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 Fine motor activity

Assessment of Assessment of
body posture Extremity movt concerned
with
Balance 1.small muscle
Extremity movt E.g
concerned with large muscle 1. buttoning
E.g- 1.crawling, 2.kneeling 2. Writing
3.Standing ,4.walking 3. Manipulating small object
,5.running
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
• FRENKEL’S 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