts, such as keeping eyes closed or protruding the tongue 2, 3.
- It is considered a sign of right-hemisphere lesions, and is related to mechanisms of directed attention that are necessary to sustain motor activity 2.
- Motor impersistence can be defined as the inability to perform more than two simple acts simultaneously, such as protruding the tongue with eyes closed 3.
Association with Right-Hemisphere Lesions
- Studies have shown that motor impersistence occurs more frequently after right than left hemispheric lesions 2, 4.
- The responsible lesion is suggested to be located in area 6 or 8 in the territory of the right middle cerebral artery 3.
- Right central and frontal lesions seem to be more responsible for motor impersistence than posterior or left-sided lesions 2.
Relationship with Other Conditions
- Motor impersistence is sometimes seen with diffuse cerebral disease, but it is also a sign of right-hemisphere lesions 2.
- The presence of neglect may influence the frequency of motor impersistence 5.
- Motor impersistence can be associated with callosal disconnection, resulting in dominant limb motor impersistence 4.
Diagnosis and Assessment
- A standardized clinical test of sustained actions can be used to assess motor impersistence 2.
- The force control test can screen for motor-intentional disorders, including motor impersistence, with a higher sensitivity than bedside examinations 5.
- The most discriminating tests for motor impersistence include eye-closure, mouth-opening, tongue-protrusion, and gaze to the left 2.