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PT-415 Motor Control > Impairment: Incoordination > Flashcards

Impairment: Incoordination Flashcards

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1
Q

Coordination: Definition

A
  1. Measure of the “QUALITY” of movement.
    - requires adequate STRENGTH and ROM
  2. Ability to perform CONSISTENTLY and ACCURATELY
    - under wide variety of conditions (open vs. closed)
  3. Allows for INVESTIGATION and INTERACTION w/ environment
  4. Ability to execute SMOOTH, ACCURATE, CONTROLLED motor responses
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2
Q

Coordination: Involves

A
  • 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)
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3
Q

Dexterity

A

Skillful use of fingers in fine motor tasks

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4
Q

Agility

A

Ability to rapidly and smoothly initiate, stop, or modify movement while maintaining posture control

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5
Q

Types of Coordination

A
  • Intralimb
  • Interlimb
  • Visual Motor
    - Eye-Hand
    - Eye-Hand-Head
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6
Q

3 Main Areas Involved w/ Coordination

A
  • Cerebellum
  • Basal Ganglia
  • Dorsal Columns
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7
Q

Schematic of Integration of the Sensory, Mootor Cortex, and the PNS

A

Go to website

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8
Q

Motor Cortex and Somatosensory Motor Pathways

A
  • Corticobulbar
  • Recticulospinal
  • Vestibulospinal
  • Rubrospinal
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9
Q

Basal Ganglia

A
  • Caudate Nucleus
  • Putamen
  • Globus Pallidus
  • Subthalmic Nucleus
  • Substantial Nigeria
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10
Q

Incoordination: Definition

A

Inability to produce “HARMONIUS, RHYTHMIC MUSCULAR ACTION” that is NOT primarily due to weakness!

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11
Q

Incoordination: Causes

A
  1. May be Sensory or Motor Disturbances (tone)
    - Deficit in Integration in Sensory, Motor, and Neural Processes
  2. Due to CNS LESION
    - Movement decomposition (asynergy)
    - Dysmetria (slow movement and decrease proximal stability)
    - TBI, Parkinsonism, MS, CP, HD, Chorea, Vestibular, etc
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12
Q

Incoordination: Characteristics

A
  • 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
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13
Q

Incoordination: Symptoms most often displayed

A
  • Activation and Sequencing Problems
  • Timing Problems
  • Scaling Forces (accuracy)
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14
Q

Activation and Sequencing Problems:

A
  • 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
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15
Q

Timing Problems:

A
  • Initiating Movement (reaction time)
    - CVA, PD
  • Movement Time decreased
    - UMNL disorders
  • Terminating Movement Problems
    - Cerebellar disorders
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16
Q

Scaling Forces: (accuracy)

A
  • Dysmetria (problems judging distance or range of movement)
  • Hypometria or Hypermetria (Parkinsons)
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17
Q

Cerebellum Function

A
  • Center for Balance and Coordinated Activity
  • Primary Function is COORDINATION/REGULATION
    - Movement
    - Equilibrium
    - Muscle Tone
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18
Q

Theory of Cerebellum: functions as a

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)
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19
Q

Damage to Cerebellum: Clinical Features

A
  • Hypotonia - Ataxia
  • Tremor. - Dysdiadochokiesia
  • Movement Decomposition - Impaired Error Correction
  • Dysmetria - Gait Disorders
  • Dysarthria - Nystagmus
  • Rebound Phenomenon - Asthenia
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20
Q

Hypotonia Definition

A
  • Low Tone
  • Decrease resistance to PROM
  • Decrease DTR’s
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21
Q

Ataxia Definition:

A

Movements that are:

  • Jerky
  • Uncoordinated
  • Inefficient
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22
Q

Tremor Definition: (intention or kinetic)

A
  • Occurs w/ voluntary movement
  • Increases as limb nears goal,
  • Decreased or Absent at rest
  • Frequency range <5Hz
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23
Q

Dysdiadochokinesia Definition

A
  • Difficulty performing rapid alternating movements (RAM)
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24
Q

