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 & interventions Effect of therapeutic & pharmacological interventions & Prognosis Motor cortex Broadmanns area 4 (primary motor cortex) Periphery Cerebellum Basal ganglia

Coordination Deficit
Basal ganglia Cerebellum

Desending system: Lateral ventromedial corticospinal

Cerebral cortex

Feedback loops
Receptor

Central pattern generator Muscles

Cerebellum
Regulate 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 ganglia
Group of nuclei located at the base of cerebral cortex. Caudate, Putamen, Globus pallidus Closely related with 2 other subcortical nuclei Subthalamic 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 dysfunction 1.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 huntingtons 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 column
It controls coordinate movement & posture Proprioceptive input (proprioception & kinesthesia) Clinical features of dorsal column lesion Equilibrium & motor control disturbance Lack of proprioceptive feedback Compensatory visual feedback Positive rhombergs sign Slow voluntary movements Disturbed gait-watching feet during ambulation Dysmetria(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 activities Gross motor activities- body posture, balance & extremity movt involving large muscles. Fine motor activities manipulation of objects, finger dexterity etc. Non-equilibrium & equilibrium test Non-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 form Stopwatch 2 chairs Mat or treatment table Location-free from distractions Test selection

Pt preparation- well rested, explanation, demo. Testing- noneq. Equil., well guarded pt., use safety belt