Impairment: Incoordination Flashcards
Coordination: Definition
- Measure of the “QUALITY” of movement.
- requires adequate STRENGTH and ROM - Ability to perform CONSISTENTLY and ACCURATELY
- under wide variety of conditions (open vs. closed) - Allows for INVESTIGATION and INTERACTION w/ environment
- Ability to execute SMOOTH, ACCURATE, CONTROLLED motor responses
Coordination: Involves
- 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)
Dexterity
Skillful use of fingers in fine motor tasks
Agility
Ability to rapidly and smoothly initiate, stop, or modify movement while maintaining posture control
Types of Coordination
- Intralimb
- Interlimb
- Visual Motor
- Eye-Hand
- Eye-Hand-Head
3 Main Areas Involved w/ Coordination
- Cerebellum
- Basal Ganglia
- Dorsal Columns
Schematic of Integration of the Sensory, Mootor Cortex, and the PNS
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Motor Cortex and Somatosensory Motor Pathways
- Corticobulbar
- Recticulospinal
- Vestibulospinal
- Rubrospinal
Basal Ganglia
- Caudate Nucleus
- Putamen
- Globus Pallidus
- Subthalmic Nucleus
- Substantial Nigeria
Incoordination: Definition
Inability to produce “HARMONIUS, RHYTHMIC MUSCULAR ACTION” that is NOT primarily due to weakness!
Incoordination: Causes
- May be Sensory or Motor Disturbances (tone)
- Deficit in Integration in Sensory, Motor, and Neural Processes - Due to CNS LESION
- Movement decomposition (asynergy)
- Dysmetria (slow movement and decrease proximal stability)
- TBI, Parkinsonism, MS, CP, HD, Chorea, Vestibular, etc
Incoordination: Characteristics
- 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
- can affect patients ability to move or learn an activity
Incoordination: Symptoms most often displayed
- Activation and Sequencing Problems
- Timing Problems
- Scaling Forces (accuracy)
Activation and Sequencing Problems:
- 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
Timing Problems:
- Initiating Movement (reaction time)
- CVA, PD - Movement Time decreased
- UMNL disorders - Terminating Movement Problems
- Cerebellar disorders
Scaling Forces: (accuracy)
- Dysmetria (problems judging distance or range of movement)
- Hypometria or Hypermetria (Parkinsons)
Cerebellum Function
- Center for Balance and Coordinated Activity
- Primary Function is COORDINATION/REGULATION
- Movement
- Equilibrium
- Muscle Tone
Theory of Cerebellum: functions as 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)
Damage to Cerebellum: Clinical Features
- Hypotonia - Ataxia
- Tremor. - Dysdiadochokiesia
- Movement Decomposition - Impaired Error Correction
- Dysmetria - Gait Disorders
- Dysarthria - Nystagmus
- Rebound Phenomenon - Asthenia
Hypotonia Definition
- Low Tone
- Decrease resistance to PROM
- Decrease DTR’s
Ataxia Definition:
Movements that are:
- Jerky
- Uncoordinated
- Inefficient
Tremor Definition: (intention or kinetic)
- Occurs w/ voluntary movement
- Increases as limb nears goal,
- Decreased or Absent at rest
- Frequency range <5Hz
Dysdiadochokinesia Definition
- Difficulty performing rapid alternating movements (RAM)
Movement Decomposition Definition:
- Dyssynergia / Asynergy
- movement by component parts vs. a single smooth movement
Impaired Error Correction, Affecting ML: Definition
- Disruption of feedforward mechanisms
Dysmetria Definition:
- Difficulty Judging Distances
- over- or under-shoot - hypermetria vs. hypoometria
Gait Disorders w/ Cerebellar damage
- > BOS
- Arms held out
- Unsteady
Nystagmus Definition
- Rhythmis Ossillatory movements of eyes
Dysarthria Definition
- Difficulty w/ speech (slow and slurred)
