PRELIMS: Assessment for Balance & Coordination

Question 1

What is the definition of coordination in the context of movement?

Answer 1

Coordination is the ability to execute smooth, accurate, and controlled movements involving multiple joints and muscles.

Question 2

What key aspects are involved in coordination?

Answer 2

Sequencing, timing, and grading of muscle activation to produce efficient and accurate movement.

Question 3

What systems and inputs does coordination rely on?

Answer 3

Sensory information, visual and vestibular input, and an intact musculoskeletal and neuromuscular system.

Question 4

What are the attributes of coordinated movement?

Answer 4

Appropriate speed, distance, direction, timing, muscular tension, synergistic muscle recruitment, easy reversal between opposing muscles, and proximal fixation for distal motion.

Question 5

What is the key descending motor pathway for skilled fine motor control?

Answer 5

The corticospinal (pyramidal) tract, which transmits motor signals from the motor cortex directly to the spinal cord.

Question 5

Define intralimb coordination.

Answer 5

Intralimb coordination involves movements within a single limb, such as flexing or extending the elbow.

Question 5

What is interlimb (bimanual) coordination?

Answer 5

It is the integrated performance of two or more limbs working together, like in walking or bilateral UE tasks during transfers.

Question 5

What is the function of the primary motor cortex (Area 4)?

Answer 5

It controls contralateral voluntary movements and contains the largest concentration of corticospinal neurons.

Question 6

Why is eye–hand coordination important?

Answer 6

Eye–hand coordination is crucial for activities of daily living (ADLs) like using utensils or reaching for objects.

Question 6

What does visual motor coordination entail?

Answer 6

It involves the integration of visual and motor abilities to accomplish a goal, such as writing or driving.

Question 7

What are the subdivisions of Area 6 in the motor cortex?

Answer 7

Supplementary Motor Area (SMA): Initiates movement, bilateral grasping, sequential tasks.
Premotor Area (PMA): Controls trunk and proximal limb movements, contributes to anticipatory postural changes.

Question 7

List some diagnoses associated with coordination impairments.

Answer 7

Traumatic brain injury, Parkinson’s disease, multiple sclerosis, Huntington’s disease, cerebral palsy, Sydenham’s chorea, cerebellar tumors, vestibular pathology, learning disabilities.

Question 8

What are the three hierarchical levels of the central motor system?

Answer 8

Highest Level: Neocortex and Basal Ganglia (Strategy)
Middle Level: Motor Cortex and Cerebellum (Tactics)
Lowest Level: BrainStem and Spinal Cord (Execution)

Question 9

A tract that merges with the corticospinal tract in the cervical region but is considered insignificant in human motor control.

Answer 9

Rubrospinal Tract

Question 9

What does the motor homunculus illustrate?

Answer 9

It illustrates the cortical area devoted to motor control of different body parts.

Question 10

Controls neurons that innervate cranial nerves.

Answer 10

Corticobulbar Tract

Question 10

Influences motor neurons innervating neck muscles and the spinal accessory nucleus (CN XI), important for guiding head movements during visual motor tasks.

Answer 10

Tectospinal Tract

Question 10

A control system with preprogrammed instructions that does not rely on feedback during execution, used for stereotypical and rapid movements.

Answer 10

Open-Loop System (Cerebellum)

Question 10

What are the key motor impairments associated with cerebellar pathology?

Answer 10

Key motor impairments include ataxia, dysmetria, dysdiadochokinesia, hypotonia, and intention tremor.

Question 11

What is ataxia, and how does it present?

Answer 11

Ataxia is a lack of muscle coordination affecting gait, posture, and movement patterns, characterized by difficulty initiating movement and errors in rate, rhythm, and timing.

Question 11

Facilitates flexion of motor neurons, having the opposite effect of the medial tract.

Answer 11

Lateral Reticulospinal Tract

Question 11

What tract, Facilitates the extension of the lower extremities, augmenting antigravity reflexes important for posture and gait.

Answer 11

Medial Reticulospinal Tract

Question 12

Contributes to postural control and movements of the head, facilitating axial extensors and inhibiting axial flexors.

Answer 12

Lateral Vestibulospinal Tract

Question 12

Involved in coordinated head and eye movements, projecting primarily to the ipsilateral cervical spinal cord.

Answer 12

Medial Vestibulospinal Tract

Question 13

Regulates movement by transmitting sensory information crucial for discriminative touch, proprioception, and kinesthesia.

Answer 13

Dorsal (Posterior) Column–Medial Lemniscal Pathway (Function

Question 13

Regulation of movement, postural control, and muscle tone.

Answer 13

Cerebellum (Primary Functions)

Question 14

Uses feedback to compare current performance with a reference, computes errors, and makes corrections for ongoing adjustments during movements.

Answer 14

Closed-Loop System (Cerebellum)

Question 15

Compares intended movements with actual movements and sends corrective signals to adjust the movement.

Answer 15

Cerebellum (Comparator and Error-Correcting Mechanism)

Question 16

Sensory fibers enter the dorsal column, ascend to the medulla, cross over, and then project to the thalamus and somatosensory cortex.

