PRELIMS: Assessment for Balance & Coordination Flashcards
What is the definition of coordination in the context of movement?
Coordination is the ability to execute smooth, accurate, and controlled movements involving multiple joints and muscles.
What key aspects are involved in coordination?
Sequencing, timing, and grading of muscle activation to produce efficient and accurate movement.
What systems and inputs does coordination rely on?
Sensory information, visual and vestibular input, and an intact musculoskeletal and neuromuscular system.
What are the attributes of coordinated movement?
Appropriate speed, distance, direction, timing, muscular tension, synergistic muscle recruitment, easy reversal between opposing muscles, and proximal fixation for distal motion.
What is the key descending motor pathway for skilled fine motor control?
The corticospinal (pyramidal) tract, which transmits motor signals from the motor cortex directly to the spinal cord.
Define intralimb coordination.
Intralimb coordination involves movements within a single limb, such as flexing or extending the elbow.
What is interlimb (bimanual) coordination?
It is the integrated performance of two or more limbs working together, like in walking or bilateral UE tasks during transfers.
What is the function of the primary motor cortex (Area 4)?
It controls contralateral voluntary movements and contains the largest concentration of corticospinal neurons.
Why is eye–hand coordination important?
Eye–hand coordination is crucial for activities of daily living (ADLs) like using utensils or reaching for objects.
What does visual motor coordination entail?
It involves the integration of visual and motor abilities to accomplish a goal, such as writing or driving.
What are the subdivisions of Area 6 in the motor cortex?
Supplementary Motor Area (SMA): Initiates movement, bilateral grasping, sequential tasks.
Premotor Area (PMA): Controls trunk and proximal limb movements, contributes to anticipatory postural changes.
List some diagnoses associated with coordination impairments.
Traumatic brain injury, Parkinson’s disease, multiple sclerosis, Huntington’s disease, cerebral palsy, Sydenham’s chorea, cerebellar tumors, vestibular pathology, learning disabilities.
What are the three hierarchical levels of the central motor system?
Highest Level: Neocortex and Basal Ganglia (Strategy)
Middle Level: Motor Cortex and Cerebellum (Tactics)
Lowest Level: BrainStem and Spinal Cord (Execution)
A tract that merges with the corticospinal tract in the cervical region but is considered insignificant in human motor control.
Rubrospinal Tract
What does the motor homunculus illustrate?
It illustrates the cortical area devoted to motor control of different body parts.
Controls neurons that innervate cranial nerves.
Corticobulbar Tract
Influences motor neurons innervating neck muscles and the spinal accessory nucleus (CN XI), important for guiding head movements during visual motor tasks.
Tectospinal Tract
A control system with preprogrammed instructions that does not rely on feedback during execution, used for stereotypical and rapid movements.
Open-Loop System (Cerebellum)
What are the key motor impairments associated with cerebellar pathology?
Key motor impairments include ataxia, dysmetria, dysdiadochokinesia, hypotonia, and intention tremor.
What is ataxia, and how does it present?
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.
Facilitates flexion of motor neurons, having the opposite effect of the medial tract.
Lateral Reticulospinal Tract
What tract, Facilitates the extension of the lower extremities, augmenting antigravity reflexes important for posture and gait.
Medial Reticulospinal Tract
Contributes to postural control and movements of the head, facilitating axial extensors and inhibiting axial flexors.
Lateral Vestibulospinal Tract
Involved in coordinated head and eye movements, projecting primarily to the ipsilateral cervical spinal cord.
Medial Vestibulospinal Tract
Regulates movement by transmitting sensory information crucial for discriminative touch, proprioception, and kinesthesia.
Dorsal (Posterior) Column–Medial Lemniscal Pathway (Function
Regulation of movement, postural control, and muscle tone.
Cerebellum (Primary Functions)
Uses feedback to compare current performance with a reference, computes errors, and makes corrections for ongoing adjustments during movements.
Closed-Loop System (Cerebellum)
Compares intended movements with actual movements and sends corrective signals to adjust the movement.
Cerebellum (Comparator and Error-Correcting Mechanism)
Sensory fibers enter the dorsal column, ascend to the medulla, cross over, and then project to the thalamus and somatosensory cortex.
Dorsal (Posterior) Column–Medial Lemniscal Pathway (Pathway)
Movement and postural control, initiation and regulation of gross intentional movements, and maintenance of normal muscle tone.
Basal Ganglia (Functions)
Components that include detecting body position and motion, organizing and executing motor synergies, and integrating sensory and motor information to develop action plans.
Key Components of Balance
Describe the motor impairments associated with midline cerebellar lesions (vermis, paleocerebellum).
Midline cerebellar lesions can cause titubation, truncal ataxia, orthostatic tremor, and gait imbalance.
What are the motor deficits commonly seen with basal ganglia pathology?
Basal ganglia pathology typically results in poverty and slowness of movement, involuntary movements, and alterations in posture and muscle tone.
What is chorea, and what condition is it most commonly associated with?
Chorea involves involuntary, rapid, irregular movements, most commonly associated with Huntington’s disease.
