Coordination Assessment
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Transcript of Coordination Assessment
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Coordination Assessment
Parminder Kaur
AJIPT
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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.
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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)
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Establish goals, outcomes & interventionsEffect of therapeutic & pharmacological interventions & Prognosis
Motor cortexBroadmann’s area 4 (primary motor cortex)
PeripheryCerebellumBasal ganglia
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Coordination Deficit
Desending system: Feedback
Lateral ventromedial loops
corticospinal
Basal ganglia Cerebellum
Cerebral cortex
Central pattern generator
Receptor
Muscles
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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.
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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.
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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.
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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
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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.
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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
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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
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• 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
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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.
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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
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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)
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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)
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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.
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Faulty posture-inactivity & prolonged sitting
Impaired balance- increase postural sway & limits of stability
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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
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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.
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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.
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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.
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Assess movement capabilities
1.Alternate /reciprocal motion
2.Movement composition
3.Movement accuracy
4.fixation/limb holding
5.equilibrium/postural stability
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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
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Testing protocol
Equipment Assessment formStopwatch2 chairsMat or treatment tableLocation-free from distractionsTest selection
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Pt preparation- well rested, explanation, demo.
Testing- noneq. Equil., well guarded pt., use safety belt
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