Answer 16

Dorsal (Posterior) Column–Medial Lemniscal Pathway (Pathway)

Question 17

Movement and postural control, initiation and regulation of gross intentional movements, and maintenance of normal muscle tone.

Answer 17

Basal Ganglia (Functions)

Question 18

Components that include detecting body position and motion, organizing and executing motor synergies, and integrating sensory and motor information to develop action plans.

Answer 18

Key Components of Balance

Question 18

Describe the motor impairments associated with midline cerebellar lesions (vermis, paleocerebellum).

Answer 18

Midline cerebellar lesions can cause titubation, truncal ataxia, orthostatic tremor, and gait imbalance.

Question 18

What are the motor deficits commonly seen with basal ganglia pathology?

Answer 18

Basal ganglia pathology typically results in poverty and slowness of movement, involuntary movements, and alterations in posture and muscle tone.

Question 18

What is chorea, and what condition is it most commonly associated with?

Answer 18

Chorea involves involuntary, rapid, irregular movements, most commonly associated with Huntington's disease.

Question 19

Define akinesia and the condition in which it is commonly observed.

Answer 19

Akinesia is the inability to initiate movement, often seen in late-stage Parkinson's disease.

Question 19

What symptoms are associated with cerebellar hemisphere lesions (neocerebellum)?

Answer 19

Symptoms include limb ataxia, dysdiadochokinesia, dysmetria, kinetic tremor, dysarthria, and hypotonia.

Question 20

How does bradykinesia present, and in which condition is it a hallmark symptom?

Answer 20

Bradykinesia presents as decreased amplitude and velocity of movement, and is a hallmark of Parkinson's disease.

Question 20

What characterizes athetosis, and where is it commonly observed?

Answer 20

Athetosis is characterized by slow, involuntary, writhing movements, often observed in the distal upper extremities, neck, face, and trunk.

Question 20

How does DCML pathology affect motor coordination?

Answer 20

DCML pathology leads to impairments in proprioception, kinesthesia, and discriminative touch, resulting in gait disturbances, dysmetria, and impaired fine motor skills.

Question 20

Describe dystonia and its typical presentation.

Answer 20

Dystonia involves sustained involuntary muscle contractions leading to abnormal postures or twisting movements, often affecting the trunk, extremities, neck, and face.

Question 21

What is the rebound phenomenon in cerebellar pathology?

Answer 21

The rebound phenomenon is the inability to stop a motion after resistance is suddenly removed, causing the patient to strike themselves or nearby objects.

Question 21

How does the Romberg test relate to DCML pathology?

Answer 21

A positive Romberg sign, where the patient cannot maintain balance with feet together and eyes closed, indicates proprioceptive loss associated with DCML pathology.

Question 21

A 65-year-old male presents with a slow, shuffling gait, difficulty initiating movements, and a resting tremor in his right hand. He also reports stiffness in his limbs and a general slowness in performing daily activities. Q: Based on the symptoms, which neurological condition is most likely, and what are the primary motor impairments associated with this condition?

Answer 21

The patient is most likely experiencing Parkinson’s disease. The primary motor impairments include bradykinesia, rigidity, resting tremor, and postural instability.

Question 22

What is hemiballismus, and what causes it?

Answer 22

Hemiballismus is characterized by large-amplitude, violent, flailing motions of one side of the body, caused by a lesion in the contralateral subthalamic nucleus.

Question 22

A 48-year-old woman presents with involuntary, rapid, and irregular movements of her face and limbs. Her family history reveals that her father had similar symptoms in his 50s. She also reports some recent cognitive decline. Q: What is the likely diagnosis, and what is the underlying pathology?

Answer 22

The likely diagnosis is Huntington’s disease, a genetic disorder characterized by degeneration of neurons in the basal ganglia, leading to chorea, cognitive decline, and psychiatric symptoms.

Question 22

A 65-year-old male who has recently suffered a mild stroke presents with difficulty maintaining balance when moving from sitting to standing and reports a sensation of spinning when changing head positions. Q:Which sensory system is likely affected, and what type of postural control might be compromised?

Answer 22

The vestibular system is likely affected, leading to issues with reactive postural control. The spinning sensation (vertigo) upon head movements suggests vestibular dysfunction, which impacts the body’s ability to stabilize during positional changes.

Question 23

Assessment using a plumb line for skeletal alignment, checking sagittal and frontal plane alignments, observing spinal curves, and muscle activity.

Answer 23

Normal Standing Posture Assessment

Question 23

A 72-year-old female presents with sudden, large-amplitude, flailing movements of her left arm and leg. Imaging reveals a lesion in her right subthalamic nucleus. Q: What is the diagnosis, and what side of the body is affected by the lesion?

Answer 23

The diagnosis is hemiballismus, caused by a lesion in the contralateral (right) subthalamic nucleus, resulting in involuntary movements on the left side of the body.

Question 23

A 55-year-old male presents with involuntary, slow, writhing movements primarily in his hands and face. He has a history of cerebral palsy. Q: What is the name of the movement disorder he is experiencing, and what neurological structure is involved?

