Exercise for coordination

Coordination or coordinated movement : is the ability to execute smooth ,accurate, controlled motor responses Coordinated movement is characterized by appropriate speed,distance,direction ,timing,and muscular tension Involves appropriate synergistic influence ,easy reversal between opposing muscle groups,and proximal fixation to allow distal motion or to maintain posture

Coordination deficits

In CNS involvement includes

Traumatic brain injury Parkinsonism Multiple sclerosis Cerebral palsy Cerebrellar tumors Vestibular pathology

Clinical features of cerebrallar dysfunction

Hypotonia : reduced muscle tension below resting level Dysmetria: Impaired ability to judge the distance or ROM Tremor-(intension and postural tremor) An involuntary oscillatory movement

 Movement decomposition: (dyssynergia)

performance of movement in a sequence of component parts rather than in single smooth activity

Disorder of gait Dysarthria disorder in speech articulation (scanning speech) Nystagmus: rhythmic,oscillatory movement of the eyes

Clinical features of lesion to basal ganglia

Bradykinesia: Abnormal slow movts Rigidity:increase in muscle tone-causing greater
resistance to passive movt (lead pipe & cogwheel)

Tremor-resting tremor Akinesia inability to initiate movt Chorea-involuntary,rapid,irregular,jerky movts Athetosis: slow involuntary movts twisting
wormlike movt

Dystonia-impaired or decreased tonicity

Purpose of performing coordination

assessment
Determine muscle activity characteristic during voluntary movement Assess the ability of muscle or muscle group to work together to perform a task or functional activity
Determine the level of skill and efficiency of movement

 Identify the ability to initiate ,control,and terminate action .

Determine the timing ,sequencing ,and accuracy of movement patterns. Assist with establishing goals the diagnosis of underlying impairments, functional limitations,and disability. Assist with establishing goals to remediate impairments,formulating outcomes

 Determine effects of therapeutic and pharmacological intervention on motor function over time
Assist with determining prognosis.

Assessment
Level or skill in activity The occurrence of extraneous movements, oscillation ,swaying or unsteadiness. Number of extremity involved

Distribution of coordination impairment (proximal or distal)

 Situation that alters the coordination deficit Amount of time required to perform an activity Level of safety

History of any fall

Coordination Two main categories

Gross motor activity Assessment of body posture Balance Extremity movt concerned with large muscle E.g- 1.crawling, 2.kneeling 3.Standing ,4.walking ,5.running Fine motor activity Assessment of Extremity movt concerned with 1.small muscle E.g 1. buttoning 2. Writing 3. Manipulating small object

Co-ordination sub divided into

Non equilibrium Finger to nose Finger to therapist finger Finger to finger Alternate nose to finger Finger opposition Mass grasp Pronation /Supination Tapping (hand)

Nonequilibrium

Tapping foot Alternate heel to knee ;heel to toe Toe to examiners finger Heel to shin Drawing a circle Fixation or position holding

equilibrium Standing in normal comfortable posture Standing feet together Standing with one foot directly in front of the other Standing on one foot Arm position altered in each posture Displace balance unexpectedly Standing alternate between forward trunk flexion and return to neutral position Standing with eye open and closed ability to maintain posture referred as positive Romberg test

Standing in tandem position with eye open to eye closed (sharpened Romberg test) Walking,placing the heel of one foot directly in front of the toe of opposite foot (tandem walking ) Walking in straight line drawn Walking sideways, backward ,or cross stepping

March in place
Step over or around obstacle Stair climbing with or without handrail

Sequence for Training Neuromuscular Control obtain relaxation of all muscles that show a reflex hypertonic The patient is instructed to think about the motion while that motion is carried out passively by the therapist in order that the patient may feel the sensations produced

EXERCISE FOR CO - ORDINATION FRENKELS EXERCISES The process of learning this alternative method of control is similar to that required to learn any new exercise, the essential being: Concentration of the attention. Precision Repetition.

PRINCIPLES AND TECHNIQUE

The patient is positioned and suitably clothed so that he can see the limbs throughout the exercise

A concise explanation and demonstration of the exercise is given before movement is attempted, to give the patient a clear mental picture of it