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INTRODUCTION

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LEARNING OBJECTIVES

  1. Understand the purposes of performing an examination of coordination and balance.

  2. List the types of data generated from the examination.

  3. Describe the common coordination and balance impairments associated with lesions of the central nervous system.

  4. Explain the primary age-associated changes that affect coordination and balance.

  5. Discuss the purpose of screenings within the context of motor function.

  6. Provide a rationale for the preliminary patient observation before performing an examination.

  7. Identify the motor task requirements and movement capabilities addressed during an examination of coordination and balance.

  8. Differentiate between tests used to examine coordination and balance.

  9. Using the case study example, apply clinical decision making skills to application of coordination and balance examination data.

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EXAMINATION OF COORDINATION

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Motor control is "the ability of the central nervous system to control or direct the neuromotor system in purposeful movement and postural adjustment by selective allocation of muscle tension across appropriate joint segments."1, p. 688 Motor control has also been defined "as the ability to regulate or direct the mechanisms essential to movement."2, p. 3 Components of motor control include normal muscle tone and postural response mechanisms, selective movements, and coordination.3

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Coordination is the ability to execute smooth, accurate, controlled movement. "Coordinated movement involves multiple joints and muscles that are activated at the appropriate time and with the correct amount of force so that smooth, efficient, and accurate movement occurs. Thus, the essence of coordination is the sequencing, timing, and grading of the activation of multiple muscles groups."2, p. 121

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The ability to produce these responses is dependent on somatosensory, visual, and vestibular input, as well as a fully intact neuromuscular system from the motor cortex to the spinal cord.4 Coordinated movements are characterized by appropriate speed, distance, direction, timing, and muscular tension. In addition, they involve appropriate synergistic influences (muscle recruitment), easy reversal between opposing muscle groups (appropriate sequencing of contraction and relaxation), and proximal fixation to allow distal motion or maintenance of a posture.5 Schmidt and Lee define coordination as the "behavior of two or more degrees of freedom in relation to each other to produce skilled activity."6, p. 494 Awkward, extraneous, uneven, or inaccurate movements characterize coordination impairments.

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Two terms often associated with coordination are dexterity and agility.1 Dexterity refers to skillful use of the fingers during fine motor tasks.7 Agility refers to the ability to rapidly and smoothly initiate, stop, or modify movements while maintaining postural control.

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There are several general types of coordination. Intralimb coordination refers to movements occurring within a single limb8,9,10,11,12,13 (e.g., alternately flexing or extending the elbow; use of one upper extremity to brush the hair; or motor performance of a single lower extremity during a gait cycle). Interlimb (bimanual) coordination refers to ...

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