The document provides an overview of coordination in terms of muscle functioning and movement management, defining coordination as the smooth and accurate execution of motor responses influenced by various factors. It highlights causes of incoordination, such as muscle weakness or cerebellar lesions, and discusses assessment methods and reeducation principles, including Frenkel's exercises aimed at improving coordinated movement. The exercises emphasize attention, precision, and repetition to aid individuals with coordination deficits in achieving independence in daily activities.

1. Coordination
Dr.Syed

2. Objectives
At the end of this class, you will be able to
•Define coordination
•Explain the factors responsible for coordination
•List out the causes for incoordination.
•Explain the coordination tests.
•Explain the principles of reeducation.
•Describe Frenkel’s exercise.

3. Coordination
• The correct timing and sequencing of muscle firing
combined with the appropriate intensity of muscular
contraction leading to the effective initiation, guiding
and grading of movement.
• Coordination is the basis of smooth, accurate, efficient
movement and occurs at a conscious or automatic level

4. 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.

5. Contd..
• Co-ordinated movement is smooth, accurate and
purposeful brought about by the integrated action of
many muscles, superimposed upon a basis of efficient
postural activity.

6. Action of Muscles
• Muscle group – agonists, antagonist, synergists and
fixators.
• Agonist – produce movement by contracting
• Antagonist - relaxation ands control the movement without
impending.
• Synergists – alter direction of pull, stabilize.
• Fixators – fix the bone of origin or insertion.

7. Nervous control
• Motor pathways – Afferent impulse from muscle or stimulus.
• Cerebral cortex – Planning the pattern of movement based
on previous memories and present impulses. Sends in the
form of efferent.
• Cerebellum – receiving station from afferent and efferent.
Also receives proprioceptive and kinesthetic sensation. Does
the minor alteration and correction.

8. Inco-ordination
• Jerky, arhythmic or inaccurate movement.
• Interference with the function of any one of the factors.

9. Causes
• Weakness or flaccidity of a particular muscle group. Eg:
LMN.
• Spasticity of muscle group. Eg: UMN
• Cerebellar lesion (ataxia)- (without order) – swaying,
irregular or tremor.
• Loss of kinaesthetic sensation (sensory ataxia) – Tabes
Dorsalis.

10. Coordination deficits are common in:
• Traumatic brain injury
• Parkinsonism
• Multiple sclerosis
• Cerebral palsy
• Cerebellar tumors
• Vestibular pathology

11. 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)

12. • Situation that alters the coordination deficit
• Amount of time required to perform an activity
• Level of safety
• History of any fall

13. Co-ordination sub divided into
Non equilibrium tests
 Finger to nose
 Finger to therapist finger
 Finger to finger
 Alternate nose to finger
 Finger opposition
 Mass grasp
 Pronation /Supination
 Tapping (hand)

14. Non equilibrium tests
Tapping foot
Alternate heel to knee ;heel to
toe
Toe to examiners finger
Heel to shin
Drawing a circle
Fixation or position holding

15. Coordination- Non Equilibrium tests

16. Coordination- Non Equilibrium tests

17. Documentation

18. Re - Education
• Use of alternative nervous pathways – If pathways are
blocked – use alternate or stimulate inactive pathways.
Initially difficult then progressively easier.
• Condition of the muscle – prepare the muscle to
receive the coordinating impulses so that their reaction
is as normal as possible.
Weak – strengthen, spastic – stretch.

19. Principles of reeducation
1. Weakness or flaccidity
•Naturally incoordination is avoided by alternate pattern
of movement – trick movement.
•Treatment:
•Improve the muscle power and tone.
•Eg: Slow reversals technique, strength training,
facilitating technique.

20. Contd..
2. Spasticity of Muscles
•Modifies their reaction as they cannot or can only do
with much difficulty. Rhythm is lost.
•Treatment:
•To promote relaxation, to train rhythm and reduce tone.
•Eg: relaxation and stretch

21. Contd..
3. Cerebellar Ataxia
•Loss of coordinating impulses from cerebellum. Lack of
sensory pathway.
•Treatment: make use of available pathway.

22. Contd..
4. Loss of Kinaesthetic Sense
•Loss of Kinaesthetic sensation.
•Treatment:
• stimulate alternate and use of available pathway.

23. • Developed by Dr.H.S.Frenkel
• Tabes dorsalis & in other conditions with
ataxias, MS etc
• Aimed at establishing the voluntary control
of movement by the use of any part of
sensory mechanism which remains intact,
notably sight, sound, touch, to compensate
for the loss of kinesthetic sensation.
Frenkel's Exercise:

24. • The essentials of Frenkel's exercise being:
• Concentration of Attention
• Precision
• Repetition
• The ultimate aim is to establish the control of movement so
that patient is able and confident in his ability to carry out
these activities which are essential for independence in
every day life.
Frenkel's Exercise:

25. 1. The patient is positioned and suitably clothed so that he
can see the limbs throughout.
2. A concise explanation and demonstration of exercise is
given before movement is attempted, to give patient a clear
mental picture of it.
3. The patient must give his full attention to the performance
of exercise to make movement smooth and accurate.
4. The speed of movement is dictated by physiotherapist by
means of rhythmic counting, movement of her hand or the
use of suitable music.
Frenkel's Exercise

26. 5. The range of movement is indicated by making the spot
on which the foot and hand is to be placed.
6. The exercise is repeated many times until it is perfect
and easy. It is then discarded and a more difficult one is
substituted.
7. All these exercises are very tiring at first, frequent rest
periods must be allowed. The patient retains little of no
ability to recognize fatigue, but it is usually indicated by
a deterioration in the quality of movement, or by a rise
in pulse rate.
Frenkel's Exercise

27. Progression
• Altering speed, range and complexity of the exercises.

29. Frenkel's Exercise: