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PT-415 Motor Control > Impairment: Incoordination > Flashcards

Impairment: Incoordination Flashcards

1
Q

Coordination: Definition

A
  1. Measure of the “QUALITY” of movement.
    - requires adequate STRENGTH and ROM
  2. Ability to perform CONSISTENTLY and ACCURATELY
    - under wide variety of conditions (open vs. closed)
  3. Allows for INVESTIGATION and INTERACTION w/ environment
  4. Ability to execute SMOOTH, ACCURATE, CONTROLLED motor responses
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2
Q

Coordination: Involves

A
  • Appropriate Synergistic (mm recruitement)
  • Easy Reversal (between mm groups)
  • Proximal Fixation (allows distal motion OR maintenance of posture)
  • Implies Efficiency (using fewest number of mm to complete action)
  • Appropriate SEQUENCING, TIMING, and GRADING of multiple muscle groups (synergistic nature)
    (Speed, Direction, Distance, Muscular Tension)
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3
Q

Dexterity

A

Skillful use of fingers in fine motor tasks

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4
Q

Agility

A

Ability to rapidly and smoothly initiate, stop, or modify movement while maintaining posture control

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5
Q

Types of Coordination

A
  • Intralimb
  • Interlimb
  • Visual Motor
    - Eye-Hand
    - Eye-Hand-Head
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6
Q

3 Main Areas Involved w/ Coordination

A
  • Cerebellum
  • Basal Ganglia
  • Dorsal Columns
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7
Q

Schematic of Integration of the Sensory, Mootor Cortex, and the PNS

A

Go to website

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8
Q

Motor Cortex and Somatosensory Motor Pathways

A
  • Corticobulbar
  • Recticulospinal
  • Vestibulospinal
  • Rubrospinal
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9
Q

Basal Ganglia

A
  • Caudate Nucleus
  • Putamen
  • Globus Pallidus
  • Subthalmic Nucleus
  • Substantial Nigeria
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10
Q

Incoordination: Definition

A

Inability to produce “HARMONIUS, RHYTHMIC MUSCULAR ACTION” that is NOT primarily due to weakness!

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11
Q

Incoordination: Causes

A
  1. May be Sensory or Motor Disturbances (tone)
    - Deficit in Integration in Sensory, Motor, and Neural Processes
  2. Due to CNS LESION
    - Movement decomposition (asynergy)
    - Dysmetria (slow movement and decrease proximal stability)
    - TBI, Parkinsonism, MS, CP, HD, Chorea, Vestibular, etc
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12
Q

Incoordination: Characteristics

A
  • Abnormal Motor Function
    • awkward, extraneous, uneven, and/or inaccurate movements
  • Alterations in Tactile, Proprioceptive, Visual, or Vestibular Systems
    • can affect patients ability to move or learn an activity
      • FUNCTIONAL MOBILITY DEFICITS
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13
Q

Incoordination: Symptoms most often displayed

A
  • Activation and Sequencing Problems
  • Timing Problems
  • Scaling Forces (accuracy)
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14
Q

Activation and Sequencing Problems:

A
  • Abnormal Synergies (inability to isolate movement)
  • Co-activation (agonist/antagonist)
    - CVA, TBI (commonly seen in younger children)
  • Movement Decomposition (impaired inter-joint connection)
    - Cerebellar Deficits, Parkinsons
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15
Q

Timing Problems:

A
  • Initiating Movement (reaction time)
    - CVA, PD
  • Movement Time decreased
    - UMNL disorders
  • Terminating Movement Problems
    - Cerebellar disorders
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16
Q

Scaling Forces: (accuracy)

A
  • Dysmetria (problems judging distance or range of movement)
  • Hypometria or Hypermetria (Parkinsons)
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17
Q

Cerebellum Function

A
  • Center for Balance and Coordinated Activity
  • Primary Function is COORDINATION/REGULATION
    - Movement
    - Equilibrium
    - Muscle Tone
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18
Q

Theory of Cerebellum: functions as a

A

“COMPARATOR AND ERROR-CORRECTING MECHANISM”

