Coordination Exercises

Original Editor - Rewan Aloush

Top Contributors - Rewan Aloush, Lucinda hampton, Joseph Olamide, Kim Jackson, Rachael Lowe, Joao Costa, Leana Louw, Amanda Ager and Lauren Lopez  

Introduction

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The definition of coordination exercises is the ability to execute smooth, accurate, controlled motor responses (optimal interaction of muscle function).

• Coordination is the ability to select the right muscle at the right time with proper intensity to achieve proper action.
• Coordinated movement is characterized by appropriate speed, distance, direction, timing and muscular tension.
• It is the process that results in activation of motor units of multiple muscles with simultaneous inhibition of all other muscles in order to carry out a desired activity.

The cerebellum is the primary centre in the brain for coordination for movement and the ability to execute smooth accurate motor response depends on:

• Deep sensations.
• Vision.
• Vestibular system and cerebellum.
• Motor system.
• Flexibility and ROM.

Components of Coordinated Movement

Coordinated movement is dependent on:

• Volition: is the ability to initiate,maintain or stop an activity or motion.

• Perception:in tact proprioception and subcortical centres to integrate motor impulses and the sensory feedback. When proprioception is affected it is compensated with visual feedback.

• Engramformation:is the neurologica lmuscular activity developed in the extrapyramidal system. Research proved that high repetitions of precise performance must be performed in order to develop an engram.

Types of Coordination

Motor coordination to complete a task a collaboration of three skills:

1. Fine Motor Skills
   • Require coordinated movement of small muscles (hands, face).
   • Examples: include writing, drawing, buttoning a shirt, blowing bubbles
2. Gross Motor Skills
   • Require coordinated movement of large muscles or groups of muscles (trunk, extremities).
   • Examples: include walking, running, lifting activities.
3. 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.

Causes of Coordination Impairments

1. Injury, disease, lesion of cerebellum and basal ganglia (ataxia, parkinsonism)
2. Alcohol/drug intoxication
3. Poisoning
4. Infectious diseases

Examples of Coordination Tests

In the Upper Limb

In the following tests, you will be looking for signs of Intention tremors and Decomposition of movements or Dysmetria: in the form of hypermetria or hypometria

• Finger-to-nose test - The shoulder is abducted to 90^o with the elbow extended, the patient is asked to bring tip of the index finger to the tip of nose.Finger to therapist finger: the patient and the therapist site opposite to each other, the therapist index finger is held in front of the patient, the patient is asked to touch the tip of the index finger to the therapist index finger.

• 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

• Finger-to-doctor's finger test - the patient alternately touch the tip of the nose and the tip of the therapist's finger with the index finger.

• Adiadokokinesia or dysdiadokokinesia - The patient asked to do rapidly alternating movement e.g. forearm supination and pronation, hand tapping.

• 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.

• Buttoning and unbuttoning test.

In the Lower Limb

• Heel-to-knee test
• Walking along a straight line. Foot close to foot:In case of cerebellar lesion, there is deviation of gait
• Rom-berg test: Ask the patient to stand with heels together. Swaying or loss of balance occurs while his eyes are open or closed.

General Principles of Coordination Exercises Involve

1. Constant repetition of a few motor activities
2. Use of sensory cues (tactile, visual,proprioceptive) to enhance motor performance
3. Increase of speed of the activity over time
4. Activities are broken down into components that are simple enough to be performed correctly.
5. Assistance is provided when ever necessary.
6. The patient there fore should have a short rest after two or three repetitions,to avoid fatigue.
7. High repetition of precise performance must be performed for the engram to form.
8. When ever a new movement is trained, various inputs are given, like instruction(auditory), sensory stimulation(touch) ,or positions in which the patient can view the movement (visual stimulation) to enhance motor performance.

Therapeutic Exercises Used to Improve Coordination

There are several interventions that can be utilised to improve coordination, such as:

1. Frenkel’s Exercises
2. Proprioceptive Neuromuscular Facilitation
3. Neurophysiological Basis of Developmental Techniques
4. Sensory Integrative Therapy

Frenkel's Exercises

Frenkel aimed at establishing voluntary control of movement by the use of any part of the sensory mechanism which remained intact, notably sight, sound and touch, to compensate for the loss of kinaesthetic sensation.

The process of learning this alternative method of control is similar to that required to learn any new exercise, the essentials being: Concentration of the attention, Precision and Repetition

The ultimate aim is to establish control of movement so that the patient is able and confident in his ability to carry out these activities which are essential for independence in everyday life. 

Frenkel’s Exercises Principles :

• Start unilateral then bilateral.
• Start fast then slow movement.
• Start by proximal then by distal joints.
• Start by symmetrical then asymmetrical movement.
• The patient must see the movements and verbal feedback is very important.

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 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 should be rhythmic through counting.
• The exercise must be repeated many times until it is perfect and easy.
• Frequent rest periods must be allowed between exercise to prevent fatigue The patient retains little or no ability to recognize fatigue
• Progression is made by altering:

1. speed of exercise: quick movements require less control than slow ones.
2. range of exercise: Wide range of movements, in which large joints are used.
3. complexity of the exercise: exercise should be starting with very simple movements and gradually advance to more complicated ones.

Frenkel's Exercises from Supine

• Flex and extend one leg by the heel sliding down a straight line on the table.Abduct and adduct hip smoothly with knee bent and heel on the table.Abduct and adduct leg with knee and hip extended by sliding the whole leg on the table .Flex and extend hip and knee with heel off the table .
• Flex and extend both legs together with the heel sliding on the table.
• Flex one leg while extending the other.Flex and extend one leg while taking the other leg into abduction and adduction.

Frenkle's Exercises for the Legs in Sitting

One leg is stretched to slide the heel to a position indicated by a mark on the floor. The alternate leg is lifted to place the heel on the marked point. From stride sitting posture patient is asked to stand and then sit .Rise and sit with knees together.

Frenkle's Exercises for the Legs in Standing

In stride standing weight is transferred from one foot to other.Place foot forward and backward on straight line.

Equilibrium Coordination Tests

• Standing in a normal comfortable posture.
• Standing with feet together (narrow base of support)
• Standing with one foot exactly in front of the other in tendon (toe of one foot touching heed of opposite foot).
• Standing on one foot.
• Arm position may be altered in each of the above postures (that is arm at sides, over head, hands on waist) .
• Displace balance unexpectedly (with carefully guarding patient).
• Standing and then alternate between forward trunk flexion and return to neutral.
• Standing with trunk laterally flexed to each side .
• Standing to test the ability to maintain an upright posture without visual feedback.
• Standing in tandem position from eyes open to eyes closed.

Instrumentation Used to Assess Coordination

Mechanical test Instrumentation used to assess coordination Pivot turning mat Frenkle's mat Side turning mat.

Resources

Frenkle's exercise

Balance & Coordination Exercises

References:

1- Alan Davis, slideplayer.com, http://slideplayer.com/slide/4638093/, accessed 17 Aug 2017