Examination of Coordination LECTURE 2 Flashcards Preview

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the ability of the central nervous system to control or direct the nervous system in purposeful movement and postural adjustment by selective allocation of muscle tension across appropriate joint segments.

Motor control

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  • Ability to execute smooth, accurate, controlled motor response
  • Need input from various sensory modalities

    Dependent on fully intact neuromuscular system

Coordination

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Coordinated movements include:

  • Appropriate speed
  • Speed
  • Distance
  • Direction
  • Timing
  • Muscular tension
  • Appropriate synergistic movements
  • Easy reversing between muscle groups
  • Proximal fixation

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use of fingers for fine motor tasks

Dexterity

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rapidly and smoothly initiate, stop or modify movement while maintaining postural control

Agility

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Coordination Impairment

Results in movements which are:

  •  Awkward
  • Extraneous
  • Uneven
  • Inaccurate

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Motor system review

WHAT system is muscles, joints, sensory and motor innervation

Peripheral

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Motor system- What area?

neocortex and basal ganglia (strategy),

middle level: motor cortex and cerebellum (tactics),

lowest level: brain stem and spinal cord (execution)

Central

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Principal area involved in motor function

Motor Cortex

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What is involved when talking about the motor cortex?

  1. includes Brodmanns’s areas 4 and 6 in frontal lobe (precentral gyrus)
  2. Planning coordintated movement requires information from many areas of the neocortex
  3. Brodmanns area 4: is the primary motor cortex, simple tasks
  4. Contains largest concentration of corticospinal neurons
  5. Controls contralateral  voluntary movements

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What is involved in Brodmann’s area 6?

  • Has supplementary motor and premotor areas
  • Innervate motor units that are involved in initiating movement, simultaneous bilat. grasp, sequential tasks, orientation of eyes and head
  • Helps control trunk and proximal limb movement
  • Helps anticipate postural changes
  • Intricate movements

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what is involved when talking about the Motor Homunculus?

  1. Somatotopic organization of motor cortex
  2. Illustrates the amount of cortical area devoted to motor control of a body part/region
  3. Larger areas associated with areas of body that have to have finer gradiation of control

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What 3 primary sources  does the Motor Cortex receives info?

  1. Somatosensory cortex: relayed to primary cortex from the thalamus
  2. Cerebellum through the thalamus
  3. Basal ganglia: through the thalamus

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  • AKA: pyramidal tract
  • Signal from motor cortex directly to spinal cord
  • Originates areas 4 and 6, passes through internal capsule and brainstem
  • Most cross to opposite side in medulla, descend through lateral spinal thalamic tract
  • Other fibers form ventral corticospinal tract: cross in cervical or upper thoracic region

Corticospinal tract

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descending pathways

directly to CN nuclei: trigeminal, facial, hypoglossal, some to the  reticular formation before going to CN nuclei

Corticobulbar tract

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descending pathways

goes to motor neurons in cervical cord: neck, CN XI, help guide head movements assoc with visual motor tasks

Tectospinal tract

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descending pathways

Project to ant horn of spinal cord: influences muscle tone, reflex activity (influences muscle spindle activity)

Reticulospinal tracts

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descending pathways affect which motor neurons?

extension and flexion

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descending pathways

Goes to all levels of spinal cord
Postural control/head movements (stimulates extensors)

 

Vestibulospinal tract

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  1. Regulates movement, postural control and muscle tone
  • Helps to compare information and correct “errors”
  • Analyzes information from cortex with peripheral feedback
  • Gets input on balance, posture, position, rate, rhythm and force of slow movements of peripheral body segments
  • If movement deviates supplies a corrective influence

Cerebellum

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  • CNS analysis of movement information, analyzes how accurate the performance is and provides for error correction
  • Uses movement information, determination of accuracy, provides for error correction

Closed Loop System

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  • Control system with an open loop system with preprogrammed instructions to an effector that does not  use feedback information and error-detecting processes

Stereotypical movements and rapid, short duration movements: they don’t allow sufficient time for feedback loop

Open Loop System

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Basal Ganglia- what are the 3 nuclei in base of cerebral cortex?