  • uses peripheral feedback loop to obtain ACTUAL movement and compares w/ the INTENDED movement.
  • signals the cortex on changes that will CORRECT the ongoing movement to reduce error w/ subsequent movement (closed loop)
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19
Q

Damage to Cerebellum: Clinical Features

A
  • Hypotonia - Ataxia
  • Tremor. - Dysdiadochokiesia
  • Movement Decomposition - Impaired Error Correction
  • Dysmetria - Gait Disorders
  • Dysarthria - Nystagmus
  • Rebound Phenomenon - Asthenia
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20
Q

Hypotonia Definition

A
  • Low Tone
  • Decrease resistance to PROM
  • Decrease DTR’s
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21
Q

Ataxia Definition:

A

Movements that are:

  • Jerky
  • Uncoordinated
  • Inefficient
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22
Q

Tremor Definition: (intention or kinetic)

A
  • Occurs w/ voluntary movement
  • Increases as limb nears goal,
  • Decreased or Absent at rest
  • Frequency range <5Hz
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23
Q

Dysdiadochokinesia Definition

A
  • Difficulty performing rapid alternating movements (RAM)
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24
Q

Movement Decomposition Definition:

A
  • Dyssynergia / Asynergy

- movement by component parts vs. a single smooth movement

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25
Q

Impaired Error Correction, Affecting ML: Definition

A
  • Disruption of feedforward mechanisms
26
Q

Dysmetria Definition:

A
  • Difficulty Judging Distances
    - over- or under-shoot
  • hypermetria vs. hypoometria
27
Q

Gait Disorders w/ Cerebellar damage

A
  • > BOS
  • Arms held out
  • Unsteady
28
Q

Nystagmus Definition

A
  • Rhythmis Ossillatory movements of eyes
29
Q

Dysarthria Definition

A
  • Difficulty w/ speech (slow and slurred)
30
Q

Rebound Phenomenon Definition:

A

“Check Reflex” impaired

31
Q

Asthenia Definition

A

Generalized mm weakness

32
Q

Basal Ganglia Parts

A
  • Caudate
  • Putamen
  • Globus Pallidus
  • Subthalmic Nucleus
  • Substantial Nigra
33
Q

Basal Ganglia “job”

A
  • Influential in INITIATION and REGULATION of movement
  • Important w/ POSTURAL ADJUSTMENTS
  • Important w/ maintaining normal background mm tone
34
Q

Basal Ganglia sends:

A

Inhibitory info to:

   - Descending Motor Tracts
   - Motor Cortex
35
Q

Clinical Features of Damage to Basal Ganglia HYPOKINETIC DISORDERS

A

(PD)

  • Bradykinesia - Akinesia
  • Rigidity - Tremor (resting)
36
Q

Bradykinesia Definition

A

Slow or decreased movements

37
Q

Akinesia Definition

A

Inability to Initiate Movement

38
Q

Rigidity Definition

A
  • Resistance to PROM
  • Lead-Pipe (constant resistance)
  • Cog-Wheel (alternating)
39
Q

Basal Ganglia Tremor

A

RESTING

  • Involuntary
  • Rhythmic Ossillatory movement at rest
  • often decreases w/ voluntary movement
  • freq in distal UE
40
Q

Basal Ganglia features w/ HYPERKINETIC DISORDERS

A

(HD)

  • Chorea - Athetosis
  • Choreoathetosis - Hemiballismus
  • Dystonia
41
Q

Chorea Definition

A

Movements that are:

  • Involuntary
  • Rapid
  • Irregular
  • Jerky
42
Q

Athetosis Definition

A

Movements that are: (> Distal)

  • Slow
  • Involuntary
  • Writhing
43
Q

Choreoathetosis Definition

A

Combo of:

  • Chorea
  • Athetosis
44
Q

Hemiballismus Definition

A

Flailing Motion of Unilateral arm/leg

  • Sudden
  • Jerky
  • Forceful
  • Wild
45
Q

Dystonia Definition

A

(Torticollis)

  • Twisting, bizarre movements caused by:
    - Involuntary contractions of axial and proximal muscles
46
Q

Dorsal Columns “job”

