coordination-220803095112-f14eb59c.pdf..

BASIC OT

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EXAMINATION OF COORDINATION

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LECTURE CONTENTS
Coordination (Definition/Purpose)
Define functions of Cerebellum & Basal ganglia &
their associated pathologies
Features of coordination impairments
Testing protocol of Coordination Examination
Non-equilibrium & Equilibrium Coordination tests
Grading for Non-equilibrium & equilibrium tests
Tests of coordination impairments

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LECTURES OBJECTIVES
At the end of the lecture the students will be
able to;
Understand the purpose of performing a coordination
examination
Describe the functions of cerebellum, basal ganglia &
its associated impairments
Differentiate between tests used to examine non
equilibrium & those used to address equilibrium
coordination
Explain the testing protocol for performing a
coordination examination
Describe the sample tests for selected coordination
impairments

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COORDINATION
Coordination is the ability to execute smooth,
accurate, controlled motor responses.
The ability to produce these responses is dependent
on somatosensory, visual & vestibular input as well as
fully intact neuromuscular system from the motor
cortex to spinal cord.
Coordinated movements are characterized by
appropriate;
Speed, distance, direction, timing, & muscular
tension

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COORDINATION EXAMINATION (PURPOSE)
The purpose of performing a coordination exam of
motor function is to determine the :
Muscle activity characteristics during voluntary
movement
Ability of muscles or group of muscles to work
together to perform a task or functional activity
Level of skill & efficiency of movement
Ability to initiate, control, & terminate movement
Timing, sequencing, & accuracy of movement
patterns
Effects of therapeutic & pharmacological
intervention on motor function over time

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CEREBELLUM
Function:
Regulation of movement, postural control, & muscle
tone.
Theories of Function:
Cerebellum functions as Comparator &
Error correcting mechanism

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BASAL GANGLIA
Function:
BG play an important role in several complex aspects
of movement & postural control
BG play an important role in maintaining normal
background muscle tone
The anatomical positioning of the BG provides
insight into its contribution to motor performance

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FEATURES OF COORDINATION IMPAIRMENTS
Cerebellum, basal ganlia& dorsal column-medial
lemniscalpathway provide input to, & act together
with, the cortex in the production of coordinated
movement.
Lesions in any of these areas impact higher level
processing & execution of coordinated motor
responses.

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CEREBELLAR PATHOLOGY
Asthenia Generalized muscle weakness
Asynergia Loss of ability to associate m/s together for complex
movement
Delayed reaction timeIncreased time require to initiate voluntary movement
Dysarthria Disorder of the motor component of speech articulation
DysdiadochokinesiaImpaired ability to perform rapid alternating movements
Dysmetria Inability to judge the distance or rangeof movement
Dyssynergia Decomposition of movement
Hypermetria/
hypometria
Overestimation /underestimation of distance or range to
accomplish movement
Nystagmus Rhythmic, quick, oscillatory movement of eyes
Rebound
phenomenon
Inability to halt forceful movements after resistive
stimulus removed; pt unable to stop sudden limb motion
Intentiontremor Oscillatory movement during voluntary motion
Postural tremor Exaggerated oscillatory movement in standing posture
Titubation Rhythemicoscillations of the head

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BASAL GANGLIA PATHOLOGY
Akinesia Inability to initiate movement
Athtosis Slow, involuntary,twisting, wormlike movements
Bradykinesia Decrease amplitude & velocity of voluntarymovement
Chorea Involuntary, rapid, irregular, jerky movements
ChoreoathetosisMovement disorderwith features of both chorea & athetosis
Dystonia Sustained involuntary contractions of agonist & antagonist
m/s
Hemiballismus Large-amplitude sudden, violent motions of the arm & leg of
one side of body
Hyperkinesia Abnormal increased muscle activity or movement
Hypokinesia Decreaedmotor responseespto a specific stimulus
Rigidity
Leadpipe
Cogwheel
Increased in muscle tone causing greater resistance to passive
movement
Uniform, constant resistance as limb is moved
Series of brief relaxations or “catches” as limb is passively
moved
Tremor (resting)Involuntary, rhythemic, oscillatory movement observed at rest

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FEATURES OF COORDINATION TESTS
Coordination tests can be divided into 2 main categories
1.Non equilibrium tests:
Address both static & mobile components of movements, when
the pt is in a sitting position
Involve both gross & fine motor activities
Tests should be performed first with eyes open and then with
eyes closed
2. Equilibrium tests:
Address both static & dynamic components of posture &
balance, when the pt is in a upright standing position
Involve primarily gross motor activities

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TESTING PROTOCOL

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GATHER EQUIPMENT
The coordination exam should be administered in a
quiet, well lighted treatment area sufficiently large to
accommodate walking activities Coordination
assessment form
Pen or pencil to record data
Stopwatch
Two standard chairs mat or treatment table
Method of occluding vision

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PATIENT PREPARATION
The coordination examination should be administered
when the patient is well rested.
A full explanation of purpose of the testing should be
provided
Each coordination test should be demonstrated
individually by the therapist before actual testing
Testing procedures require mental concentration &
physical activity
Fatigue, lack of clarity or fear may adversely influence
tests results

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TESTING PROTOCOL
Does increased speed of performance affect quality of motor
activity ?
Can appropriate motor adjustments made if speed & direction are
changed ?
Can a position or posture of the body or specific extremity be
maintained without swaying, oscillations, or extraneous movements
Does occluding vision alter the quality of motor activity ?
Does patient fatigue rapidly ?

