|Year : 2014 | Volume
| Issue : 4 | Page : 143-145
The music of movement - in health - n - disease
Manu Kothari1, Atul Goel2
1 Department of Anatomy, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
2 Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
|Date of Web Publication||16-Dec-2014|
Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kothari M, Goel A. The music of movement - in health - n - disease. J Craniovert Jun Spine 2014;5:143-5
The title has been inspired by Pythagorean Music of the Spheres, and by a recent tome by Sudhindra Kulkarni, as a tribute to Mahatama'aCharakha, entitled The Music of the Spinning Wheel.
The distinguishing feature of the animal kingdom is movement- translatory in nature with reference to the ambient space. Plants sway with the winds and water. The movement faculty must be accorded to the microbial universe as well. A microcrawl of a paramecium is a miniaturized version of the slithering of a python. E. coli and Einstein are alike. The Entamoeba puts forth its facultative pod, and its body follows in tow. An Einstein puts forth the fore/hind limb, and the body follows suit. The curling and unfurling of leaves and flowers is more of a hydrodynamic play.
The maker of the music of movement is a universal couple comprising Myosin and Actin, or the MA pair. Myosin (mightosin) is a universal protein capable of contraction and decontraction mediating the diapedesisof a leucocyte or the dash of a dinosaur.
MA is universally distributed in all cells, being copius and manifest in muscle cells-smooth and striated. Here we shall restrict to the movement by the (so-called) voluntary striated muscles.  At the very outset, it must be realized that the ease and/or the complexity of any movement has defied analysis so as to border on the mysterious. Human walking involves unilateral stance, both in alternate weight-bearing and movement. The weight bearing limb is a monopillar overlaid with up to 300 kg, eccentrically placed with the grossest mechanical disadvantage. And yet, the body manages this miracle with spontaneity and ease. The sprint of Ussain Bolt and the waddling gait of a bulky dowager are, given all the computer analytic assistance, nothing short of a miracle.
Going a little more aesthetic, the sheer grace of a feline leap, equine jump and gallup, the 3 Ύ midair somersaults of a trapeze artist, the breathtaking precision of an ice-skater, or the spin of a ballet dancer are all an outcome of immensely unfathomable neuromuscular orchestration, a poem to which no syllable can be added not a punctuation mark subtracted. All are a saga of concerted muscle power overseen by flawless precision. The lashing of a sperm's tail in a seminal pool and the lashing of the tail of a whale differ only quantitatively, vis-à-vis the power generated.
Any ordinary movement, e. g. signing a paper, picking up a needle, a stroke in cricket or a backhand return in tennis, so on and so forth, is an outcome of a finely tuned symphony of power of the drive and the precision of restraint. The dictate is: Move this far and no further, this strong and no more, no less, this much no more, no less. Every time, it is a philharmonic orchestra conducted by an invisible Zubin Mehta.
The deliberate use of the term orchestration in the foregoing merits some explanation. It is an amazing fact and a feat that human gait is highly individualistic, as idiosyncratic as the person's pinna or the fingerprints. The seeming ordinariness of human translation in space is underwritten by a gigantic partnership of neurons, muscles, brain large and small, sensory receptors, all in a chorus that has the finesse of a grand opera. The Gray's Anatomy writes that the brain knows movements and not muscles. The noumenon of a movement and the phenomenon of that movement, are so designed that a particular performance is unprecedented, unparalleled and unrepeatable. A trillion cheques pass the banker's scrutiny and are cleared un-confusingly because of the distinctive character of every signature. A few 3-20 letters are so arranged that no two signatures dare to be mistaken as just the same. A jet of much the same air gets injected through the vocal apparatus to produce the uniqueness of the voice of the speaker, or a singer through the individual specific orchestration going into it unasked for. The personality of any human is a cosmic event. A report from London (Times of India, Mumbai, October 14, 2014) declares that voiceprints are as unique as fingerprints.
An important factor governing the power-n-precision of a movement is dictated by the size of a motor unit. A single lower motor neuron innervates just six fibers in an eye muscle and 600 fibers in a limb muscle. Granted the inevitability of 'all or none law', the firing of an impulse down a single axon would beget just a gentle twitch or a massive push or pull. The power play is discreet and precise.
Let us now turn to the emergent discipline of the science of Movement Disorder (MD). MD is a merry mix of power too little or too much, coupled with precision too little or too much. The leading members of muscular dystrophy (MD) are myopathies, Parkinson's disease (PD) or syndrome and various forms of chorea.
