Lower Limb Motor Coordination

Original Editor - Joseph Olamide

Top Contributors - Joseph Olamide, Chloe Waller, Kim Jackson and Leana Louw  

Introduction

Motor coordination, otherwise referred to as dexterity refers to the ability to perform a motor task in an accurate, rapid and controlled manner (1). The test for motor coordination requires temporal and spatial accuracy (2). Lower limb motor coordination is essential for the performance of most daily motor activities, such as walking, running, ascending/descending stairs, standing from a chair. The effective performance of these tasks are critical for an independent life (2, 3). It is also important for community activities, its limitation may cause people to become housebound and isolated from the society, especially for those who had suffered stroke (4). Motor tasks performed within different contexts require between-limb coordination, which is essential for an independent and safe life, especially in elderly individuals (5). Adequate lower limb motor coordination significantly contributes to functionality of stroke individuals, its loss is the major contributor to disability in this population (6, 7, 8). Thus, therapeutic approaches aimed at restoring lower limb motor coordination are of great interest for rehabilitation professionals who are involved in research and clinical settings (9).

Medical conditions that may exhibit deficits in lower limb motor coordination

Schizophrenia or other psychiatric disorders (10)

Spinal cord injuries (11)

Ataxia (12, 13)

Stroke (2, 6 7, 8, 14, 15)

Parkinson disease (16)

Assessment of lower limb motor coordination

Lower limb motor coordination evaluation is very important for a physical therapist practice, as it enables the understanding of the nature and level of impairments of the individual in a standardized way (17, 18). The information gathered from the assessment tools may help planning the interventions and monitoring the clinical status of the patients before, during, and after physical therapy interventions (19, 20).

The tools used to assess lower limb motor coordination are divided into two; non-specific and specific.

Non-specific tests:

Auditory-paced ankle dorsi and plantarflexion task (11)

Fugl Meyer Scale (14)

Rapid alternating movement patterns test (RAMP) (15)

Scale for the Assessment and Rating of Ataxia (SARA) (12, 13)

Standardized Neurological Examination in Schizophrenia (NSS) (10)

Specific tests:

Foot tapping test (FTT) (16)

Lower Extremity Motor Coordination Test (LEMOCOT) (2)

Multi-joint lower-limb tracking-trajectory test (Tracking-trajectory test) 21

Resources

• Pinheiro M, Scianni A, Ada L, Faria C, Teixeira-Salmela L. Reference Values and Psychometric Properties of the Lower Extremity Motor Coordination Test. Archives of Physical Medicine and Rehabilitation. 2014;95(8):1490-1497.

References

1. Bernstein, N.A. Dexterity and its development. (1st edition ed.). Mahwah: Lawrence Erlbaum Associates; 1996.

2. Desrosiers, J, Rochette, A, Corriveau, H. Validation of a new lower extremity motor coordination test. Arch Phys Med Rehab. 2005;86(0): 993–998.

3. Carr J, Shepherd R. Reabilitação neurológica: otimizando o desempenho motor. São Paulo: Manole; 2008

4. Gao, K.L, Ng, S.S, Kwok, J.W, Chow, R.T, Tsang, W.W. Eye-hand coordination and its relationship with sensori-motor impairments in stroke survivors. J Rehabil Med. 2010;42(0): 368–373.

5. Capranica, L, Tessitore, A, Olivieri, B, Minganti, C, Pesce, C. Field evaluation of cycled coupled movements of hand and foot in older individuals. Gerontol. 2004; 50(6):399-406.

6. Menezes, K.K.P, Scianni, A.A, Faria-fortini, I, Avelino, P.R, Faria, C.D.C.M, Teixeira-Salmela, L.F, Lower Limb Motor Coordination of Stroke Survivors, Based Upon Their Levels of Motor Recovery and Ages. J Clin Neurophysiol 2015;6(6): 338-340.

7. Menezes, K.K.P, Nascimento, L.R, Pinheiro, M.B, Scianni, A.A, Faria, C.D.C.M, Avelino, P.R, et al Lower-limb motor coordination is significantly impaired in Ambulatory people with chronic stroke: a cross-sectional study. J Rehabil Med 2017; 49: 322–326

8. Menezes , K.K.P, Nascimento, L.R, Faria, C.D.C.M, Avelino , P.R, Scianni , A.A. et al. Deficits in motor coordination of the paretic lower limb best explained activity limitations after stroke. Physiother Theory Pract. [Online] 2018;1(0): Available from: https://www.ncbi.nlm.nih.gov/pubmed/29927672 [Accessed 21st October, 2018].

9. Ada, L, Canning, C. Changing the way we view the contribution of motor impairments to physical disability after stroke. In: Refshauge, K, Ada, L, Ellis E (2005) editors. Science-based rehabilitation: theories into practice. Sydney: Elsevier; 87–106.

10. Krebs, M.O, Gut-Fayand, A, Bourdel, M.A, Dischamp, J, Olié, J.P. Validation and factorial structure of a standardized neurological examination assessing neurological soft signs in schizophrenia. Schizophr Res. 2000;45(3):245-60.

11. Wirth B, Hedel H, Curt A. Foot control in incomplete SCI: distinction between paresis and dexterity. Neuro Res. 2008;30(1):52-60.

12. Braga-Neto P, Gordeiro-Junior C, Dutra LA, Pedroso JL, Barsottin OGP. Translation and validation into Brazilian version of the Scale of the Assessment and Rating of Ataxia (SARA). Arq Neuropsiquiatr. 2010; 68(2):228-30.

13. Schmitz-Hübsch T, Montcel ST, Baliko L, Berciano J, Boesch S, Depondt C, et al. Scale for the assessment and rating of ataxia: Development of a new clinical scale. Neurology. 2006;66(11):1717-20.

14. Maki T, Quagliato EMAB, Cacho EWA, Paz LPS, Nascimento NH, Inoue MMEA, et al. Estudo de confiabilidade da aplicação da escala de Fugl-Meyer no Brasil. Rev Bras Fisioter. 2006;10(2):177-83.

15. Dittiger M, Bohannon RW, Andrews AW. Reliability, responsiveness, and validity of timed, large amplitude, rapid alternating movement patterns among patients with stroke. J Phys Ther Sci. 2001;13(2):75-81.

16. Gunzler SA, Pavel M, Koudelka C, Carlson NE, Nutt JG. Foot-tapping rate as an objective outcome measure for Parkinson disease clinical trials. Clin Neuropharmacol. 2009;32(2):97-102.

17. Cavaco NS, Alouche SR. Instrumentos de avaliação da função de membros superiores após acidente vascular encefálico: uma revisão sistemática. Fisioter Pesqui. 2010;17(2):178-83.

18. Soriano FFS, Baraldi K. Escalas de avaliação functional aplicáveis a pacientes pós acidente vascular encefálico. ConScientiae Saúde. 2010;9(3):521-30.

19. Lima RCM. Adaptação transcultural do Stroke Specific Quality of Life – SSQOL: um instrumento específico para avaliar a qualidade de vida de hemiplégicos [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais; 2006.

20. Gadotti IC, Vieira ER, Magee DJ. Importance and clarification of measurement properties in rehabilitation. Rev Bras Fisioter. 2006;10(2):137-46.

21. Maffiuletti NA, Bizzini M, Schatt S, Munzinger U. A multi-joint lower-limb tracking-trajectory test for the assessment of motor coordination. Neurosci Lett. 2005;384(1-2):106-11.