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LEARNING OBJECTIVES

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

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

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

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

EXAMINATION OF COORDINATION

A key component of motor function, 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.”1, p. 121

The ability to produce these responses is dependent on sensory information from the body and environment, visual and vestibular input, and a fully intact musculoskeletal and neuromuscular system. 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.2 Schmidt and Lee define coordination as the “behavior of two or more degrees of freedom in relation to each other to produce skilled activity.”3, p. 494 Awkward, extraneous, uneven, or inaccurate movements characterize coordination impairments.

Two terms often associated with coordination are dexterity and agility.4 Dexterity refers to skillful use of the fingers during fine motor tasks.5 Agility refers to the ability to rapidly and smoothly initiate, stop, or modify movements while maintaining postural control.

There are several general types of coordination. Intralimb coordination refers to movements occurring within a single limb6-9 (e.g., alternately flexing or extending the elbow; use of one upper extremity [UE] to brush the hair; or motor performance of a single lower extremity [LE] during a gait cycle). Interlimb (bimanual) coordination refers to the integrated performance of two or more limbs working together10-16 (e.g., alternately flexing one elbow while extending the other; bilateral UE tasks as required during transfers or dressing activities; or between limb movements of the LEs and/or UEs during walking). Visual motor coordination17-21 refers to the ability to integrate both visual and motor abilities with the environmental context to accomplish a goal (e.g., tracing over a zigzag line, writing a letter, riding a bicycle, or driving an automobile). A subcategory of visual motor coordination with important implications for activities of daily living (ADL) is ...

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