 

  1. Caudate nucleus,
  2. putamen
  3. globus pallidus

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This helps with Help with:

  • initiation and regulation of gross intentional movements
  • Planning and executing complex motor responses
  • Facilitation of desired motor response while inhibiting the undesirable response
  • Accomplish  automatic movements and postural adjustments
  • Normal background muscle tone
  • Has somatotopic organization
  • Influence of this  is indirect and mediated by descending projections from cortical motor areas: there is a feedback loop: there is information flowing from areas assoc with movement to the BG and then information flowing back to the other areas

Basal Ganglia

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  • This is pathway is Responsible for afferent transmission of discriminative sensations
  • Fine gradiation of intensity and precise localization on the body surface are mediated here

Dorsal Column-Medial Lemniscal pathway

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Where do the Dorsal Column-Medial Lemniscal pathway senses transmit ?

  • Discriminative touch 
  • stereognosis
  • Tactile pressure  
  • barognosis
  • graphesthesia  
  • recognize texture
  • Kinesthesia  
  • two point discrimination
  • Proprioception  
  • vibration

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What are some Coordination Impairments of the cerebellar pathology?

  • Difficult to execute accurate, smooth controlled movements
  • Affect muscle tone, equilibrium, posture, initiation and force of movement
  • Ataxia

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what are some Motor Impairments with 
Cerebeller Pathology?

  1. Asthenia
  2. Dysarthria
  3. Dysdiadochokinesia
  4. Dysmetria
  5. hypermetria
  6. hypometria
  7. Dyssynergia
  8. Asynnergia
  9. Gait ataxia
  10. Hypotonia
  11. Nystagmus

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  1. What is the definition of Ataxia
  • What may ataxia effect in the body?

  • loss of muscle coordination

 

 

  1. may affect gait, posture, patterns of movement
  2. Difficult to initiate movement and errors in rate, rhythm and timing

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generalized mm weakness

Asthenia

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motor portion of speech articulation: speak one word at a time: slow, hesitant, change in melodic quality

Dysarthria

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impairment in performing rapidly alternating movements: movements are irregular

Dysdiadochokinesia

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cant judge distance or range of a movement

 

Dysmetria

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overestimation of range needed to reach object

hypermetria

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underestimation of range needed

hypometria

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break down movements into sequences instead of smooth motion

Dyssynergia

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cannot associate muscles together to make a complex movement

Asynnergia

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 broad base of support, poor upright balance, stepping is irregular, unsteady gait

Gait ataxia

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decrease in muscle tone, will see less resistance to passive movement, muscles soft

Hypotonia

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rhythmic, quick, oscillatory movement of eyes back and forth.  Will have trouble holding gaze on an object in the peripheral field

Nystagmus

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loss of  check reflex: cannot halt forceful movements when resistance is eliminated

Rebound Phenomenon

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involuntary oscillatory movement from alternate contractions of opposing muscle groups-  

name the two types

Tremor

2 types -

Intention tremor- only tremor with trying to move (picking up pencil)

Postural- tremor is always apparent

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  • Slowness of movement
  • Involuntary extraneous movement
  • Alterations in posture and muscle tone
  • Will see everything from very diminished movement (think Parkinsons) to excessive extraneous motion (think Huntingtons Disease)

what can you expect to be affected?

Basal Ganglia

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can’t initiate movement, have episodes of fixed postures-FREEZING EPISODES

Akinesia

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 slow involuntary, writhing, twisting movements, usually > in distal UE’s, wrists and fingers may hyperextend and then flex, combined with rotary movements of extremities.  Can effect other areas of body.  AKA athetoid movements: usually see in combo with spasticity, tonic spasms or chorea.

