Phys Assess
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| _____ is the ability to execute smooth accurate controlled motor responses | coordination
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| what type of input is coordination dependent on | visual, somatosensory, vestibular input (think of the three things that the balance/biodex tested). you also need a fully intact neuromuscular system.
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| what two terms are often associated with coordination? | AGILITY (gross motor, rapid + smoothly control movement while maintaining postural control) + DEXTERITY (fine motor tasks)
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| whats INTRALIMB coordination vs INTERLIMB? | intra- single limb use (brushing teeth), interlimb- double limb use- (walking/transfers)
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| whats the PT term for "hand-eye coordination?" | visual motor coordination -integrate vision and motor abilities with the enviro (type notes from slide, riding bicycle), eat, use utensils, reach for something of shelf
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| what does a coordination prob typical signify? | some type of CNS pathology
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| the motor system can be grossly divided into peripheral and central elements. briefly describe what each do | peripheral- includes motor +sensory innervation of mm and joints. central is further divided into 3 HIERARCHICAL levels (1. neocortex + basal ganglia, 2. motor cortex + cerebellum, 3. brain stem + spinal cord
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| what is the NEOCORTEX + BASAL GANGLIA concerned with in the motor system? | STRATEGY
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| what is the MOTOR CORTEX + CEREBELLUM concerned with in the motor system? | TACTICS (sequencing + timing)
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| what is the BRAIN STEM + SPINAL CORD concerned with in the motor system? | EXECUTION
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| how do you rule out sensory impairments as a contributing factor to coordination impairments? | by testing sensory BEFORE the coordination exam
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| what is the principle area involved in motor function in the MOTOR CORTEX? | bordmann's (aka cortical) areas 4 + 6 (in the forntal lobe, just anterior to the central sulcus).
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| what is the difference btwn area 4 + 6? | 4=designated as PRIMARY MOTOR CORTEX , controls contrallateral voluntary movemnts,has the largest concent. of corticospinal neurons. 6 is ant. to 4 + is subdivded into SUPPLMENTARY MOTOR AREA (intiating mvmnt/bilat grasp) + PREMOTOR AREA (trunk +limb)
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| area ___ typically results in uncomplcated movements of a SINGLE joint while stimulation to area ___ evokes a more intricate coordinated movement involving MULTIPLE joints. | 4- single joint, uncomplicated
6- multiple, intricate movment
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| who does the motor cortex recieve info from? (3 primary areas) | somatosensory cortex, cerebellum, and basal ganglia. (the THALAMUS is the major relay center for all 3!)
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| corticospinal pathway: what/where? | aka pyramidal. from motor cortex (4+ 6) to spinal cord= SKILLED FINE MOTOR OF DISTAL LIBMS. longest and largest CNS tract! MOST fibers cross @ medulla to descend contralaterally. others eventually cross at cervical or upper thoracic regions.
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| corticobulbar pathway: what/where? | pathway from motor cortex directly to CN 5, 7, 12 nuclei
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| tectospinal pathway: what/where? | (aka colliculospinal tract)fibers from midbrain to contralateral muscles in CERVICAL region. GUIDES HEAD MOVMENT
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| reticulospinal pathway: what/where? | brainstem to ant horn of spinal cord. impt in REFLEX ACTIVITY @ SPINAL CORD LVL via MUSCLE SPINDLE ACTIVITY!
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| vestibulospinal pathway: what/where? | descend to all levels of spinal cord, postural control and coordinate head and eye movments.
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| where are the three places that coordination impairments come from? | cerebellum basal ganglia and the ASCENDING dorsal column medial leminscal pathway
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| what does the cerebellum do? | REGULATION of movmt, postural control, mm tone. The “compartor” compares plans of intended movement from motor cortex with actual performance of segment. CORRECTIVE INFLUENCE. Feed forward control.
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| give examples of the cerebellar closed loop vs open loop? | o Closed loop: utilizes all levels of input, modifies
o Open loop: no time for feedback, preprogramed memory. Like gait
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| what are some typical impairments a result of cerebellar pathlogy? | o Decreased motor fx, uncoordinated movments, mm tone off
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| o Ataxia | general term for motor impairment of cerebellum. Uncoordinated. Loss of motor coordination. Ataixic gait: uncoordinated gait
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| o Asthenia | generalized mm weakness (in latin, asthenēs means weak)
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| o Dysarthria: | motor speech dysfunction (articulation), scanning speech)('dys' meaning 'difficult or painful'; 'arthr' meaning 'articulating' 'ia' means condition of)
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| o Dysdiadochokinesia | impaired ability to perform rapid alternating movment. from Greek dys "bad", diadocho "receive", kinesia "movement"),
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| o Dysmetria | inability to judge distance or range of movement
Overreaching! Esp after final destination has changed.
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| Dyssynergia | Failure of parts of the anatomy to work together correctly.movement performed in a sequence of component parts rather than as a single smooth activity. decomposition.
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| o Asynergia | loss of ability to associate mm together for complex movments
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| o Gait ataxia | wide BOS, arms out, upright posture, staggering
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| o Rebound phenomenon | loss of check reflex, pt unable to stop sudden limb motion and will hit themself
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| o Tremor: | involuntary oscillatory movement due to alternate contractions of opposing mm groups
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| intention/kinetic tremor vs postural/static tremor | Intention (tremor when u try to do something) vs postural (static-resting/all the time)
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| what is the Basal Ganglia's role in coordination | • Initiation of movement and regulating gross movments. Facilitates desired responses, inhibited unwanted moment.
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| what are the characteristics of basal ganglia pathology? | oInvoluntary, EXTRANEOUS movment, slow, atlerations in posture or mm tone.
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| o Akinesia | inability to initate movments, associated with fixed postures
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| Athetosis | slow involuntary writhing, twisting WORMLIKE movments. from Gk. athetos "not fixed, without position or place"
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| o Bradykinesia | decreased amplitude and velocity of voluntary movement (shuffling gait ex) parkinsons pts will have this
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| o Chorea | rapid, abnormal gait/involuntary movments, brief, purposeless, sudden, jerk rhythmic, series, complex movements. “huntingtons chorea” ("dance", from Greek khoreia)
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| o Choreoathetosis | movemt disorder with features of both chorea + athetosis
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| o Hemiballisumus | large amp sudden, violent, flailing motions
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| o Rigidity: | ↑ mm tone. Leadpipe, cogwheel. Very stiff, ↓ step length.
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| o Tremor | involuntary, rhymic, oscillatory, mainly at REST.
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| what are some characteristics of Dorsal Column pathology? | o Less characteristic than those produced by cerebellear or basal gang
o Coordination and equilibrium Impairments
o Lack of joint position, awareness onf momentum localization touch sensation
o Gait distrubances
o Dysmetira
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| what is a "romberg sign?" | inability to maintain standing balance with the feet together when the eyes are closed
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tpostrel
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