Coordination and Balance Assessment

Question 1

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

Answer 1

motor control

Question 2

ability to execute smooth, accurate, and controlled movement; involves multiple joints and muscles activated in the appropriate timing and sequence for efficient movement

Answer 2

coordination

Question 3

all forces acting on the body are balanced such that the COM is within the bodys BOS

Answer 3

balance

Question 4

measurement of how a person performs certain tasks and fulfills their various roles in life

Answer 4

functional assessment

Question 5

compares and makes corrections between intended movement and actual movement, involved in feedforward and feedback control

Answer 5

cerebellum

Question 6

what tracts control voluntary movement and which control involuntary movement

Answer 6

voluntary: corticospinal (pyramidal)
involuntary: extrapyramdial tracts (5)

Question 7

how does the cerebellum act indirectly to contribute to coordination

Answer 7

connections with primary motor cortex and descending extrapyramidal tracts

Question 8

compares and makes corrections between intended movements and actual movement; fine tuning movement; involved in feedforward and feedback control

Answer 8

cerebellum

Question 9

what area of the brain is heavily involved in motor learning and motor programming via connects with memory centers in temporal lobe

Answer 9

cerebellum

Question 10

list impairments associated with cerebellar pathology

Answer 10

• ataxia
• gait ataxia
• asthenia/hypotonia
• dysdiadochokinesia
• dysmetria
• dysarthria
• dyssynergia
• nystagmus
• intention tremor
• delayed reaction/movement time
• rebound phenomenon

Question 11

uncoordinated movement

Answer 11

ataxia

Question 12

damage to where in cerebellum would cause ataxia in the limbs

Answer 12

hemispheres (more lateral)

Question 13

damage where in cerebellum would cause ataxia in trunk

Answer 13

vermis (central)

Question 14

presents with wide BOS, staggering, path deviations, flinging of limbs

Answer 14

gait ataxia

Question 15

generalized muscle weakness

Answer 15

asthenia

Question 16

low tone

Answer 16

hypotonia

Question 17

inability to perform rapid alternating movements

Answer 17

dysdiadochokinesia

Question 18

inability to judge distance between points (over or underestimation)

Answer 18

dysmetria

Question 19

movement decomposition

Answer 19

dyssynergia

Question 20

tremor that occurs with movement

Answer 20

intention tremor (cerebellum lesion)

Question 21

involved in initiation and regulation of movement; planning and execution of complex motor patterns; provides input to regulate normal motor tone

Answer 21

basal ganglia

Question 22

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

Answer 22

basal ganglia

Question 23

impairments associated with basal ganglia pathology

Answer 23

• bradykinesia/akinesia
• rigidity (cogwheel and leadpipe)
• resting tremor
• chorea/athetosis
• dystonia
• hemiballismus

Question 24

how does age effect coordination and balance

Answer 24

• 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

Question 25

examples of CNS lesions that can produce changes in motor control that affect coordination and balance

Answer 25

stroke, parkinsons, MS, huntington's, CP, cerebellar tumors, central vestibular pathology, TBI

Question 26

list the elements of coordination

Answer 26

- 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

Question 27

what does Romberg EC test

Answer 27

somatosensation

Question 28

alternate or reciprocal movements, movement composition, movement accuracy, fixation or limb holding patters, UL/BL tasks, B/L asymmetrical tasks/ multilimb tasks

Answer 28

non-equilibrium tests

Question 29

ability to maintain equilibrium in both static and dynamic positions

Answer 29

postural control and balance testing

Question 30

postural control and balance assessment is the integration of what

Answer 30

- sensory system input (visual, vestibular, proprioceptive) - motor system synergies - output - CNS control - input and output

Question 31

what makes up sensorimotor integration

Answer 31

vision proprioception vestibular function

Question 32

what clinical test is used to assess VOR

Answer 32

head impulse/thrust test

Question 33

stabilizes the body, multiple reflexes working together, information from vestibular system used to guide postural reflexes for body righting

Answer 33

vestibulospinal reflex (VSR)

Question 34

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

Answer 34

cervico-ocular reflex (COR)

Question 35

what nuclei help maintain where our head is on our neck (COR)

Answer 35

C1-3

Question 36

input from neck proprioceptors; helps stabilize the body; works at low gain

Answer 36

cervicospinal reflex (CSR)

Question 37

how to measure sensorimotor integration

Answer 37

- romberg/sharpened - balance master - clinical test for sensory interaction in balance - mCTSIB

Question 38

what are the 3 strategies used to control COM over BOS

Answer 38

ankle strategy hip strategy stepping strategy

Question 39

occurs in quiet, static standing; lower level of sway; disturbances in COM are small and within LOS; recruitement from distal to proximal mm

Answer 39

ankle strategy

Question 40

what muscles are activated with a forward sway for ankle strategy

Answer 40

posterior muscles: gastroc/soleus, HS, paraspinals

Question 41

what mm are activated by backward sway for ankle strategy

Answer 41

anterior muscles: anterior tibialis, quads, abdominals

Question 42

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

Answer 42

hip strategy

Question 43

what mm are activated with forward sway hip strategy

Answer 43

abdominals --> quads

Question 44

what mm are activated with backward sway hip strategy

Answer 44

paraspinals --> HS

Question 45

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

Answer 45

stepping/reach strategies

Question 46

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

Answer 46

standing control

Question 47

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

Answer 47

seated control

Question 48

backward sway in sitting would active what mm

Answer 48

hip flexors, abs and neck flexors

Question 49

forward sway in sitting should activate what mm

Answer 49

extensors throughout

Question 50

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

Answer 50

anticipatory control

Question 51

perform secondary cognitive or motor tasks while observing static and dynamic posture; remember the theory of cognitive reserve from motor control

Answer 51

dual task control