neuro impairments: coordination testing and motor control

if motor control isn’t intact what can this lead too

coordination deficits

what does motor control require

1. activation and sequencing

2. timing

3. scaling

what is activation and sequencing

right muscle in the right order (proximal to distal)

what is timing

muscles activate at the right time

what is scaling

match muscle force with task demands (lift an object with certain mass to move a limb quickly or slowly)

what is coordination

motor control interactions and cooperation between opposing muscle groups during a movement

-required coordination between agonists and antagonistic muscle groups

coordinated movements are:

smooth, controlled, precise

formal testing of coordination is associated with

non-equilibrium coordination tests (unrelated to balance)

-supported position!!

-measure function of the cerebellum

when there is a coordination deficit, what are the consequences

1. smoothness: interrupted velocity and trajectory

2. accuracy: errors in movement

3. amplitude: overshooting or undershooting the target

4. speed/timing: uncontrolled or slowness

5. stability: LOB, difficulty with maintaining self over BOS

how do you document motor planning/coordination

NEED TO CREATE OWN DOCUMENTATION CATEGORY

DOCUMENT MOVEMENT QUALITY

1. initiation

2. termination

3. quality of movement

4. scale

5. speed

what are types of coordinated movement

1. intralimb

2. interlimb

3. visual motor

4. dexterity

5. agility

what is intralimb coordination

movements within 1 limb

ex: eating, brushing teeth, waving

what is interlimb coordination

movements between 2 limbs

ex: typing, clapping, walking

what is visual motor coordination

ex: eye-hand-head

ex: basketball, driving, catching

what is dexterity

skillful use of fingers

ex: pian, knitting, typing

what is agility

the ability to rapidly and smoothly start, stop, or modify a movement while maintaining postural control

ex: cutting, sports

what are amplitude/accuracy/speed problems with coordination

1. dysmetria

2. hypermetria

3. hypometria

what is dysmetria

disturbance in ability to judge the distance or ROM

what is hypermetria

overshooting a target or goal

what is hypometria

undershooting a target or goal

what are smoothness problems with coordination

1. dyssynergia

2. dysdiadochokinesia

3. ataxia

what is dyssynergia

errors in the timing and metrics of multi-joint movements

1. movement decompensation = decomposition - move 1 joint at a time

   1. assists to control (decrease) degrees of freedom

what is dysdiadochokinesia

difficulty performing rapid alternating movements

what is ataxia

abnormal or uncoordinated volitional movement

what are involuntary movements

1. tremor

   1. intention tremor

   2. resting tremor

   3. essential tremor

2. athetosis

3. ballisum

4. dystonia

5. chorea

6. myoclonus

what is a tremor

oscillating motion

what is an intention tremor

occurs during the performance of voluntary movement

-cerebellar disorders

what is a resting tremor

tremor at rest (ex: pill rolling, neck)

-Basal ganglia disorders (ex: parkinsons)

what is an essential tremor

seen typically with position change

-familial, idiopathic

what is athetosis

twisting, writhing motions

what is ballisum

large amplitude throwing types of motions

what is dystonia

sustained muscle contraction

what is chorea

involuntary, rapid, irregular, jerky movements, involving multiple jts; more in UEs (basal ganglia)

ex: Huntington’s disease

what is myoclonus

fast, jerky but small movements

observation of coordination

1. number of extremities involved, side involved

2. distal or proximal impairment

3. UE? LE?

4. occurrence of extraneous movements, swaying, unsteadiness, tremor

5. amount of assistance required

6. level of safety

7. situations that either increase or decrease impairment

8. general impression of efficiency in completing task

what do you select coordination tests based on

your observations and knowledge of patient’s pathology

general guidelines before you start coordination testing

1. screen for strength and ROM first

2. consider other possible threats to validity of the testing (ex: synergy, cognition, weakness)

3. appropriate location (ex: are you testing coordination or balance)

what is the general coordination test guidelines for the procedure

1. start with self-selected speed

2. ask pt to speed up and observe differences

3. begin with eyes open and then assess with eyes closed

through full ROM

what is the coordination testing technique

examiner ensures proper technique (ex: full elbow ext in alternating finger to nose test)

how is neuro testing graded

0-4

0= activity is impossible

4= normal performance

what are the parts of the coordination test

1. finger to nose

2. finger to PT finger

3. finger to finger

4. alternate nose to PT finger

5. pronation/supination

6. finger opposition

7. mass grasp

8. tapping hand/foot

9. alternate heel-to-knee; heel-to-toe

10. heel on shin (rebound test)

consider:

1. which impairments have I identified? -motor control, coordination or both

2. am I testing only coordination with my technique

3. is my technique accurate to capture deficits

4. why did I select the tests I did? What impairments do they help me understand