Coordination and Balance Assessment Flashcards
ability of CNS to control/direct the neuromotor system in purposeful movement/postural adjustment; accomplished by selective allocation of muscle tension across appropriate joint segments
motor control
ability to execute smooth, accurate, and controlled movement; involves multiple joints and muscles activated in the appropriate timing and sequence for efficient movement
coordination
all forces acting on the body are balanced such that the COM is within the bodys BOS
balance
measurement of how a person performs certain tasks and fulfills their various roles in life
functional assessment
compares and makes corrections between intended movement and actual movement, involved in feedforward and feedback control
cerebellum
what tracts control voluntary movement and which control involuntary movement
voluntary: corticospinal (pyramidal)
involuntary: extrapyramdial tracts (5)
how does the cerebellum act indirectly to contribute to coordination
connections with primary motor cortex and descending extrapyramidal tracts
compares and makes corrections between intended movements and actual movement; fine tuning movement; involved in feedforward and feedback control
cerebellum
what area of the brain is heavily involved in motor learning and motor programming via connects with memory centers in temporal lobe
cerebellum
list impairments associated with cerebellar pathology
- ataxia
- gait ataxia
- asthenia/hypotonia
- dysdiadochokinesia
- dysmetria
- dysarthria
- dyssynergia
- nystagmus
- intention tremor
- delayed reaction/movement time
- rebound phenomenon
uncoordinated movement
ataxia
damage to where in cerebellum would cause ataxia in the limbs
hemispheres (more lateral)
damage where in cerebellum would cause ataxia in trunk
vermis (central)
presents with wide BOS, staggering, path deviations, flinging of limbs
gait ataxia
generalized muscle weakness
asthenia
low tone
hypotonia
inability to perform rapid alternating movements
dysdiadochokinesia
inability to judge distance between points (over or underestimation)
dysmetria
movement decomposition
dyssynergia
tremor that occurs with movement
intention tremor (cerebellum lesion)
involved in initiation and regulation of movement; planning and execution of complex motor patterns; provides input to regulate normal motor tone
basal ganglia
helps with automatic movements (reciprocal arm swing, blinking) and postural adjustments; indirect and direct pathways allow for excitatory or inhibitory influences on motor thalamus and primary motor cortex
basal ganglia
impairments associated with basal ganglia pathology
- bradykinesia/akinesia
- rigidity (cogwheel and leadpipe)
- resting tremor
- chorea/athetosis
- dystonia
- hemiballismus
how does age effect coordination and balance
- decreased strength due to sarcopenia (decreased fast twitch fibers and oxidative capacity of muscles, loss of antigravity mm)
- slowed reaction time (impacts speed accuracy tradeoff, cognitive changes lead to decreased dual task performance)
- decreased ROM
- postural changes (FHF, FSP, altered lordotic curves, increased hip/knee flexion, wider BOS)
- impaired postural control
examples of CNS lesions that can produce changes in motor control that affect coordination and balance
stroke, parkinsons, MS, huntington’s, CP, cerebellar tumors, central vestibular pathology, TBI
list the elements of coordination
- agility: body
- dexterity: hand
- speed, distance, and direction of movement
- timing of movement
- muscle tension needed to produce coordinated/balanced motions
- intralimb and interlimb coordination
- eye-hand coordination
what does Romberg EC test
somatosensation
alternate or reciprocal movements, movement composition, movement accuracy, fixation or limb holding patters, UL/BL tasks, B/L asymmetrical tasks/ multilimb tasks
non-equilibrium tests
ability to maintain equilibrium in both static and dynamic positions
postural control and balance testing
postural control and balance assessment is the integration of what
- sensory system input (visual, vestibular, proprioceptive)
- motor system synergies - output
- CNS control - input and output
what makes up sensorimotor integration
vision
proprioception
vestibular function
what clinical test is used to assess VOR
head impulse/thrust test
stabilizes the body, multiple reflexes working together, information from vestibular system used to guide postural reflexes for body righting
vestibulospinal reflex (VSR)
input from neck proprioceptors; assists with eye movement; low gain; important during vestibular therapy; may be adaptable with therapy; assesses where your head is on your neck
cervico-ocular reflex (COR)
what nuclei help maintain where our head is on our neck (COR)
C1-3
input from neck proprioceptors; helps stabilize the body; works at low gain
cervicospinal reflex (CSR)
how to measure sensorimotor integration
- romberg/sharpened
- balance master
- clinical test for sensory interaction in balance
- mCTSIB
what are the 3 strategies used to control COM over BOS
ankle strategy
hip strategy
stepping strategy
occurs in quiet, static standing; lower level of sway; disturbances in COM are small and within LOS; recruitement from distal to proximal mm
ankle strategy
what muscles are activated with a forward sway for ankle strategy
posterior muscles: gastroc/soleus, HS, paraspinals
what mm are activated by backward sway for ankle strategy
anterior muscles: anterior tibialis, quads, abdominals
shifts in COM by flexing or extending the hips; provides mediolateral stability in static/perturbed standing; recruited when sway frequency is faster, larger disturbance of COM within BOS, small or compliant surface; proximal then distal mm recruited
hip strategy
what mm are activated with forward sway hip strategy
abdominals –> quads
what mm are activated with backward sway hip strategy
paraspinals –> HS
upper or lower limbs reach or step out to align COM within BOS when fast, large perturbations occur or when ankle/hip strategies fail; protective; CNS continually uses feedback to monitor and adapt posture using these strategies
stepping/reach strategies
weakness in antigravity mm will influence recruitment of strategies; observe responses in static and perturbated stance; perturbate in both AP and ML directions to note ability to restabilize
standing control
observe in quiet sitting noting symmetry in BOS; observe sway responses; note pelvic position in regard to rotation and elevation; observe for grasping and hooking strategies
seated control
backward sway in sitting would active what mm
hip flexors, abs and neck flexors
forward sway in sitting should activate what mm
extensors throughout
create opportunities to randomly destabilize; raise arms overhead, lift feef from the surface when in sitting; ball toss; common to see deficits in reaction times, motor recruitement
anticipatory control
perform secondary cognitive or motor tasks while observing static and dynamic posture; remember the theory of cognitive reserve from motor control
dual task control