Rebound Phenomenon Definition:
“Check Reflex” impaired
Asthenia Definition
Generalized mm weakness
Basal Ganglia Parts
- Caudate
- Putamen
- Globus Pallidus
- Subthalmic Nucleus
- Substantial Nigra
Basal Ganglia “job”
- Influential in INITIATION and REGULATION of movement
- Important w/ POSTURAL ADJUSTMENTS
- Important w/ maintaining normal background mm tone
Basal Ganglia sends:
Inhibitory info to:
- Descending Motor Tracts - Motor Cortex
Clinical Features of Damage to Basal Ganglia HYPOKINETIC DISORDERS
(PD)
- Bradykinesia - Akinesia
- Rigidity - Tremor (resting)
Bradykinesia Definition
Slow or decreased movements
Akinesia Definition
Inability to Initiate Movement
Rigidity Definition
- Resistance to PROM
- Lead-Pipe (constant resistance)
- Cog-Wheel (alternating)
Basal Ganglia Tremor
RESTING
- Involuntary
- Rhythmic Ossillatory movement at rest
- often decreases w/ voluntary movement
- freq in distal UE
Basal Ganglia features w/ HYPERKINETIC DISORDERS
(HD)
- Chorea - Athetosis
- Choreoathetosis - Hemiballismus
- Dystonia
Chorea Definition
Movements that are:
- Involuntary
- Rapid
- Irregular
- Jerky
Athetosis Definition
Movements that are: (> Distal)
- Slow
- Involuntary
- Writhing
Choreoathetosis Definition
Combo of:
- Chorea
- Athetosis
Hemiballismus Definition
Flailing Motion of Unilateral arm/leg
- Sudden
- Jerky
- Forceful
- Wild
Dystonia Definition
(Torticollis)
- Twisting, bizarre movements caused by:
- Involuntary contractions of axial and proximal muscles
Dorsal Columns “job”
Important role in Coordinated MOVEMENT and POSTURE
- Mediates Proprioceptive Input
Clinical Features of Damage to Dorsal Columns (less characteristic)
- 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
Factors that increase Incoordination:
- Emotions
- Interfering Sensory Inputs (pain/temp/vision)
- Decreased Motivation
- Aging
- *** Decrease Strength/ROM/Disuse
- Overflow/Irradiation
- Fatigue
Assessing Functional Limitations (coordination assessment)
- initiating/terminating tasks? - rolling
- supine to sit - sitting
- sit to stand - standing
- transfers - ambulatory
- stairs
Four Basic Motor Task Requirements
- Mobility (alternate or reciprocal motion)
- Stability (movement composition (synergy))
- Controlled Mobility (movement accuracy)
- Skill (equilibrium)
Focus on Assessment of Movement Capabilities:
- Alternate or Reciprocal Motion
- Movement Composition or Synergy
- Movement Accuracy
- Fixation or Limb Holding (steadiness)
- Equilibrium
Assessing the IMPAIRMENT: Incoordination
- first screen sensation (*Strength and *ROM)
- test both sides
- eyes open and then eyes closed
- gross motor then fine motor
- nonequilibrium and equilibrium
Non-Equilibrium Tests:
- 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
Equilibrium (balance) Test
- Static and Dynamic in “upright” standing position
- Eyes open/closed (gross motor)
Coordination Assessment: general info to assist in localizing specific areas of deficit (documentation)
- 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
Rating Scale for Documentation
- 4 (normal)
- 3 (slight difficulty)
- 2 (mod difficulty, decreased performance w/ speed)
- 1 (severe difficulty)
- 0 (unable to accomplish activity)
Treatment Intervention
- 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
Specific Treatment Intervention: Timing Problems
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
Scaling Intervention Treatment
- Practice wide variety of tasks that require precise grading effort (**Provide KR and KP)
- SLOW to FAST
- Small to Larger ROM
Motor Skills
- 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)
