Coordination Examination

what is coordination?

smooth, accurate, controlled movement involving multiple joints and muscles being activated at appropriate time and with appropriate force (synergistic movements)

what are the characteristics of coordination?

appropriate speed, distance, direction, timing and muscle tension. force accuracy, normal variability, regularity, consistency

what is intralimb coordination?

movements within a single limb, involving 2 or more joints of a single limb, how segments within a limb are coupled

what is interlimb coordination?

movements involving homologous muscles of both limbs, movements involving left and right limbs

what is the role of sensory inputs in motor performance and coordination?

provides internal representation of environment used to inform and guide motor response

what is the purpose of the coordination examination?

• observe muscle activity during voluntary movements

• assess how muscles or muscle groups work together (muscle/movement synergy)

• look at initiation or termination of movement and control of speed, timing, accuracy, and sequencing of movement

• look at skill level, efficiency, and variability of movement

what is a hallmark sign of incoordination?

increased variability

what is the coordination examination comprised of?

gross motor and fine motor skills

what tests can be used to assess gross motor coordination?

• frenkel’s exercises (heel to shin test)

• unilateral and bilateral foot tap, alternative tapping, and alternative knee flexion/extension

• unilateral finger to nose, rapid alternating movements (forearm supination/pronation)

• bilateral symmetrical and asymmetrical movements

what tests are used to assess fine motor in the coordination exam?

• finger opposition test

• thumb-finger opposition

• purdue pegboard test

coordination impairments typically results from damage to which area of the brain?

The cerebellum is primarily responsible for coordination, so impairments typically result from damage in this area of the brain.

what impairments might result from cerebellar pathology?

Coordination impairments such as dysdiadochokinesia, dysmetria, dyssynergia, intention tremor, postural tremor, dysarthria, hypotonia, and generalized muscle weakness (asthenia), nystagmus, ataxia

what impairments might result from basal ganglia impairments?

Impairments such as bradykinesia/hypokinesia/akinesia, rigidity (leadpipe and cogwheel), resting tremors, postural instability, athetosis (writhing/worm-like movements), chorea, hemiballismus

what does the rebound test assess?

assesses the ability to regulate muscle activity and is used to evaluate coordination and control, particularly for detecting cerebellar dysfunction.

what tests can be made to assess dysdiadochokinesia?

• finger to nose

• alternative nose to finger

• pronation/supination

• knee flexion/extension

• walking, alter speed or direction

what tests can be made to assess dysmetria?

• pointing and past pointing

• drawing a circle or figure eight

• heel on chin

• placing feet on floor markers, sitting, standing

what tests can you use to assess intention tremor?

• observation during functional activities

• alternate nose to finger

• finger to finger

• finger to therapist’s finger

• toe to examiner’s finger

how might you be able to assess bradykinesia?

• walking, observation of arm swing and trunk motions

• walking, alter speed and direction

• request that a movement or gait activity be stopped abruptly

• observation of function activities, timed tests

what tests can be used to assess dyssynergia?

• finger to nose

• finger to therapist’s finger

• alternate heel to knee

• toe to examiner’s finger

what can tandem gait be used to assess?

ataxia