coordination problems

Definition of coordination

Ability to produce smooth + accurate + controlled motor output w/ respect to 

1. Timing 

2. Speed 

3. Distance 

4. Direction 

5. Force of mvmt 

outcome of movement cycle

Function of cerebellum

1. Coordinate acquisition of sensory input 

2. Organise sequence + timing of muscle activation

True coordination difficulties conditions

1. Genetic early onset ataxia 

2. Injury to cerebellum → ataxic cerebral palsy 

3. Developmental coordination disorder: neurodevelopmental disorder related to acquisition + execution of coordinated motor skills 

Diagnosis of developmental coordination disorder

	Details
Motor skills	Difficulty acquiring + executing coordinated motor skills compared to children of same age + learning opportunities
Performance	Interference w/ ADLs + all participation areas
Onset	In early developmental period
X alternate explanation	X better explained by intellectual delay/ visual impairment/ other neurological conditions

Presentation of developmental coordination disorder

Aspect of body structure + function	Presentation
Neurological	Low/ variable tone  Depressed deep tendon reflexes  Persistent infant patterns of mvmt when fatigued  Clonus/ tremor/ other involuntary mvmts
Sensation	Vision: poor oculomotor control + attention  Proprioception: poor position awareness + seeking pressure sensations  Tactile: poor registration + perception + stereognosis  Vestibular: postural instability during/ after mvmt/ when watching mvmt; vestibular seeking or avoidance

Aspect of body structure + function	Presentation
Motor planning	Hard to follow verbal instructions/ visual demo Disorganised movements  Reliance on sensory cues
MSK	Decreased ROM + muscle length secondary to postures of low tone  Decreased strength + power  → causes: ↓ recruitment + imbalance + activation  Decreased activity Postures of activity ( slumping + toe walking )

Observations in fine motor activities ( hand writing )

Rubbing/ moving fingers when asked to write  Watching pencil X the page  Using hand + shoulder to write/ draw

Observations in fine motor activities ( eating meals )

Difficulty manipulating cutlery + bringing to the mouth  Difficulty opening packets → pull too hard  Cutting too hard/ X hard enough/ spill liquids when pouring

Observations in fine motor activities ( recreation )

1. Difficulty w/ playing musical instruments → finger placement + timing 

2. Increased pressure + inaccuracy when drawing 

3. Difficulty w/ games involving small pieces

Gross motor observations ( sports )

Inaccurate kicking  Difficulty coordinating/ skipping/ galloping  X make repetitive mvmts e.g. high knees

Gross motor observations ( mobility )

1. Tripping frequently 

2. X walking straight lines/ bumping into peers 

3. Gait impacted by low tone 

Patterns: 

• Toe walking 

• Bouncy gait 

• Heavy flat footed → limited spring/ push off 

1. Poor balance → arms in guard/ neck extended to counter balance smaller AP BoS

Definition of ataxia + characteristics of ataxic cerebral palsy

Definition of ataxia	Characteristics of ataxic CP
Difficulty controlling strength + timing + rhythm + direction of movement	Shaky movements  Coordination difficulties → hard to do repeated movements  Intention tremor  Hypotonia

	Explanation
Mastery	Promote self-awareness + Mx  → use own cognitive function + control own movement as soon as possible  → ask to solve “ why” behind their own performance + what they can do differently when they try again → promote consistency → if they have difficulties w/ motor planning
Guided mvmt	Minimal handling for independence  → prepare environment e.g. w/ visual target + verbal request + tactile cueing to guide movement → encourage independent mastery

	Explanation
Antigravity	Encourage movement up against gravity needed for participation  → Weight bearing  → common co-morbidity of coordination issues: hypotonia  → practice coming up against gravity
Variable practice	More variable movement → struggle w/ consistency  + variation of task ( hard to quickly calibrate movement + speed to new task requirements )  Cueing variation in speed/ amount of mvmt ( consistency )  Visual cues e.g. markers/ tape/ chalk Auditory cues e.g. metronome/ clapping Training variability in performance  Right challenge level → speed-accuracy trade off  → start slower → more accuracy  → increasing speed + unpredictability when practiced a few times ( other aspects e.g. changing goals/ uneven surfaces/ decision making )