Define akinesia and the condition in which it is commonly observed.
Akinesia is the inability to initiate movement, often seen in late-stage Parkinson’s disease.
What symptoms are associated with cerebellar hemisphere lesions (neocerebellum)?
Symptoms include limb ataxia, dysdiadochokinesia, dysmetria, kinetic tremor, dysarthria, and hypotonia.
How does bradykinesia present, and in which condition is it a hallmark symptom?
Bradykinesia presents as decreased amplitude and velocity of movement, and is a hallmark of Parkinson’s disease.
What characterizes athetosis, and where is it commonly observed?
Athetosis is characterized by slow, involuntary, writhing movements, often observed in the distal upper extremities, neck, face, and trunk.
How does DCML pathology affect motor coordination?
DCML pathology leads to impairments in proprioception, kinesthesia, and discriminative touch, resulting in gait disturbances, dysmetria, and impaired fine motor skills.
Describe dystonia and its typical presentation.
Dystonia involves sustained involuntary muscle contractions leading to abnormal postures or twisting movements, often affecting the trunk, extremities, neck, and face.
What is the rebound phenomenon in cerebellar pathology?
The rebound phenomenon is the inability to stop a motion after resistance is suddenly removed, causing the patient to strike themselves or nearby objects.
How does the Romberg test relate to DCML pathology?
A positive Romberg sign, where the patient cannot maintain balance with feet together and eyes closed, indicates proprioceptive loss associated with DCML pathology.
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?
The patient is most likely experiencing Parkinson’s disease. The primary motor impairments include bradykinesia, rigidity, resting tremor, and postural instability.
What is hemiballismus, and what causes it?
Hemiballismus is characterized by large-amplitude, violent, flailing motions of one side of the body, caused by a lesion in the contralateral subthalamic nucleus.
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?
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.
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?
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.
Assessment using a plumb line for skeletal alignment, checking sagittal and frontal plane alignments, observing spinal curves, and muscle activity.
Normal Standing Posture Assessment
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?
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.
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?
The patient is experiencing athetosis, a movement disorder often associated with basal ganglia pathology, particularly damage to the striatum.
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?
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).
Maintaining the relative positions of body parts with respect to each other and gravity.
Postural Control
What is reactive postural control?
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.
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?
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.
What is the goal of stability in postural control?
The goal of stability is to ensure the body remains upright and steady.
Allows for modification of postural responses based on changing task and environmental demands.
Adaptive Postural Control
What is proactive (anticipatory) postural control?
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.
Located about two-thirds of body height above the base of support (BOS).
Center of Mass (COM)
Provides information on the movement and orientation of body segments and the body in space, using focal and ambient vision.
Visual System
Detects angular and linear acceleration of the head and helps with postural control and balance.
Vestibular System
Refers to how the CNS prioritizes sensory inputs based on the sensory environment and task demands to maintain balance.
Sensory Weighting Theory
Test condition where the patient stands with feet together, eyes open (EO) for 20-30 seconds to observe stability.
Initial Setup for Romberg Test
A variation of the Romberg Test where the feet are placed in a tandem position, challenging balance further.
Sharpened Romberg Test
Impaired sensory inputs can lead to increased reliance on vision or vestibular inputs for maintaining balance, potentially increasing fall risk.
Effect of Somatosensory Deficits on Balance
Strategy that controls the center of mass (COM) by moving the body as a fixed pendulum around the ankle joints.
Ankle Strategy
Strategy that involves flexing or extending at the hips to control larger shifts of the COM.
Hip Strategy
Assesses sensory contributions to postural control and balance through dynamic posturography with six different sensory test conditions.
Sensory Organization Test (SOT)
Movements that assist in stabilizing the COM over the BOS by extending the BOS and providing protective functions.
Upper Limb Movements (Reach or Grasp)
Plays a critical role in interpreting sensory information and planning effective postural responses, crucial for maintaining balance during complex tasks.
Cognitive Processes in Postural Control
Strategy that realigns the base of support (BOS) under the COM by taking rapid steps or hops.
Stepping Strategy
A long-standing test used to assess sensorimotor control, originally developed to diagnose tabes dorsalis.
Romberg Test
Self-report measure evaluating the confidence of performing various activities without falling.
Activities-Specific Balance Confidence Scale
Movements that occur in response to backward sway, primarily involving hip flexors, abdominals, and neck flexors.
Backward Sway Movements
Performance-based measure evaluating balance while walking and talking simultaneously.
Walking While Talking Test
A simplified version of the Sensory Organization Test (SOT) using medium-density foam and a visual conflict dome to assess balance.
Clinical Test of Sensory Interaction and Balance (CTSIB)
Performance-based measure assessing gait and balance through tasks like walking and navigating obstacles.
Dynamic Gait Index
Self-report measure assessing fear of falling and its impact on daily activities.
Tinetti Falls Efficacy Scale
Muscles activated during forward sway to counteract forward movement, including hip extensors and trunk extensors.
Forward Sway Movements