Myopathies, including the badly named pseudohypertrophic muscular paralysis, are an outcome of timerelated apoptosis of muscle cells affecting groups near or distal. The muscle loss just occurs regardless of the best of preventive efforts. It's akin to graying of hair, inexorable, progressive unpredictable.
Such apoptotic atrophy affects neurons as well, MND or Motor Neuron Disease being a prime example. The start and the run of MND, and any allied neuronal disorder, is undeterminedly autonomous, has its fits and starts, crawling or leapfrogging. Stephen Hawking is an outstanding example of the Shakespearean "the spirit is willing, but the flesh is weak." Hawking's consistent genius and creativity border on being at the crest of a Nobel prize, illustrative of the method in madness that governs MND.
The medical term for PD is an oxymoron called Paralysis Agitans. The juxtaposition of two contradictory elements is educative about much of MD. Any movement-minute to the grossest-is a balance of muscle power regulated with strictly equally powerful neuromuscular restraint or precision. A set of neuromuscular units go into action to generate the power to move, and simultaneously or even a fraction of a millisecond earlier, an ensemble of neuromuscular units offers checks and balances to consummate the movement towards desired perfection.
With aging, circuitocytes comprising sensory receptors, neurons and muscle cells dwindle in number at a steady but relentless pace. The outcome is age-related dampening of muscle skill without any gross imbalance between Power‐n‐Precision. That's what makes sportsstars retire between 30 and 40. Life is good, but a little dull, little slow.
In PD there is age-governed scattered loss of power units in some areas and precision units in the other. That leads to that seemingly contrary blend of paralyzed rigidity on the one hand and uncontrolled mobility on the other, thus well deserving the epithet shaking-palsy that James Parkinson talked about.
In chorea, the precision units are grossly on the wane so that the power units have a field day, occasioning painful, relentless, uncoordinated movements whereby the person looks like a battery operated baby doll executing the wildest movements in all directions. Chorea is related to dance and hence choreography and cholerography. Medical chorea is Dance Macabre, an affliction that is so causeless and so human.
Any form of the spontaneous MD non-infective is kind of Normality that the prejudiced but well-intentioned medical eye fails to see. Loss of power units and precision-units is time-governed, the time that is crawling in some, trots in others, and gallops in the third group. All these processes are part and parcel of the normal distribution curve for which no theory of pathogenesis has as yet worked nor is expected to work. MD is with us to stay, as integral as any other human feature.
INNTOE, reads as In Nature No Terror of Error. ,, MD, PD and chorea are variants of normality. Pope puts it poetically:
ORDER IS HEAVEN'S FIRST LAW
All Nature is but art, unknown to thee;
All chance, direction which thou canst not see;
All discord, harmony not understood;
All partial evil, universal good;
And spite of pride, in erring reason's spite,
One truth is clear, whatever is, is right.
Herdity, not heredity, governs MD, a few get it so that the majority escape. Many are called, but a few are chosen to bear the cross of MD.
Logically much of MD is, to use Andrey's phrase, an Ordered Disorder, that is part of the human corporate herd program - HERDITY, impervious to the pleas and platitudes of modern medicine. Godwin Austen a British neurologist says it all when he says it about PD: "You must remember first of all that Parkinson's Disease has NOT resulted from something you have done (or not done) in the past. It is NOT caused by overwork or overindulgence, and that is very unusual for Parkinson's disease to be related to injury of any sort." Being human is enough to develop and exhibit some disturbed music of movement, called MD.
On movement, one can paraphrase Rene Descartes who aphorized: Cogito, ergo sum, I think and therefore I am.
We could say Agito, ergo sum, I move and therefore I am.
Isn't life a perpetual flux, a ceaseless movement in all the three kingdoms, within the cells, between the cells and beyond the cell?
Isn't that celestial music? The music of movement
| Acknowledgement|| |
This article is the last literary contribution of Dr. Manu L. Kothari. The article was written one day prior to his death. Dr. Kothari taught each one of us about the supremacy of Nature. His astonishingly great contributions to medical science will always be remembered with awe and respect.
| References|| |
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Kothari M, Goel A. Let us not just work at the spinal level. Neurol India 2005;53:396.
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Kothari M, Goel A. Neuraxial healing. Neurol India 2007;55:319-21.