Coordination Assessment

Parminder Kaur

AJIPT

Introduction

Coordination is the ability to execute smooth, accurate, controlled movt. Responses.

Complex process- requires appropriate speed, distance, direction, timing & muscular tension.

Coordination impairment

requires synergestic influences, posture maintenances

Integration of Sensory, motor & neural processes.

Purpose

Determine muscle activity

Ability of muscles to work together

Skill & efficiency of movement

Ability to initiate ,control & terminate the movement

Timing, sequencing & accuracy of movt patterns

Diagnosis (Impairment, Functional limitation, Disability)

Establish goals, outcomes & interventionsEffect of therapeutic & pharmacological interventions & Prognosis

Motor cortexBroadmann’s area 4 (primary motor cortex)

PeripheryCerebellumBasal ganglia

Coordination Deficit

Desending system: Feedback

Lateral ventromedial loops

corticospinal

Basal ganglia Cerebellum

Cerebral cortex

Central pattern generator

Receptor

Muscles

CerebellumRegulate movement, postural control & muscle tone.

Several theories of cerebellum function

Mostly acceptable function as a comparator or error correcting mechanism

CNS analysis of movement information, determination of the level of accuracy & provision of error correction is referred to as a closed –loop system.

Stereotypical movt., rapid short-duration movt, controlled by open-loop system.

Clinical features of cerebellar dysfunction

1.hypotonia- disruption of afferent input from stretch receptors

-lack of cerebellar facilitatory efferent influences on the fusimotor system

-ms. soft & flabby

-diminished DTRs.

2.dysmetria- inability to judge the distance or ROM, overestimation (hypermetria) or underestimation (hypometria)

3.dysdiadochokinesia- impaired ability to perform RAM. movt irregular, loss of range or rhythm

4.Tremor- involuntry oscillatory movement due to contraction of alternating muscle groups.

Types of tremors:-

a. intention or kinetic tremor

b. Postural (static) tremor

5.Dyssynergia (movt decomposition)- movt in sequence of component parts rather than as a single, smooth activity. asynergia is the loss of ability to associate muscles together for complex movt.

FTN test

6.Disorders of gait- broad BOS, high guard position.L/L starts slowly then flung rapidly & forcefully forward.

Gait-unsteady, irregular & staggering, deviation from forward line of progression.

7.dysarthria-disorder of motor component of speech articulation. Scanning speech seen.

8.Nystagmus- causes difficulty in accurate fixation & vision.

Involuntary drift back to midline position when eyes are moved away from midline resting point to fix on a peripheral object.

9.Rebound phenomenon- unable to check the movt, when application of resistance to an isometric contraction is suddenly removed.

10.Asthenia

Basal gangliaGroup of nuclei located at the base of cerebral cortex.

Caudate, Putamen, Globus pallidusClosely related with 2 other subcortical nucleiSubthalamic nucleus & Substantia gelatinosa

Functions• Initiation and regulation of gross intentional

movements• Planning and execution of complex motor responses

• Facilitation of desired motor responses with selective inhibition

• Ability to accomplish automatic movements and postural adjustment

• Maintaining normal background of muscle tone

• Also affects both perceptual and cognitive functions

Motor portion in somatotropic organization

Clinical features of basal ganglion dysfunction1.Bradykinesia-decrese arm swing, slow shuffling

gait, difficulty in initiating and changing direction, lack of facial expression, difficulty stopping the movement once begun

2.Rigidity-leadpipe and cogwheel rigidity (leadpipe with tremors)

3.Tremor-involuntry,oscillatory,rhythmic movt at rest. eg. Pill- rolling.

4.Akinesia- inability to initiate the movt, maintenance of fixed postures

5.Chorea- associated with huntington’s chorea. involuntry, rapid, jerky & irregular, also known as choreiform movements

6.Athetosis- slow, writhing, twisting, wormlike movements. mostly in distal upper extremities including face, neck, tongue & trunk.

7.Choreoathetosis

8.Hemiballismus- sudden, jerky, forceful, wild, flailing motion of the one side of the arm & leg. axial & proximal musculature of the limb involved, c/l subthalamic nucleus lesion. Associated hyperkinesis/hypokinesis

9.Dystonia- bizarre, twisting, involuntry contraction of the axial & proximal muscle

Torsion spasm,prolonged contraction at the end of the movement (dystonic posture)

Dorsal columnIt controls coordinate movement & postureProprioceptive input (proprioception & kinesthesia)

Clinical features of dorsal column lesionEquilibrium & motor control disturbanceLack of proprioceptive feedbackCompensatory visual feedbackPositive rhomberg’s signSlow voluntary movementsDisturbed gait-watching feet during ambulationDysmetria(u/l & l/l)

Changes in coordination with increasing age

Decreased strength- loss of alpha motor neurons & type II myofibrils.

Slowed reaction time- deg. Of motor units. More in sedentary & fine motor activities

Loss of flexibility- deg of collagen, dietary def, arthritic changes etc.

Faulty posture-inactivity & prolonged sitting

Impaired balance- increase postural sway & limits of stability

Testing procedure

Accurate & careful observation (functional activities)

Localize area of deficit

1. Level of skill in each activity

2. Extraneous movements

3. Extremities, proximal/distal musculature involvement

4. A/F, time reqd., level of safety, h/o fall

Screen for strength, ROM, sensations

Coordination test

Gross & fine motor activitiesGross motor activities- body posture, balance &

extremity movt involving large muscles.Fine motor activities – manipulation of objects, finger

dexterity etc.

Non-equilibrium & equilibrium testNon-equilibrium –static\ dynamic components of

movt not in upright position. Involves gross & fine activities.

equilibrium –static\ dynamic components of movt. in upright position. Involves gross activities

Coordination tests assess 4 basic motor task

1.Mobility – refers to initial movt occurring in func. Movt

2.stability(static postural control)- maintenance of stability in weight bearing antigravity positions.

3.Controlled mobility (dynamic postural control)- ability to alter a position without loosing stability

4.Skill – highly coordinated movt that allows interaction with the environment. Deficit – 1. inability to stabilize the proximal segments

2. Movts requiring increased effort, lacking direction and timing.

Assess movement capabilities

1.Alternate /reciprocal motion

2.Movement composition

3.Movement accuracy

4.fixation/limb holding

5.equilibrium/postural stability

Gait assessment-

- timed up & go test – Normal-within 10min

for elderly – 11-20 min

abnormal if more than 20 min.

- Functional independence measure

- PPME (physical performance & mobility examination

Testing protocol

Equipment Assessment formStopwatch2 chairsMat or treatment tableLocation-free from distractionsTest selection

Pt preparation- well rested, explanation, demo.

Testing- noneq. Equil., well guarded pt., use safety belt