Motor testing in neurology: an historical overview

Systematic testing of muscle tone, bulk, and strength and analysis of the distribution of abnormal findings is a key element of bedside cerebral localization. A codified neurological examination was developed in the 20th century, but physicians have commented on weakness since antiquity. The ancient Egyptians, Greeks, and Romans described weakness in patients with head injuries and strokes, explaining it in terms of the pathophysiology of their times. Diagnostic principles of lateralization and localization developed in the Enlightenment, alongside an understanding of the anatomy of the motor system. In the 19th century, the work of Romberg, Todd, Charcot, and Gowers popularized the use of motor localization by demonstrating the power of scientific reasoning at the bedside. The concept of the upper motor neuron, as elaborated by Gowers, has enduring clinical utility.