1. PHT 1261C Tests and Measurements Dr. Kane
Coordination
PHT 1261C Tests and Measurements
Dr. Kane

2. Definitions
Motor Control
Coordination
Dexterity
Agility

3. Types of Coordination Intralimb Interlimb Visual Motor Eye- hand
Eye-hand-head

4. Purposes of Coordination Examination
Determine muscle activity characteristics during voluntary movement
Determine ability of muscles or groups of muscles to work together to perform a task
Determine level of skill & efficiency of movement
Determine ability to initiate, control & terminate movement
Timing, sequencing, & accuracy of movement patterns
Effects of therapeutic & pharmacological intervention on motor function over time

5. Other Purposes
Assists with establishing diagnosis of underlying impairments, functional limitations, & disability.
Assists with establishing anticipated goals to remediate impairments
Assists with formulating expected outcomes to remediate functional limitations and disability
Support decision making in establishing prognosis & determining specific, direct interventions

6. Motor System Peripheral Element Central Element
Muscles & joints & sensory & motor innervation
Central Element
Neocortex and basal ganglia – strategy; goal of movement & strategy to help her win
Motor Cortex and cerebellum – tactics; how do we plan out achieving that goal
Brain Stem and Spinal cord – execution; carry out movement plan & make adjustments as needed

7. Motor Cortex Brodmann’s (cortical) area 4 Brodmann’s (cortical) area 6
Precentral gyrus; Primary Motor Cortex (PMC)
Largest concentration of corticospinal neurons
Controls contralateral voluntary movements; single joint motion
Brodmann’s (cortical) area 6
Anterior to area 4;
Supplementary Motor Area (SMA) – axons that directly innervate motor units involved in initiation of movement, simultaneous B grasping, sequential tasks, orientation of eyes & head
Premotor Area (PMA) – input to reticulospinal neurons that innervate motor units that control trunk & proximal limb; anticipatory postural changes; multiple joints; intricate motions

8. Motor Cortex - continued
SMA & PMA arranged like motor homunculus
Motor Cortex receives information from:
Somatosensory cortex – peripheral receptor fields; via thalamus
Cerebellum
Basal Ganglia

9. Descending Motor Pathways
Corticospinal (pyramidal) Tracts
From Areas 4 & 6 directly to spinal cord
Cross to opposite side in medulla
Skilled, fine motor control distal limbs
Corticobulbar Tract
Motor cranial nerves
Tectospinal Tract
Motor neurons in cervical spinal cord; head motions during visual motor tasks

10. Descending Motor Pathways (continued)
Reticulospinal Tract (medial & lateral)
Anterior horn of SC: muscle tone & reflex activity
Important influence on posture and gait
Vestibulospinal Tract (medial & lateral)
Postural control & head movements
Coordinated head & eye movements
Rubrospinal Tract
Merges with corticospinal tract; insignificant function

11. Cerebellum Regulation of movement, postural control & muscle tone
Comparator & error-correcting mechanism
Feed forward control; closed loop system

12. Basal Ganglia Caudate nucleus, putamen, globus pallidus;
Also includes subthalamic nucleus and substantia nigra
Initiation & regulation of gross intentional movement
Planning & execution of complex motor responses
Facilitation of desired motor responses (inhibiting others)
Ability to accomplish automatic movements & postural adjustments

13. Dorsal Column Medial Lemniscal Pathway
Responsible for afferent transmission of discriminatory sensations
Discriminative touch, stereognosis, tactile pressure, barognosis, graphesthesia, texture recognition, kinesthesia, 2 point discrimination, proprioception, vibration

14. Coordination Impairments – Cerebellar Pathology
See table 7.1 page 200
Ataxia
Dysarthria (scanning speech)
Dysdiadochokinesia
Dysmetria (hyper or hypometria)
Dyssynergia (movement decomposition)
Asynergia
Gait Ataxia
Hypotonia
Nystagmus
Rebound Phenomenon
Tremor
Intention/kinetic
Postural/static
Titubation
Delayed reaction time
Difficulty in changing force, speed, or direction of movement

15. Basal Ganglia Pathology
Poverty & slowness of movement
Involuntary extraneous movement
Alterations in muscle tone and posture
Akinesia – freezing
Athetosis – distal UE
Bradykinesia
Chorea – UE
Choreoathetosis
Dystonia
Hemiballismus
Hyperkinesis/hypokinesis
Rigidity
Lead pipe
Cogwheel
Resting tremors

16. Dorsal Column Medial Lemniscal Pathology
Less characteristic
Lack of joint position sense
Lack of awareness of movement
Impaired localized touch sensation
Gait abnormalities
Dysmetria
Decreased fine motor skills
Positive Romberg's sign

17. Screenings Prior to Coordination Exam
Purpose:
Determine need for further/more detailed exam
Rule out or differentiate specific system involvement
Determine need for referral to another health care professional
Focus search for origin of symptoms to a specific body part
Identify system related impairments that contribute to functional limitations or disability
Determine which specific tests & measurements are needed for examination

18. Screening ROM –active; grossly functional; WFL; WNL
Strength – not specific testing positions
Sensation – superficial, deep, combined

19. Coordination Tests Gross Motor Movements Fine Motor Movements
Posture, balance, large muscle extremity movements
Crawling, kneeling, standing, walking, running
Fine Motor Movements
Small muscle groups that involve skillful controlled manipulation of objects
Finger dexterity – buttons, typing, handwriting

20. Coordination Tests - continued
Nonequilibrium tests
Static and mobile components of movement while sitting (gross and fine motor)
Equilibrium Tests (balance or postural stability)
Static and dynamic components of posture and balance in standing (primarily gross motor)

21. Motor Task Requirements
Mobility
Stability (static postural control)
Controlled Mobility (dynamic postural control)
Static dynamic control
Skill

22. Areas of Movement Capabilities
Alternate or reciprocal motion
Movement composition (synergy)
Movement accuracy
Fixation or limb holding
Equilibrium (postural stability)

23. Preparation for Coordination Exam
Testing Environment
Patient Preparation
Preliminary Observation
Gait Analysis (or observation)

24. Coordination Examination
Non-Equilibrium Tests – see Table 7.3 page 212
16 tests
Equilibrium Tests – see Box 7.3 page 213.
24 tests

25. Basic Balance Tests Double limb stance Single Limb Stance
Tandem Stance
Romberg test
Sit to stand (STS)
Sit Down (SIT)
Reaching Movements
Turning
Step ups
Walking – with turns, timed, with head motions, stop/start

26. Grading Basic Balance Tests
See Table 8.9 page 254 O’Sullivan
Normal
Good
Fair
Poor

27. Standardized Balance Testing (O’Sullivan pp. 254-259)
Berg Balance Test
Tinetti POMA
Timed up and Go (TUG)/Get up and GO (GUG)
Romberg Test
Functional Reach Test/ Multidirectional Reach Test
Timed Walking Test
Balance Efficacy Scale (BES)