Coordination

1. Coordination

2. Definition • Coordination refers to using the right muscles at the right time with correct intensity, extensive organization within the central nervous system is necessary to guide motor patterns, coordination is the basis of smooth and efficient movement, which often occurs automatically. • Coordination and gross or fine motor skills are a highly complex aspect of normal motor function

3. Factors affecting on coordination: • Anatomical Factors • Deformity • Asymmetry • Mal posture

4. Environmental factors: • Temperature • Pollution • Mental and psychological stress

5. Pain • Occupation • Life style • Fullness of bladder • Any medication • Repeated pregnancy • Overweight • Age • Type of muscle tone

6. Evaluation

7. Consideration before evaluation A- Outside the clinic • The presence of parking. • Rail way of stair up & down. • Light at entrance. • Ramp for wheel chair. • If there is lifter or not

8. B- Inside the Clinic • Clearness of room. • Silence and privacy. • Suitable temperature and light. • Comfortable and relaxed position for the patient. • Adjustable and wide bed. • Explain procedure to patient. • Patient pared skin or with light clothes. • Avoid air draft but maintain good ventilation. • All equipment near the therapist to avoid interruption. • Evaluation sheet should be present.

9. Consideration during evaluation • Pain • Sweating • Abnormal heart rate. • Abnormal B.P. • Fever • Fainting. • Hypermobility • Infection • Recent wound and injury

10. Avoid position that may exaggerated muscle tone or  patient complication. • Mental stress. • All tests done with tolerance of patient and according the stage of the disease. • All tests are done within the limit of pain. • All tests from zero starting position.

11. Decision Making • Diagnostic interview. • Screening examination • Comprehensive examination. • Special tests. • Long term goals. • Short term goals. • Out come

12. DIAGNOSTIC INTERVIEW Personal History: • Name:To be familiar with the patient • Age:occurs in people aged 40-50 years (cerbrovascular stroke) • Sex:affects men and women equally • Marital status:Married or single • Style of life:his habits, activities and if he living a sedentary life. It assist in providing the therapist with hint about causes and the expected prognosis.

13. Occupation:Know the patients interests and hopes • Habits: Smokers, non smokers, alcohol drinkers, coffee or tea drinker. • Weight: obesity increase the difficulty in performing activities.

14. Environmental assessment: A) Outside door • - Surrounding home. • - Stairs (height – width) – (sharp, smooth) . • - Entrance . • - Noisy – pollution. • - Light at entrance . • - rails of stairs – height of pavement .

15. B) Inside door • - Entrance • - Carpets • - Type of floor • - Furniture • - Arrangement • - Devices and accessories

16. Work assessment: • Desks. • Height of table and chair. • Width and height of weed chair . • How communicate with people.

17. B- History The importance of History taking: • To know precautions. • To know Contra-indications. • To decide the plane of care/treatment.

18. Onset & duration of the disease. • Site and extent of the lesion: (It affect level of consciousness and prognosis as the site either Rt of Lt determine aphasia and speech affection) • Etiology of the disease. • Mechanism of the lesion. • Distribution of paralysis • Past history: any disease (diabetes- hypertension- congenital heart disease), any previous operation, any previous trauma. • History of functional A.D.L:

19. Functional A.D.L is divided into: • Transfer activities. • Hygiene. • Feeding. • Dressing & undressing. • Gait & ambulation. Grades (He can do –He can do with minimal assessment – He can do with maximum assistant- He can't do)

20. Family history : • Any hereditary disease • Heart diseases • diabetes • Neuromuscular diseases due congenital or genetic factors

21. Psychological history: IQ. Level, Cognitive level, Education level, Affection (emotions – nervous - fairs), memory, judgment, depression, how to solve problems. • Social History: Relationship between patient and his family members and if they accept or reject the patient.

22. Pain History: • (time of pain – location of pain– If movement increase or decrease the pain –– severity of pain – distribution of pain).

23. Chief complain • Difficulties in performing ADL • Difficulty using arms to dress, feed self, or perform other tasks • Urinary incontinence • Problems with balance • Decreased sensation, numbness, or tingling on affected side of the body • Difficulty speaking and/or or understanding words • Difficulty walking • Depression

24. Problem list • Spasticity . • Muscle weakness • Loss of balance • Loss of coordination • Inability to do functional activities . • Shoulder pain. • Poor hand function. • Respiratory and circulatory problems.

25. Medical record • Medications • Associated handicapped (Vision, Hearing, Speech) • Associated reaction. • Any epileptic fits. • Incontinence. • Bed sores. • Vital signs (B.P.- Heat rate - Temperature) • X-ray - C.T Scan – M.R.I Respiratory and circulatory disorders. • Orofacial dysfunction.