Athetosis

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decreased amplitude and velocity of voluntary movement: decrease arm swing, shuffling gait, 

Bradykinesia

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 involuntary, rapid, irregular, jerky movements involving multiple joints.  Cannot voluntarily control movements

Chorea

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involuntary, rapid, irregular, jerky movements involving multiple joints.  Cannot voluntarily control movements

Chorea

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have features of both chorea and athetosis

Choreoathetosis

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 large amplitude, sudden, violent, flailing motions of arm and leg on one side of body: affects axial and proximal musculature of limb

Hemiballismus

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increase in muscle tone causing greater resistance to passive movement: more pronounced in flexor muscles: 

Name the two types and decribe them.

 

Rigidity

Leadpipe- stiff all the way thru
Cogwheel- gives a little then stiffens

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involuntary, rhythmic, oscillatory movement observed at rest: disappear with purposeful movement, may increase with emotional stress: “pill rolling” is typical, may also affect jaw or other areas

Tremor

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  • Coordination and equilibrium impairments due to lack of position sense and impaired localized touch sensation
  • Will have difficulty with proprioception, kinesthesia, discriminative touch
  • Gait disturbances : wide based and swaying, uneven step length
  • Dysmetria: cant judge the required distance or range of movement
  • Usually use vision to compensate

Dorsal Column
Medial-Lemniscal Pathology-don’t know where they are in space (do better in light because they need there vision

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Dorsal Column     
Medial-Lemniscal Pathology

the Romberg sign will be positive:  describe what you will see.

pt closes eyes, cannot maintain standing balance with feet together

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Age Related Changes in Coordinated Movement

With normal aging will have more difficulty executing ?

smooth, accurate controlled responses 

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Age Related Changes in Coordinated Movement

Where will you see Decreased strength and Loss of strength?

  • Decreased strength: loose alpha motor neurons, atrophy of fast twitch fibers, loss of diameter of muscle fibers, etc
  • Loss of strength worse in antigravity muscles in back and LE’s

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Age Related Changes in Coordinated Movement

  • Slowed reaction time:
  • Reaction time:

Describe theses two

  • Slowed reaction time: speed decreases so that movement can be accurate
  • Reaction time is slowed between stimulus and initiation of movement (pre-motor time) and movement time (time interval between initiation of movement and completion of movement)

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Age Related Changes in Coordinated Movement

will you see more of a delay in fine motor or gross motor activities?

fine

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Age Related Changes in Coordinated Movement

Decreased ROM- name some areas where you might see  this.

Decreased ROM is linked to what?

  • Wrist flexion and extension, hip and shoulder rotation
  • Small decreases in hip and knee motion,  one researcher noted consistent declines in 10 joints of LE in AROM and PROM in pts >70 y.o.
  • Decreased ROM linked to biological age of jt surfaces, degenerative changes in collagen fibers, dietary deficiencies, sedentary lifestyle

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Age Related Changes in Coordinated Movement

Postural Changes

Impaired Balance

Describe what you might see with each of these.

  • Postural Changes
    • Head forward, rounded shoulders, altered lordotic curve (flattened or increased), increase in hip and knee flex, sometimes wider BOS
    • More difficulty with preparatory postural adjustments
  • Impaired Balance
    • Decreased Balance, Increased postural sway
    • Decreased limits of stability and functional reach

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What will screening help to determine?

  • Will help to determine what other testing needs to be done, helps rule out/differentiate specific system involvement, help determine if referral needed
  • Helps to determine all contributing factors for a functional limitation
  • Need to look at the basics: ROM, Strength and the Sensory System

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what type of test?

  • Need to look at fine and gross motor movements
  • Gross motor: body posture, balance, extremity movements using large muscle group
    • Crawling, kneeling, walking, running
  • Fine motor: utilizes small muscle groups
    • Uses finger dexterity: writing, typing, eating

Coordination tests

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What type of test?
  • Nonequilibrium
    • Pt in sitting: static and mobile components of movement
    • Gross and fine motor
  • Equilibrium
    • Pt in standing: static and dynamic components
    • Primarily gross motor

Balance tests

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what are the Goals of postural control?

