Coordination tests

Introduction

• Coordination :-
 It Is The Ability to execute Smooth,
accurate controlled movements.
Purposes of Performing a coordination examination

 Muscle Activity Characteristics During Voluntary Movement

 Ability of Muscles or Groups of Muscles to Work Together to Perform

a task or Functional activity
 Level of Skill and efficiency of movement

 Ability to initiate,control, and Terminate movement

 Timing,sequencing,and accuracy of movement

patterns

 Effects of the therapeutic intervention on motor

function over time
ADMINISTERING THE COORDINATION EXAMINATION

1. Preparation

• Testing Environment

• Patient Preparation

• Preliminary Observation

2. Examination
 Grading for Nonequilibrum Coordination Tests

4. Normal performance

3. Minimal impairment – Able to accomplish

activity,slightly less than normal control,speed, and steadines

2. Moderate impairment, Able to accomplish

activity, movement are slow and unsteady
1.Severe impairment,Able only to initiate activity without
completion,movements are slow with significant
unsteadiness,oscillation,and/or extraneous movements

0. Activity impossible
NONEQULIBRIUM COORDINATION
TESTS
Finger-to-nose
Finger-to-therapist finger
Finger-to-finger
Alternate nose-to-finger
Finger opposition
 Mass Grasp
• An alternation is made between opening and closing fist
(from finger flexion to full extension)

• Speed may be Gradually increased

Pronation/supination
Rebound test
Tapping (hand)
Tapping (foot)
Pointing and past pointing
Alternate heel-to-knee,heel-to-toe
Toe to examiner’s finger
Heel on Shin
 Drawing a circle

• The patient draws an imaginary circle in the air

with upper extremity or lower extremity

• Also done using a figure-eight pattern

 Fixation or position holding

1. UE – The patient holds arms horizontally in

front (sitting or standing)

2. LE – The patient is asked to hold the knee in

an extended position (sitting)
Grading for postural Control And Balance Tests

4. NORMAL : Able to maintain steady balance without

handhold support (static)
- Accepts maximal challenge and can shift weight easily
within full range in all directions (dynamic)

3. GOOD : Able to maintain balance without handhold

support, limited postural sway (static)
- Accept moderate challenge;able to maintain balance while
picking object off floor (dynamic)
2. FAIR : Able to maintain balance with handhold
support;may require occasional minimal assistance (static)
- Accepts minimal challenge;Able to maintain balance while
turning head/trunk (dynamic)

1. POOR : Requires handhold support and moderate to

maxima assistance to maintain position (static)
- Unable to accept challenge or move without loss of
balance (dynamic)

0. ABSENT : Unable to maintain balance

 BALANCE TEST

1. Sitting
2. Standing
3. walking
Sitting
Sitting in normal comfortable position
Sitting, weight shifting in all directions
Sitting, multidirectional functional reach
Sitting picking an object up off floor
Standing
Standing in normal comfortable posture
Standing, feet together(narrow base of support)
Standing on one foot
Standing,with one foot directly in front of the
other(tandem position)
Standing, eyes open to eyes closed (Romberg test)
Standing, in tandem position eyes open to eyes closed
(Sharpenend Romberg Test)
Standing, multi directional functional reach
Toe Standing
Heel Standing
One leg standing
Walking
 WALKING
• Walking, placing foot on a floor markes

• Walk : Side to side

• Walk : Backwards

• Walk : Forwards

• Walk : Cross-steeping
• Walk: in a circle, alternate directions

• Walk: on heels

• Walk: on toes

• March in place

• Walk with horizontal and vertical head turns

• Step over or around obstacles

• Stair climbing with handrail

• Stair climbing without handrail

• Stair clumbing: one step at a time

• Stair climbing: step-over-step

MANAGEMENT
• The procees of learning this alternative method of control is
simmiler to that required to lear any new exercise, the essentials
being-

