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Are we being too ‘selective’ about motor control?

In our early clinical experience of evaluating children with cerebral palsy (CP), it became clear that selective motor control (SMC) was an important but unrecognized prognostic factor for responsiveness to a variety of treatment interventions, such as selective posterior rhizotomy. At the time, there was no consensus definition of SMC or a standardized assessment, which led to our development of the Selective Control Assessment of the Lower Extremity (SCALE). Consensus definitions and the development of a range of clinical assessment tools for movement disorders in CP have substantially moved the field forward. Technological advances now enable direct assessment of brain white matter, affording an exciting opportunity to better understand the relationship between movement disorders and specific neuroanatomical correlates. In this regard, the review by Cahill-Rowley and Rose discusses evidence that rubrospinal tracts (RSTs) are responsible for synergistic movement patterns observed in patients following stroke and this may have important implications for patients with CP. The primary focus of the review is ‘obligatory co-activation of synergist muscles’, which is one feature of SMC impairment attributed to corticospinal tract (CST) damage. Other features include lack of movement, isolated movement through partial range, inability to reverse direction, reduced speed, and obligatory involuntary movement at another joint (including mirror movement).