Stability and function

  • involves sensory input, motor response, integrated CNS control
  • Also need reactive postural control, proactive postural control, adaptive postural control

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What are some Motor task requirements?

Mobility

  • Initial movement

Stability

  • Maintain a steady position

Controlled mobility

  • Alter position while maintaining stability

Skill

  • Highly coordinated movement

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what are the Areas Assessed in Coordination Testing ?

Alternate or reciprocal motion

  • Reverse movement between opposing mm groups

Movement composition

  • Movement with mm groups acting together

Movement accuracy

  • Gauge or judge distance and speed

Fixation or limb holding

  • Hold position

Equilibrium

  • Maintain balance with perturbations 

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How would you Prep for administering exam?

  • Get needed equipment together
  • Know what need to tell patient, should be rested
  • Quiet, well lit environment
  • Make sure have watch or clock with second hand
  • Demonstrate each test before doing it
  • Initial observations should be noted: dressing, position changes, walking, etc: how much assistance needed? What extremities involved? Where does the weakness in the extremities seem to be? etc

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How would you Choose which Test to do?

  • Tests will be chosen according to what you see when you are doing initial observations
  • It is not necessary to do every test with each patient

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what is involve with a Gait Analysis?

  • Observing gait can add important information
  • Analyze the quality of the gait: movement control, muscle tone, synergistic patterns, etc
  • Standardized testing
    • Get Up and Go Test, Timed Up and Go test, Functional Independence Measure, Sickness Impact Profile, Physical Performance and Mobility Examination, Performance Oriented Mobility Assessment, etc

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what are the Coordination Exams?

  • Finger to nose  
  • Pointing and past
  • Finger to therapists finger pointing
  • Finger to finger  
  • Alternate heel to knee 
  • Alternate nose to finger   
  • heel to toe
  • Finger opposition  
  • Toe to examiners finger
  • Mass grasp   
  • Heel on shin
  • Pronation/supination 
  • Drawing a circle
  • Rebound test  
  • Fixation or position
  • Tapping (hand)    holding
  • Tapping (foot) perform with eyes open, then eyes closed

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what are the Equilibrium Coordination Tests?

 

  1. Standing with normal BOS
  2. Standing with narrow BOS
  3. Standing in tandem
  4. Standing on one foot
  5. Altering arm position while standing
  6. Perturbations
  7. Functional reach
  8. Standing with lateral flex
  9. Romberg test
  10. Tandem eyes open to eyes closed
  11. Tandem walking
  12. Walk strait line
  13. Walk sideways, backward, cross-step
  14. March
  15. Alter speed of amb
  16. Start/stop abruptly
  17. Walk and pivot
  18. Walk in circle
  19. Heel or toe walk
  20. Horiz or vertical head turn with amb
  21. Step over obstacles
  22. Stair climbing with and without support
  23. Jumping jacks
  24. Therapy ball, alternate knee flex/ext

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how do you Record Results?

  1. Be specific in your documentation
  2. Upper extremities: more standardized instruments
  3. Use forms when possible
  4. Make it measurable: time
  5. Consider videotaping

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what are the Quantitative coordination testing

CATSYS System
Computer based, helps quantify certain impairments
Tremor pen, reaction time, pronation/supination, postural sway
Postural Sway Analyzer
Choice Reaction Time Analyzer
Monitors simple reaction time or reaction time to 2 different opjects
Dynamic Posturography
Measures posture changes with visual input

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what are test for the Upper extremity Coordination?

Jebsen-Taylor Hand Function Test
Hand and finger coordination
Minnesota Manual Dexterity Test
Coordination of arm/hand/finger movement, eye hand coordination
Purdue Pegboard
Gross and fine coordination

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