A. Concentration of attention
B. Precision
C. repetition
• The ultimate aim is to establish control of movement so that the
patient is able and confident in his ability to carry out those activities
which are essential for independence in everyday life.
 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.
• The patient must give his full attention to the performance of the
exercise to make the movement smooth and accurate.
• The speed of movement is dictated by the physiotherapist by means
of rhythmic counting, movement of her hand, or the use of suitable
music.
• The range of movement is indicated by marking the spot on which
the foot or hand is to be placed.
• The exercise must be repeated many times until it is perfect and
easy. It is then discarded and a more difficult one is substituted.
• As these exercises are very tiring at first, frequent rest periods must
be allowed. The patient retains little or no ability to recognise
fatigue, but it is usually indicated by a deterioration in the quality of
the movement, or by a rise in the pulse rate.
 Progression

• Progression is made by altering the speed, range and complexity of

the exercise.
• Fairly quick movements require less control than slow ones.
• Later, alteration in the speed of consecutive movements, and
interruptions which involve stopping and starting to command, are
introduced.
• Wide range and primitive movements, in which large joints are used,
gradually give way to those involving the use of small joints, limited
range and a more frequent alteration of direction.
• Finally simple movements are built up into sequences to form specific
actions which require the use and control of a number of joints and
more than one limb, e.g. Walking
• According to the degree of disability, re-education exercises start in
lying with the head propped up and with the limbs fully supported
and progress is made to exercises in sitting, and then in standing.
 Examples of Frenkel's Exercises
Exercise for the legs in lying

 lying (Head raised) Hip abduction and adduction

 The leg is fully supported throughout on the smooth surface
of a plinth or on a re-education board.
• lying (Head raised) one Hip and Knee flexion and extension.
The heel is supported throughout and slides on the plinth to a
position indicated by the physiotherapist.
• lying (Head raised); one Leg
raising to place Heel on
specified mark-
 The mark
may be made on the plinth, on
the patient’s other foot or shin,
or the heel may be placed in the
palm of the physiotherapist’s
hand.
• lying (Head raised) Hip and Kneeflexion and extension, abduction
and adduction
 The legs may work alternately or in
opposition to each other. Stopping and starting during the course of
the movement may be introduced to increase the control required
to perform any of these exercises.
 Exercise for the legs in sitting
• Sitting- one Leg stretching, to slide Heel to a position indicated by a
mark on the floor.
• Sitting- alternate Leg stretching and lifting to place Heel or Toe on
specified mark.
• Stride sitting-
change to standing and then sit down again.
The feet are drawn back and the trunk inclined forwards from the
hips to get the centre of gravity over the base. The patient then
extends the legs and draws himself up with the help of his hands
grasping the wall-bars or other suitable apparatus.
 Exercise for the legs in standing
• Stride standing :- transference of weight from Foot to Foot.

• Stride standing :- walking sideways placing Feet on marks on the

floor.
Some support may be necessary, but the patient must be able to see
his feet.
• Standing:- walking placing Feet on marks.
The length of the stride can be varied by the physiotherapist
according to the patient’s capacity.
• Standing:- turn round.
If Patients find this difficult and are helped by marks on the floor.
• Standing:- walking and changing direction to avoid obstacles.
 Exercises for the arms

• Sitting:- (one Arm supported on a table or in slings) Shoulder flexion

or extension to place Hand on a specified mark.

• Sitting:- one Am stretching, to thread it through a small hoop or ring.

• Sitting:- picking up objects and putting them down on specified

marks.
• Diversion activities such as building with toy bricks, or drawing on a
blackboard, lead to more useful movements such as using a knife
and fork, doing up buttons and doing the hair.
Exercises to Promote Movement and Rhythm

• All exercises are repeated continuously to a rhythmic count, or to

suitable music.
• Sitting:- one Hip flexion and
adduction (to cross one Thigh
over the other), the movement
is then reversed and repeated.
• Half lying:- one Leg abduction to
bring Knee to side of plinth,
followed by one Knee bending to
put Foot on floor, the movement
is then reversed and repeated.
• Sitting:- lean forward and take
weight on Feet (as if to stand),
then sit down again. Later this
can be done progressing along
the seat as if moving up to make
room for someone else to sit.
• Standing:- Arm swingforwards
and backwards (with partner,
holding two sticks).
• Standing or walking:- bounce and catch, or throw and catch a ball.
Marching to music, ballroom dancing or swimming, if possible,
should be encouraged.
 Reference

• physical rehabilitation susan o'sullivan

• The Principles of Exercise Therapy – by M.

Deena Gardiner
Thank you