![]() A complete supination is possible only among the most evolved animals, so that the palm of the hand can be completely turned upwards the second part of the outward rotation movement appears then to be related to the formation and development of the pyramidal pathways.Pronation, associated with flexion and abduction movements, represents the most important movement in amphibians, fish and reptiles – necessary to set the water back and to move forward, and that it is still strongly present in mammals.Similar reflex was seen in newborns with pyramidal system not fully developed – confirmation that this sign was related to dysfunction of the pyramidal tract.Why pronator overcomes supinator in pyramidal lesion?Īccording to Phylogenetic theory of Gierlich:.Why pronator drift occurs when eyes are closed?.Here, we will try to answer the questions like: If only one motor test could be done in a patient – the best single test would be to examine the drift.Included in the initial examination of stroke as “FAST”.Can detect subtle upper motor neuron lesion which goes unrecognized by routine motor examination.Drift without pronation: Functional upper limb paresis (Conversion disorder).“ Updrift” (involved arm rising overhead without patient awareness): Parietal lobe lesions (loss of position sense).Outward and upward drift: Cerebellar drift.Positive with eyes closed: Sensory deficit (Posterior column).Interpretation of positive pronator drift The examiner can simple wait for the response or hasten the process by tapping on the patient’s palms or having the patient turn the head back and forth, or both. Not necessarily abnormal – must be interpreted in clinical context.Slight pronation, without downward drift of the dominant arm.Components of pronator drift as mentioned above is seen in the weaker side (asymmetric response) which indicates a lesion in contralateral. ![]() on both the sides – dominant hand may pronate slightly more than the non-dominant hand) Symmetrical deviation from this position (i.e.Palm will remain flat, elbows straight and the limbs horizontal OR.When the patient extends both arms upright in the supinated position and hold them at shoulder height for atleast 10 seconds (Patients should be asked to keep eyes open initially and later test again with eyes closed): Interpretation of positive pronator drift.Method of assessment for pronator drift.
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