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NON EQUILIBRIUM COORDINATION TESTS
FINGER-TO-NOSE-TEST:
The patient is asked to
bring the tip of the index
finger to the tip of his or
her nose.
Alternations may be made
in the initial starting
position to observe
performance from different
planes of motion.
Observe intention tremor

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NON EQUILIBRIUM COORDINATION TESTS
Finger to finger test
Finger-to-therapist’s finger
Alternate nose-to-finger
Finger opposition
Mass grasp: An alteration is made between opening
& closing fist, speed may be gradually increased
Pronation/supination

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NON EQUILIBRIUM COORDINATION TESTS
Rebound test:
The patient is positioned in sitting . The
PT applies sufficient manual resistance
to produce an isometric contraction of
biceps. Resistance is suddenly released.
Normally the opposing muscle group
will contract & “check” movement of
limb.
The patient with dysfunction will be
unable to arrest the progress of the arm,
and it will rebound markedly off your
arm.

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NON EQUILIBRIUM COORDINATION TESTS
Heel on shin:
From a supine
position, the heel of
one foot is slid up and
down the shin of the
opposite LE

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NON EQUILIBRIUM COORDINATION TESTS
Tapping (hand): with the elbow flexed & forearm
pronated, the pt is asked to tap the hand on the knee.
Tapping (foot): The pt is asked to tap the ball of the
foot on the floor without raising the knee; heel
maintains contact with the floor
Alternate heel-to-knee; heel to toe: From a supine
position, the patient is asked to touch the knee & big
toe alternatively with the heel of the opposite
extremity.

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EQUILIBRIUM COORDINATION TESTS
Normal stance
Stance (narrow BOS)
Tandem stance
One leg stance
Perturbations: displace balance unexpectedly
Standing, functional reach test: forward trunk
flexion with UE reach
Standing, laterally flex trunk to each side

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EQUILIBRIUM COORDINATION TESTS
Romberg test:
Standing EO to EC; inability
to maintain an upright posture
without visual input is
referred to as positive
Romberg sign.
Sharpened Romberg:
Standing in tandem position
EO to EC

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EQUILIBRIUM COORDINATION TESTS
Tandem walking: Heel to toe walk
Walking along a straight line or place feet on floor markers
while walking
Walk sideways, backward, or cross stepping
March in place
Start and stop abruptly
Walk and pivot on command (turn 90,180 or 360)
Walk with horizontal & vertical head turns on command
Step over or around obstacles
Stair climbing with or without using handrail
Jumping jacks
Sitting on a therapy ball

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GRADING FOR NON -EQUILIBRIUM & EQUILIBRIUM TESTS
5. Normal performance
4. Minimal impairment: Able to accomplish; slightly
less than normal speed; requires
supervision/minimal contact guarding
3. Moderate impairment: Able to accomplish activity;
movements are slow, awkward, and unsteady;
requires moderate contact guarding
2. Severe impairment: Able only to initiate activity
without completion; requires maximal contact
guarding
1. Activity impossible

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TESTS FOR COORDINATION IMPAIRMENTS
DYSDIADOCHOKINESIA
Finger nose finger test
Pronation/supination
Knee flexion/extension
Tapping
Walking, alter speed or duration

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TESTS FOR COORDINATION IMPAIRMENTS
DYSMETRIA
Finger nose finger test
Finger to therapist’s finger
Drawing a circle
Heel on shin
Placing feet on floor markers while walking

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TESTS FOR COORDINATION IMPAIRMENTS
DYSSYNERGIA
Finger-to-nose
Finger-to-therapist’s finger
Alternate heel-to-knee
Toe-to-examiner’s finger

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TESTS FOR COORDINATION IMPAIRMENTS
TREMOR (INTENTION)
Observation during functional activities
Alternate nose-to-finger
Finger-to-finger
Finger to therapist’s finger
Toe to examiner’s finger

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TESTS FOR COORDINATION IMPAIRMENTS
TREMOR (RESTING)
Observation of patient at rest; limb or jaw
movements
Observation during functional activities (tremor will
disappear with movement
Tremor (postural)
Observation of steadiness of normal posture;
sitting, standing

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TESTS FOR COORDINATION IMPAIRMENTS
ASTHENIA
Application of manual resistance to determine
ability to hold
RIGIDITY
Passive movement
Observation during functional activities
Observation of resting posture
BRADYKINESIA
Walking, observation of arm swing & trunk motions
alter speed & direction
Movement or gait activity be stopped abruptly

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TESTS FOR COORDINATION IMPAIRMENTS
DISTURBANCE OF GAIT
Walk along a straight line
Walk sideways, backward
March in place
Alter speed & direction of ambulatory activities

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REFERENCES
O’Sullivan SB, Schmitz TJ, Physical
Rehabilitation, Fifth Edition, F.A. Davis
Company, 2007; Ch.7

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QUESTIONS !!!!

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