A

Important role in Coordinated MOVEMENT and POSTURE

- Mediates Proprioceptive Input

47
Q

Clinical Features of Damage to Dorsal Columns (less characteristic)

A
  • Equilibrium and Motor control Disturbances
    - b/c lack of proprioceptive input (worse w/ eyes closed)
  • Gait Disorders
    - Increased BOS, Swaying, uneven steps, lateral displacement
  • Dysmetria
48
Q

Factors that increase Incoordination:

A
  • Emotions
  • Interfering Sensory Inputs (pain/temp/vision)
  • Decreased Motivation
  • Aging
  • *** Decrease Strength/ROM/Disuse
  • Overflow/Irradiation
  • Fatigue
49
Q

Assessing Functional Limitations (coordination assessment)

A
  • initiating/terminating tasks? - rolling
  • supine to sit - sitting
  • sit to stand - standing
  • transfers - ambulatory
  • stairs
50
Q

Four Basic Motor Task Requirements

A
  • Mobility (alternate or reciprocal motion)
  • Stability (movement composition (synergy))
  • Controlled Mobility (movement accuracy)
  • Skill (equilibrium)
51
Q

Focus on Assessment of Movement Capabilities:

A
  • Alternate or Reciprocal Motion
  • Movement Composition or Synergy
  • Movement Accuracy
  • Fixation or Limb Holding (steadiness)
  • Equilibrium
52
Q

Assessing the IMPAIRMENT: Incoordination

A
  • first screen sensation (*Strength and *ROM)
  • test both sides
  • eyes open and then eyes closed
  • gross motor then fine motor
  • nonequilibrium and equilibrium
53
Q

Non-Equilibrium Tests:

A
  • finger to nose test
  • finger to nose and examiners finger
  • ABC’s w/ fingers or toes and writing
  • heel to shin or heel to ankle
  • tracking test w/ or w/o computer
  • gross movement patterns
  • RAMs
54
Q

Equilibrium (balance) Test

A
  • Static and Dynamic in “upright” standing position

- Eyes open/closed (gross motor)

55
Q

Coordination Assessment: general info to assist in localizing specific areas of deficit (documentation)

A
  • level of skill/efficiency in each activity
  • occurrence of extra movements
  • # of extremities involved
  • distribution (proximal/distal)
  • situations which alter
  • time required for activity
  • level of safety and history of any falls
56
Q

Rating Scale for Documentation

A
  • 4 (normal)
  • 3 (slight difficulty)
  • 2 (mod difficulty, decreased performance w/ speed)
  • 1 (severe difficulty)
  • 0 (unable to accomplish activity)
57
Q

Treatment Intervention

A
  • address any ROM (mobility), Weakness, or Proximal Instability
    - ISO->ECC->CONC
    - WB activities
    - PNF techniques
  • Repetition and Practice (NO substitutions)
  • Geared towards Functional Activities
  • Start w/ low effort, slow speed, and precise performance
  • Break activity into simple components/parts then add
  • Progress only after correct performances later
  • Sensory Cues (KP and KR feedback) (intermittent vs. constant)
  • Eyes Open to Eyes Closed
  • Ataxic movements, add light weights to increase sensory
  • ALWAYS end session w/ SUCCESSFUL effort
58
Q

Specific Treatment Intervention: Timing Problems

A

Reaction/Movement/Terminating:

  • Practice functional movement w/ external time constraints
  • Increase speed as control improves
  • Verbal, Visual, Manual Feedback (speed of performance)
  • Sensory Stimulation
  • Bilateral symmetrical/asymmetrical/reciprocal PNF patterns
59
Q

Scaling Intervention Treatment

A
  • Practice wide variety of tasks that require precise grading effort (**Provide KR and KP)
  • SLOW to FAST
  • Small to Larger ROM
60
Q

Motor Skills

A
  • Discrete Motor Skills
    - clear beginning and end
  • Serial Motor Skills
    - discrete skills put together in series
  • Continuous Motor Skills
    - swimming/running/walking
  • Single or Simultaneous (dual-task)
  • Self-Paced Action (voluntary)
  • Externally Paced Action (environment driven)

PT-415 Motor Control (4 decks)

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