Chp 7 Examination and Coordination Flashcards
So how do we define Coordination Impairments
Ueven, unaccurate, arkward or extraneous
So why does a Coordination test help therapists
Diagnosing underlying origin of impairment
Noting functional limitations that are related to a type, extent and location of some CNS pathologies
Purpose of performing Coordination Assessments
Determine muscle activity during voluntary movements
Assess muscles ability to perform a task
Determine skill and efficiency level
Identify ability to initiate, control, and terminate movements
Determine timing, sequencing, accuracy
Assist with diagnosis of impairment, FL, disability
Establish goals to remediate impairment, formulating outcomes to remediate FL & disabilities,
direct interventions
Determine effects of therapeutic & pharmacological interventions on function over time
Assist with determining a prognosis
Specific Coordination Deficits &Central Nervous System Involvement of CEREBELLUM
Primary function is regulation of movements, postural control, and muscle tone
Lesions produce typical patterns of motor function deficits, impaired balance, and decreased muscle tone
Functions as a comparator & error correcting mechanism
Describe an open loop movement and give an example
Stereotypical movements (gait)
Rapid, short duration movements
Those not allowing for FB to occur
Control originates centrally from a motor program
Motor program is in memory or a preprogrammed pattern of information for coordinated movement
Clinical features of Cerebellar Pathology/Dysfunction
Ataxia- comprehensive term (CD & sensory dysfunction) Hypotonia Dysmetria Dysdiadochokinesia Tremor Movement decomposition Disorders of gait Dysarthria Nystagmus Rebound phenomenon asthenia
Characteristics of Hypotonia
Decrease in muscle tone
Diminished resistance to passive movement
Muscles feel soft & flaccid
Diminished deep tendon reflexes may be noted
Charateristics of Dysmetria
Disturbance in judging distance or range of movements
Hypermetria (overestimation of range needed)
Hyometria (underestimation)
Dysdiadochokinesia
Impaired ability to perform rapid alternating movements (RAM)
Rapid loss of range & rhythm (especially as speed increases)
Tremors what are the 2 types
Involuntary oscillatory movement resulting from alternate contractions of opposing muscle groups
Postural/static tremor-
Back & forth oscillatory body movements during standing
Up/down oscillatory limb movement when held against gravity
Titubation= head oscillations
Intention/kinetic tremor-
occurs during voluntary motion of a limb
increases upon reaching intended goal
when speed is increased
Diminished or absent at rest
Movement decomposition (dyssynergia) just think like robotic movement
Performance of a movement in sequence of parts rather than smooth, single activity
Asynergia- loss of ability to associate muscles together for complex movements
Disorders of gait
Broad base of support
High guard arm position
LE initiation starts slowly
Unexpected rapid flinging towards the floor with forceful audible sound
Unsteady, irregular, staggering gait with deviations from forward line of progression
Whats a rebound and no I am not talking about the rebound you are thinking of.
Loss of check reflex/factor which halts forceful active movements
Asthenia is???????
Loss of check reflex/factor which halts forceful active movements
Increased time required to initiate voluntary movements
Difficulty in stopping or changing force, speed, or direction
Basal Ganglia Pathology name somethings that go wrong and where it is happens think SN
Nuclei group- Caudate, Putamen, Globus Pallidas, sub cortical-subthalamic nucleus, substantia nigra
Initiation and regulation of gross intentional movements
Planning & execution of complex motor responses
Facilitation of desired motor responses/inhibitions of others
Automatic movements
Postural adjustments
Maintaining normal muscle background tone (inhibit motor cortex & lower brainstem)
Influences perceptual & cognitive functions
2 Types of Rigidity
Leadpipe – uniform, constant resistance as the extremity is moved through ROM
Cogwheel- is combination of the leadpipe with tremor. Series of brief relaxations or catches as extremity is passively moved
Common diagnostic groups that demo BG involvement (3)
Parkisons, Williams, Huntingtons
Dorsal (Posterior) Column- Medial Lemniscal (DCML) Gives us what info, where in brain is info received, What positive test is usally performed with people with expected issues.
Fasciculus gracilis & cuneatus
Coordinated movement & posture
Mediate proprioceptive input from muscles & joint receptors
Proprioceptive-
Position, awareness of the position of a joint at rest
Kinesthesia, awareness of movement
Equilibrium & motor control disturbances because of proprioceptive loss
Vision however assists in guiding movements and maintaining balance
Positive Romberg sign (inability to maintain balance with feet together, eyes closed)
Wide based gait, swaying, uneven steps lengths, excessive lateral displacements
Foot watching
dysmetria
Review table on pg 201
review pg 201
Does age influence coordination?
Yes it does. Decreased strength Slowed reaction time Loss of flexibility Faulty posture Impaired balance Sensation, perceptual skills, vision, hearing acuity Box 7.1 p 202
Things to think about before engaging in any kind of Activity? Like Level of safety Age, Falls, etc…
Level of skill in each activity Occurrence of extraneous, oscillatory, swaying movements or unsteadiness Number of extremities involved Distribution of coordination impairments Situations or occurrences that alter coordination Time to perform activity Level of safety Falls history Screen for ROM, Strength, Sensation
Coordination tests Fine vs. Gross Motor Control
Equilibrium vs non (Don’t over think this one)
Fine Motor Control- finger dexterity and fine motor control Gross- Body Posture and balance involving larger muscle groups
Equilibrium - test the body when it is upright and non test when it is not
Coordination tests assess 4 basic motor requirements Table 7.2 p 210 think mobility and stablility are 2 explain them.
Mobility- initial movements occurring within a functional pattern
Stability- ability to maintain steady position in weight bearing, antigravity position
Controlled mobility- ability to alter/change a position while maintain stability
Skill- highly coordinated movements that allow for interaction with the environment
Coordination tests focus on assessing movement capabilities in 5 areas
Alternating or reciprocal movements Movement composition/synergy Movement accuracy limb fixation or holding Postural stability/equilibrium
Postural control system includes TWO MAJOR system just think what two types of tracts a nerve has.
Sensory system for detection of motion
CNS integrative function
Motor system responsible for execution of movement responses controlling body position
