Coordination Examination

Coordination Examination
Overview of Motor System
Motor Cortex
Descending Motor Pathways
Cerebellum
Basal Ganglia
Dorsal-Column-Medial Lemniscal Pathway
Feats. Coordination Impairments
Cerebellar Pathology
Basal Ganglia Pathology
Dorsal Column-Medial Lemniscal Pathology
Age-Related Changes Impacting Coordinated Movement
Screening
Examples of Screenings
ROM
Strength
Sensation
Feats. Coordination Tests
Gross & Fine Motor Movements
Nonequilibrium & Equilibrium (Bal) Tests
Motor Task Requirements
Movement Capabilities
Motor Task Requirements & Movement Capabilities Addressed During Examination of Coordination
Preparation for Administering Coordination Exam
Testing Environment
Pt. Preparation
Preliminary Observation
Coordination Exam
Recording Test Results
Table 7.3: Nonequilibrium Coordination Tests p. 212:
1. Finger-to-nose
2. Finger-to-PT's finger
3. Finger-to-finger
4. Alternate nose-to-finger
5. Finger Opposition
6. Mass Grasp
7. Pronation/Supination
8. Rebound test
9. Tapping (hand)
10. Tapping (foot)
11. Point & Past Pointing
12. Alternate heel-to-knee; heel-to-toe
13. Toe to PT's finger
14. Heel on shin
15. Drawing a circle
16. Fixation or Position Holding
Box 7.3 Equilibrium Coordination Tests p. 213
1. standing, comfortable posture with normal BOS
2. standing, feet together (narrow BOS)
3. standing in tandem position
4. standing on 1 foot
5. arm position may be altered in each of the above postures
6. perturbations: displays balance unexpectedly ( while carefully guarding pt)
7. standing, functional reach: forward trunk flexion with UE reach
8. standing, lateral flex trunk to each side
9. standing: eyes open to eyes closed; inability to maintain upright posture without visual input= positive Romberg sign
10. standing in tandem position eyes open to eyes closed (Sharpened Romberg)
11. tandem walking
12. walking along straight line drawn or tape to floor, or place feet on four markers while walking
13. walk sideways, backwards, or cross stepping
14. March in place
15. alter speed of ambulatory activities; observed pt. Walking at normal speed, as fast as possible & as low as possible
16. stop & start abruptly on command while walking
17. walk & pivot on command (90, 180, 360°)
18. walk in a circle, alternate directions
19. walk on heels or toes
20. walk with horizontal & vertical head turned on command
21. step over or around obstacles
22. stairclimbing with & without using hand rail; 1 step at a time, step overstep
23. jumping jacks
24. sitting on TherEx ball; alternate flexing & extending these (Chordata movement with upright balance)
Table 7.4 Sample Tests for Selected Coordination Impairments: p. 214
Dysdiadochokinesia
• Finger to nose
• Alt nose-to-finger
• Pronation/supination
• Knee flx/ext
• Walking, alter speed or direction
Dysmetria
• Pointing & past pointing
• Join a circle or figure 8
• Heel on shin
• Placing feet on floor markers; sitting, standing
Dyssynergia
• Finger to nose
• Finger to PT’s finger
• Alternate heel to me
• Toe to PT’s finger
Hypotonia
• Passive movement
• DTRs
Tremor (intention)
• Observation during functional activities (tremor will typically increase as target is approached him movement speed increase)
• Alternate nose to finger
• Finger to finger
• Finger to PTs finger
• Toe to PTs finger
Tremor (resting)
• Observation of patient at rest; limb or jaw movements
• Observation during functional activities (tremor will diminish significantly/disappear with movement)
Tremor (postural)
• Observation of steadiness abnormal posture; sitting, standing
Asthenia
• Fixation or position holding (UE & LE))
• Application of manual resistance to determine ability to hold
Rigidity
• Passive movement
• Observation during functional activities
• Observation of resting posture(s)
Bradykinesia
• Walking, observation of arm swing & trunk motions
• Walking, alter speed & direction
• Request that a movement or gate activity be stopped abruptly
• Observation of functional activities: timed tests
Disturbances of Posture
• Fixation or position holding (UE & LE)
• Displace balance unexpectedly in sitting or standing (perturbations)
• Standing, altar BOS
Disturbances of Gait
• Walking along a straight line
• Walk sideways, backwards
• March in place
• Alter speed & direction of ambulatory activities
• Walk in a circle
Quantitative Coordination Testing & Specialized Testing Instruments
CATSYS System
Postural Sway Analyzer
Choice Reaction Time Analyzer
Dynamic Posturography
Standardized Instruments: UE Coordination
9