Answer 23

The patient is experiencing athetosis, a movement disorder often associated with basal ganglia pathology, particularly damage to the striatum.

Question 24

A 70-year-old female patient presents with a history of frequent falls, particularly when walking on uneven surfaces. She mentions feeling unsteady and sometimes dizzy. Upon examination, her visual acuity is found to be 20/60, and she has a positive Romberg test. Q: What sensory system is likely impaired, and how might this contribute to her balance issues?

Answer 24

The visual system is likely impaired, as evidenced by her poor visual acuity (20/60) and positive Romberg test. Her balance issues may stem from an inability to adequately use visual inputs for postural control, particularly in environments where somatosensory feedback is less reliable (e.g., uneven surfaces).

Question 25

Maintaining the relative positions of body parts with respect to each other and gravity.

Answer 25

Postural Control

Question 25

What is reactive postural control?

Answer 25

Reactive postural control is the response to external forces that displace the center of mass (COM) or move the base of support (BOS), involving corrective actions in response to perturbations.

Question 25

A 45-year-old office worker complains of lower back pain and increased fatigue after prolonged sitting. Observation reveals a forward head posture, increased thoracic kyphosis, and a posterior pelvic tilt while sitting. Q: What aspects of postural alignment are contributing to his symptoms, and what interventions might help improve his posture?

Answer 25

The patient’s poor sitting posture, characterized by a forward head posture, increased thoracic kyphosis, and posterior pelvic tilt, is likely contributing to his back pain and fatigue. Interventions might include ergonomic adjustments to his workspace, strengthening of core and postural muscles, and education on maintaining neutral pelvic and spinal alignment.

Question 26

What is the goal of stability in postural control?

Answer 26

The goal of stability is to ensure the body remains upright and steady.

Question 27

Allows for modification of postural responses based on changing task and environmental demands.

Answer 27

Adaptive Postural Control

Question 27

What is proactive (anticipatory) postural control?

Answer 27

Proactive postural control occurs in preparation for destabilizing forces generated by the body’s own movements, with the system pre-tuned based on prior experiences.

Question 28

Located about two-thirds of body height above the base of support (BOS).

Answer 28

Center of Mass (COM)

Question 29

Provides information on the movement and orientation of body segments and the body in space, using focal and ambient vision.

Answer 29

Visual System

Question 30

Detects angular and linear acceleration of the head and helps with postural control and balance.

Answer 30

Vestibular System

Question 31

Refers to how the CNS prioritizes sensory inputs based on the sensory environment and task demands to maintain balance.

Answer 31

Sensory Weighting Theory

Question 31

Test condition where the patient stands with feet together, eyes open (EO) for 20-30 seconds to observe stability.

Answer 31

Initial Setup for Romberg Test

Question 31

A variation of the Romberg Test where the feet are placed in a tandem position, challenging balance further.

Answer 31

Sharpened Romberg Test

Question 31

Impaired sensory inputs can lead to increased reliance on vision or vestibular inputs for maintaining balance, potentially increasing fall risk.

Answer 31

Effect of Somatosensory Deficits on Balance

Question 32

Strategy that controls the center of mass (COM) by moving the body as a fixed pendulum around the ankle joints.

Answer 32

Ankle Strategy

Question 32

Strategy that involves flexing or extending at the hips to control larger shifts of the COM.

Answer 32

Hip Strategy

Question 32

Assesses sensory contributions to postural control and balance through dynamic posturography with six different sensory test conditions.

Answer 32

Sensory Organization Test (SOT)

Question 32

Movements that assist in stabilizing the COM over the BOS by extending the BOS and providing protective functions.

Answer 32

Upper Limb Movements (Reach or Grasp)

Question 32

Plays a critical role in interpreting sensory information and planning effective postural responses, crucial for maintaining balance during complex tasks.

Answer 32

Cognitive Processes in Postural Control

Question 32

Strategy that realigns the base of support (BOS) under the COM by taking rapid steps or hops.

Answer 32

Stepping Strategy

Question 32

A long-standing test used to assess sensorimotor control, originally developed to diagnose tabes dorsalis.

Answer 32

Romberg Test

Question 32

Self-report measure evaluating the confidence of performing various activities without falling.

Answer 32

Activities-Specific Balance Confidence Scale

Question 32

Movements that occur in response to backward sway, primarily involving hip flexors, abdominals, and neck flexors.

Answer 32

Backward Sway Movements

Question 32

Performance-based measure evaluating balance while walking and talking simultaneously.

Answer 32

Walking While Talking Test

Question 33

A simplified version of the Sensory Organization Test (SOT) using medium-density foam and a visual conflict dome to assess balance.

Answer 33

Clinical Test of Sensory Interaction and Balance (CTSIB)

Question 33

Performance-based measure assessing gait and balance through tasks like walking and navigating obstacles.

Answer 33

Dynamic Gait Index

Question 33

Self-report measure assessing fear of falling and its impact on daily activities.

Answer 33

Tinetti Falls Efficacy Scale

Question 33

Muscles activated during forward sway to counteract forward movement, including hip extensors and trunk extensors.

Answer 33

Forward Sway Movements