Movement Decomposition Definition:

A
  • Dyssynergia / Asynergy

- movement by component parts vs. a single smooth movement

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25
Impaired Error Correction, Affecting ML: Definition
- Disruption of feedforward mechanisms
26
Dysmetria Definition:
- Difficulty Judging Distances - over- or under-shoot - hypermetria vs. hypoometria
27
Gait Disorders w/ Cerebellar damage
- >BOS - Arms held out - Unsteady
28
Nystagmus Definition
- Rhythmis Ossillatory movements of eyes
29
Dysarthria Definition
- Difficulty w/ speech (slow and slurred)
30
Rebound Phenomenon Definition:
"Check Reflex" impaired
31
Asthenia Definition
Generalized mm weakness
32
Basal Ganglia Parts
- Caudate - Putamen - Globus Pallidus - Subthalmic Nucleus - Substantial Nigra
33
Basal Ganglia "job"
- Influential in INITIATION and REGULATION of movement - Important w/ POSTURAL ADJUSTMENTS - Important w/ maintaining normal background mm tone
34
Basal Ganglia sends:
Inhibitory info to: - Descending Motor Tracts - Motor Cortex
35
Clinical Features of Damage to Basal Ganglia HYPOKINETIC DISORDERS
(PD) - Bradykinesia - Akinesia - Rigidity - Tremor (resting)
36
Bradykinesia Definition
Slow or decreased movements
37
Akinesia Definition
Inability to Initiate Movement
38
Rigidity Definition
- Resistance to PROM - Lead-Pipe (constant resistance) - Cog-Wheel (alternating)
39
Basal Ganglia Tremor
RESTING - Involuntary - Rhythmic Ossillatory movement at rest - often decreases w/ voluntary movement - freq in distal UE
40
Basal Ganglia features w/ HYPERKINETIC DISORDERS
(HD) - Chorea - Athetosis - Choreoathetosis - Hemiballismus - Dystonia
41
Chorea Definition
Movements that are: - Involuntary - Rapid - Irregular - Jerky
42
Athetosis Definition
Movements that are: (> Distal) - Slow - Involuntary - Writhing
43
Choreoathetosis Definition
Combo of: - Chorea - Athetosis
44
Hemiballismus Definition
Flailing Motion of Unilateral arm/leg - Sudden - Jerky - Forceful - Wild
45
Dystonia Definition
(Torticollis) - Twisting, bizarre movements caused by: - Involuntary contractions of axial and proximal muscles
46
Dorsal Columns "job"
Important role in Coordinated MOVEMENT and POSTURE | - Mediates Proprioceptive Input
47
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
48
Factors that increase Incoordination:
- Emotions - Interfering Sensory Inputs (pain/temp/vision) - Decreased Motivation - Aging - *** Decrease Strength/ROM/Disuse - Overflow/Irradiation - Fatigue
49
Assessing Functional Limitations (coordination assessment)
- initiating/terminating tasks? - rolling - supine to sit - sitting - sit to stand - standing - transfers - ambulatory - stairs
50
Four Basic Motor Task Requirements
- Mobility (alternate or reciprocal motion) - Stability (movement composition (synergy)) - Controlled Mobility (movement accuracy) - Skill (equilibrium)
51
Focus on Assessment of Movement Capabilities:
- Alternate or Reciprocal Motion - Movement Composition or Synergy - Movement Accuracy - Fixation or Limb Holding (steadiness) - Equilibrium
52
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
53
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
54
Equilibrium (balance) Test
- Static and Dynamic in "upright" standing position | - Eyes open/closed (gross motor)
55
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
56
Rating Scale for Documentation
- 4 (normal) - 3 (slight difficulty) - 2 (mod difficulty, decreased performance w/ speed) - 1 (severe difficulty) - 0 (unable to accomplish activity)
57
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
58
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
59
Scaling Intervention Treatment
- Practice wide variety of tasks that require precise grading effort (**Provide KR and KP) - SLOW to FAST - Small to Larger ROM
60
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)

PT-415 Motor Control (4 decks)

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