Co-ordination Exercise,Definitions,Nervous control,Motor pathway,Cerebral cortex,Kinesthetic sensation,Causes of Incoordination,Flaccidity Spasticity ,Cerebellar ataxia,Loss of kinesthetic sensation,Types of coordination,Posterior column,Test for Incoordination.

1. CO-ORDINATION EXERCISE

5. Definitions
 It is the ability to perform smooth, accurate
and controlled movements.
 Coordination is the ability to select the right
muscle at the right time with proper intensity to
achieve proper action.
 Co- ordinate movement, which is smooth,
accurate and purposeful activity is performed by
the integrated action of many muscles.
 Lack of coordination is said to be incoordination
or asynergia.
 Incoordination is the jerky, inaccurate non-
purposeful movement done by the group of
muscles.

7. Nervous control
 Motor pathway
 Cerebral cortex
 Cerebellum
 Kinesthetic sensation

8. Motor pathway
 The action of each muscle group is
determined by the afferent impulses which
reach it by the motor pathways.

9. Cerebral cortex
 Voluntary movement is usually, if not in
variably, initiated in response to some
sensory stimulus.
 Cerebral is responsible for planning the
patterns of movement.
 This plan is based on memories of patterns
used on previous occasions.

10. Cerebellum
 The cerebellum is the primary center in the
brain for coordination of movement.
 The cerebellum is a receiving station of
information which reaches it by the afferent
pathways conveying impulses of kinesthetic
sensation from the periphery and from the
other parts of the brain including cerebral
cortex and vestibular action.

11. Kinesthetic sensation
 The afferent impulses of kinesthetic
sensation arise from proprioceptors situated
in muscles, tendons and joints.
 They record contraction or stretching of
muscle and the knowledge of movement and
position of the limbs.

12. Causes of Incoordination
 Flaccidity
 Spasticity
 Cerebellar ataxia
 Loss of kinesthetic sensation

13. Flaccidity
 Any of the lower motor lesion results in the
flaccidity.
 In this case the nerve impulses cut off before
reaching the muscles.
 Muscles said to be paralyzed and are
otherwise called as atonic muscles.

16. Spasticity
 Upper motor neuron lesion results in
spasticity.
 Tone of the muscle is more.
 Muscles are tight and contracted.
 Spasticity never occurs in one group of
muscles
 It is always part of total flexors or total
extensor synergy.

20. Cerebellar ataxia
 Cerebellar lesion results in incoordinated
movements.
 Normally, the muscles are hypotonic.
 There will be “ ataxic ” type of gait.

21.  Ataxia is the most common term used to
describe motor impairments of cerebellar
origin. Ataxia may affect gait, posture, and
patterns of movement and is linked to
difficulty initiating movement as well as
errors in the rate, rhythm, and timing of
responses.

22.  Dysarthria is a disorder of the motor
component of speech articulation.The
characteristics of cerebellar dysarthria are
referred to as scanning speech (one word at a
time).

23.  Dysdiadochokinesia is an impaired ability to
perform rapid alternating movements.
Movements are irregular, with a rapid loss of
range and rhythm especially as speed is
increased.

24.  Dysmetria is an inability to judge the distance
or range of a movement. It may be
manifested by an overestimation
(hypermetria) or an underestimation
(hypometria) of the required range needed to
reach an object.

25.  Nystagmus is a rhythmic, quick, oscillatory,
back-and-forth movement of the eyes.

26.  Tremor is an involuntary oscillatory
movement resulting from alternate
contractions of opposing muscle groups.
 An intention or kinetic tremor occurs during
voluntary motion of a limb and tends to
increase as the limb nears its intended goal or
speed is increased.
 Postural or Static tremor may be evident by
back-and-forth oscillatory movements of the
body while the patient maintains a standing
posture

27. Loss of kinesthetic sensation
 Loss 0f kinesthetic sensation seen in the
neuropathic joints.
 These types of joints are called as Charot’s
joints.
 This variety is seen in:
 Tabes dorsalis
 Syringomyelia
 Leprosy
 Diabetes Mellitus

28. Types of coordination:
 Fine motor skills:
 Require coordinated movement of small muscles (hands,
face).
 Examples: include writing, drawing, buttoning a shirt,
blowing bubbles
 Gross motor skills:
 Require coordinated movement of large muscles or
groups of muscles (trunk, extremities).
 Examples: include walking, running, lifting activities.
 Hand-eye skills:
 The ability of the visual system to coordinate visual
information. Received and then control or direct the
hands in the accomplishment of a task .
 Examples : include catching a ball, sewing, computer
mouse use.

30. Posterior column

33. Test for Incoordination

34.  Upper Limb
 Finger nose test
 Finger to finger test
 Rapid alternating movement
 Lower Limb
 FingerToeTest
 Heel-ShinTest
 Romberg’sTest

35. Finger nose test
 The patient is asked to touch the tip of the
index finger of the one hand and the nose
alternatively with the index finger of another
hand.
 In cerebellar disease, the patient touches the
nose with wavy and oscillatory motion.
 In posterior column disease, the patient can
touch the nose accurately with eye opening
but he cannot with closed eyes.

36. Finger to finger test
 Both shoulders are abducted to bring both
the elbow extended, the patient is asked to
bring both the hand toward the midline and
approximate the index finger from opposing
hand.

37. Rapid alternating movement
 The patient asked to do rapidly alternating
movement e.g. forearm supination and
pronation, hand tapping.
 In cerebellar lesion the patient feels difficulty
in performing this movement, this
phenomena is called as dysdiadochokinesia.

38. Rebound phenomena
 The patient with his elbow fixed, flex it
against resistance.
 When the resistance is suddenly released the
patient's forearm flies upward and may hit his
face or shoulder.

39. Finger Toe Test
 The therapist’s finger is pointed two feet
above the patient’s great toe and instructs
him to touch with the great toe.

40. Heel-shin Test
 Patient’s is asked to touch the knee with the
opposite side heel and is sliding on the shin
towards the great toe.
 Same test is asked to the patient to perform
without rubbing on the skin.

41. Rhomberg’s Test
 Patient is made to stand straight with the
eyes opened.
 Then the patient is instructed to shut the eyes
 Patient may begin to sway and may even fall
if he is not supported, it occurs the patient
with posterior column disease.