26. Screening examination General observation: • Any abnormalities. • Asymmetry. • Distribution & Pattern of paralysis. • Position of head in relation to spasticity. • Position of head in relation to spasticity. • Associated reactions • Imbalance

27. General heath (out look of face). • Gait & ambulation. • Assistive device. • Way of taking off clothes, way of getting up & down bed. • Handling of the patient with his family. • If the family reject or accept the patient.

28. Specific observation: with the patient pared skin. Postural assessment from three views (lateral – anterior - posterior). • Dermatological system (Scar – operation – skin disease). • Skeletal system (size of bone – mal alignment of bone). • Muscular system (atrophy – asymmetry – hyper trophy). • Join system (edema – swelling). • Breathing pattern.

29. Palpation • Tender point • Muscle tone • Soft tissue Mobility • Trigger point • Fascial restriction. • Skin texture& temperature.

30. Comprehensive examination A- Communication abilities • Vision • Hearing – speech • Way of solving problem • Judgment • Excitement. • Interest. By Pantomine. Communication board

31. B- Mental Status • IQ level • Cognitive level • Education level C- Arousal status: see the response of the patient to any movement and see if the arousal status is low or high.

32. D- Motor control stages: • Muscle test : Group muscle test (voluntary muscle test because of spasticity or in pattern of movement) (gross movement) • Functional ROM test : as feeding – dressing – undressing – hygiene a- Mobility stage

33. Flexibility test (Sound, Affected, and associated areas Examples: • long sitting test • Straight leg raising test • Cross sitting test • Standing with forward bending test • Supine and hand stretched overhead

34. b- Stability stage • Elbow prone test: importance • Sitting position on a table • Sitting position on an armchair. Then sitting on a stool: Test patient ability to maintain position against gravity • Standing position

35. For head control • raise head and sustain position for 30 sec • If collapse quickly  poor • If can't take or sustain in the position  zero • If maintain it for 30 sec  normal

36. Sitting position • Sitting on the edge of the bed or table, test the patient ability to maintain position against gravity . • Sitting on arm chair then on a stool to test the patient ability to maintain position against gravity • Maintain postural alignment

37. Standing position • Test the patient ability to maintain position against gravity.

38. C- Control mobility stage • Change position with maintaining postural control 1) Rocking (body shift): Bushing from different directions, and from different positions or by lying on rocking plate . • Done from different positions (Elbow Prone, quadruped, sitting, kneeling , standing) • Rocking plate from supine - prone and raise from different direction all testes done 2-3 times before giving grade. 2) Quadruped position  raise one hand, then the other hand, raise one hand with opposite leg, raise one leg then another

39. d- High Skilled activity stage • Swallowing test. • Speech test. • chewing test • Cranial nerve assessment. • Hand function test: a- Volk's man angle test & b- Metacarpal stability test Hand • Gait and ambulation test: also test patient ability to get up & down stairs.

40. E- Voluntary movement • Observe pattern and sequence of movement from different position • *Supine: do flexion –extension – abduction – rotation- abdominal exercises • *Sitting: the same movements +trunk rotation + trunk bending. • *From supine to standing: observe the sequence of movement: some patients make side bending + rotation of trunk then stand while others take the kneeling position then stand.

41. F- Functional A.D.L test: Causes of disability of ADL: • Physical • Affection (emotion - psychological) • Mental (IQ level – Cognitive level - education) • Social. ADL are assessed by: *Questionnaire or Self questionnaire *Multi dimensional function: it include physical examination to detect if patient can do ADL or not.

42. factors affecting muscle tone • Anxiety • Temperature • Tension • Drugs • Fear • Fullness of bladder • Position of the head • Environmental condition • Vision and hearing • Pain

43. G- Assessment of Muscle Tone • Passive Movement Ashworth Scale : To perform this test, the part is moved through the joint range-of-motion (ROM). Ashworth Score Criteria: 0 No increase in tone 1Slight increase in tone, giving a “catch” when the limb is moved in flexion or extension 2More marked increase in tone, but limb easily flexed 3 Considerable increase in tone; passive movement difficult 4 Limb rigid in flexion or extension

44. H- Reflex assessment: Assess superficial and deep reflexes (tendon reflex,, and babiniski sign).

45. I- Postural assessment testes: • Shobber test • Adam's test • Forward bending test.

46. J- Sensation & perception tests: • Superficial sensation: assessment of pain, touch, and temperature. Sensation test is done by pin pricking or test tube.

47. Deep sensation (Proprioception): • Dynamic sense (sense of movement) • Static sense (sense of position) • Vibration sense

48. Joint sense: • Rate of motion • Velocity of motion • Direction of motion

49. Combined sensation: • stereognosis, two point discrimination, tactile localization, vibration, paragnosis, and texture of different materials.

50. Perception can be evaluated by observation: patients with perceptual defect have the following criteria: • Can't follow instruction. • Suffer from confusion • Difficulty in performing A.D.L. • Repeated mistakes • Can't repeated movement • Can't discriminate between body image and body parts (Summate). • Can't do purposeful movement (Apraxia). • Can't do any construction form.