Exercise for coordination

Coordination or coordinated movement : is the ability to execute smooth ,accurate, controlled motor responsesCoordinated movement is characterized by appropriate speed,distance,direction ,timing,and muscular tension Involves appropriate synergistic influence ,easy reversal between opposing muscle groups,and proximal fixation to allow distal motion or to maintain posture

Coordination deficits In CNS involvement includes

• Traumatic brain injury• Parkinsonism• Multiple sclerosis• Cerebral palsy• Cerebrellar tumors• Vestibular pathology

Clinical features of cerebrallar dysfunction

• Hypotonia : reduced muscle tension below resting level

• Dysmetria: Impaired ability to judge the distance or ROM

• Tremor-(intension and postural tremor) An

involuntary oscillatory movement

• Movement decomposition: (dyssynergia)– performance of movement in a sequence of

component parts rather than in single smooth activity

• Disorder of gait

• Dysarthria disorder in speech articulation (scanning speech)

• Nystagmus: rhythmic,oscillatory movement of the eyes

Clinical features of lesion to basal ganglia

• Bradykinesia: Abnormal slow movts

• Rigidity:increase in muscle tone-causing greater resistance to passive movt (lead pipe & cogwheel)

• Tremor-resting tremor -• Akinesia –inability to initiate movt

• Chorea-involuntary,rapid,irregular,jerky movts

• Athetosis: slow involuntary movts twisting ‘wormlike’ movt

• Dystonia-impaired or decreased tonicity

Purpose of performing coordination

assessment

• Determine muscle activity characteristic during voluntary movement

• Assess the ability of muscle or muscle group to work together to perform a task or functional activity

• Determine the level of skill and efficiency of movement

• Identify the ability to initiate ,control,and terminate action .

• Determine the timing ,sequencing ,and accuracy of movement patterns.

• Assist with establishing goals the diagnosis of underlying impairments, functional limitations,and disability.

• Assist with establishing goals to remediate impairments,formulating outcomes

• Determine effects of therapeutic and pharmacological intervention on motor function over time

• Assist with determining prognosis.

Assessment • Level or skill in activity

• The occurrence of extraneous movements, oscillation ,swaying or unsteadiness.

• Number of extremity involved

• Distribution of coordination impairment(proximal or distal)

• Situation that alters the coordination deficit

• Amount of time required to perform an activity

• Level of safety

• History of any fall

Coordination –Two main categories

Gross motor activityAssessment of

Fine motor activityAssessment of

body posture Extremity movt concerned with

Balance 1.small muscle

Extremity movtconcerned with large muscle

E.g 1. buttoning

E.g- 1.crawling, 2.kneeling 2. Writing

3.Standing ,4.walking ,5.running

3. Manipulating small object

Co-ordination sub divided into Non equilibrium

• Finger to nose • Finger to therapist finger• Finger to finger• Alternate nose to finger• Finger opposition• Mass grasp• Pronation /Supination • Tapping (hand)

Nonequilibrium

•Tapping foot•Alternate heel to knee ;heel to toe•Toe to examiners finger•Heel to shin •Drawing a circle•Fixation or position holding

equilibrium

Standing in normal comfortable posture

Standing feet together

Standing with one foot directly in front of the other

Standing on one foot

Arm position altered in each posture

Displace balance unexpectedly

Standing alternate between forward trunk flexion and return to neutral position

Standing with eye open and closed ability to maintain posture referred as positive Romberg test

Standing in tandem position with eye open to eye closed (sharpened Romberg test)

Walking,placing the heel of one foot directly in front of the toe of opposite foot (tandem walking )

Walking in straight line drawn

Walking sideways, backward ,or cross stepping

March in place

Step over or around obstacle

Stair climbing with or without handrail

Sequence for Training Neuromuscular Control

obtain relaxation of all muscles that show a reflex hypertonic

The patient is instructed to think about the motion while that motion is carried out passively by the therapist in order that the patient may feel the sensations produced

EXERCISE FOR CO - ORDINATION • FRENKEL’S EXERCISESThe process of learning this alternative

method of control is similar to that required to learn any new exercise, the essential being:Concentration of the attention.PrecisionRepetition.

PRINCIPLES AND TECHNIQUE • The patient is positioned and suitably

clothed so that he can see the limbs throughout the exercise

• A concise explanation and demonstration of the exercise is given before movement is attempted, to give the patient a clear mental picture of it