Rehab-ch 6

the ability of the central nervous system to control or direct the neuromotor system in purposeful movement and postural adjustment through selective allocation of muscle tension across join segments

• normal muscle tone
• postural response mechanisms
• selective movements
• coordination

• smooth, accurate, controlled movements
• appropriate speed, distance, direction timing, muscular tension

• intralimb
• interlimb
• visualmotor
• eye-hand
• eye-hand-head

Skillful use of fingers during fine motor tasks

ability to rapidly and smoothly initiate, stop, modify movements while maintaining postural control

eye-hand and eye-hand-head coordination

• strategy
• neocortex & basal ganglia

the goal of the movement and the movement strategy that best achieves the goal

• Tactics
• motor cortex and cerebellum

the sequences of muscle contraction, arranges in space and time, required to smoothly and accurately achieve the strategic goal

• execution
• brain stem and spinal cord

activation of the motor neuron and interneuron pools that generate the goal-directed movement and make any necessary adjustments of posture

• most specific cortical motor area
• low intensity to evoke motor response

• UNCOMPLICATED MOVEMENTS
• initiation of movement
• simultaneous bilateral grasping
• sequential tasks
• orientation of eyes and head

• MORE INTRICATE MOVEMENTS (interlimb)
• controls trunk and prox limb movements
• contributes to anticipatory postural changes

• periphery- via thalamus to primary motor cortex & primary somatosensory cortex
• cerebellum- via thalamus to primary & premotor cortex
• basal ganglia- via thalamus

• Pre-Central Gyrus
• Primary motor cortex

• supplementary motor area
• pre-motor area

• Corticospinal (pyramidal) tract
• reticulospinal tract
• vestibulospinal tracts

• transmits signals form motor cortex to spinal cord
• the fibers cross in medulla before descending lateral corticospinal tracts

influences muscle tone and reflex activity

affect postural control and movements of the head

affect coordinated head and eye movements

• regulates movement, postural control, and muscle tone
• functions as an error correcting mechanism
• processing info in context to the environment and other stimulation

• part of the cerebellum
• CNS analysis of:
• movement info
• determination of level of accuracy
• provision for error correction

stereotypical movements that are rapid& short duration which doesn't allow time for feedback to occur so preprogrammed instructions to an effector are needed

memory, preprogrammed pattern for coordinated movements which has required practice to be established

• central pattern generator
• programmed set of coordinated movements

• collection of nuclei at the base of the cerebral cortex
• takes part in planning and execution of complex motor responses
• facilitation of desired motor response
• inhibiting unwanted responses

• selection or modification of appropriate movement strategy based on task demands and environment
• large, myelinated fibers for rapid conduction of sensory info to medulla and thalamus to sensory cortex

• asthenia
• dysarthria
• dysdiadochokinesia
• dysmetria
• dyssynergia
• asynergia
• gait ataxia
• hypotonia
• nystagmus
• rebound phenomenon
• tremor

• generalized weakness
• associated with cerebellar lesions

motor component of speech articulation, scanning speech, word use intact, quality of speech altered

rapid alternating movements

• inability to judge the distance or range of a movement
• (overshoots or undershoots)

movements performed in a sequence of component parts rather than a single smooth activity

inability to associate muscles together for complex movements

• broad base of support
• high guard arm position
• slow initiation of LE
• unsteady, irregular, staggering

• decrease in muscle tone
• diminished resistance to passive movements

rhythmic quick, oscillatory back-and-forth movements of the eyes

halts forceful movements when resistance is stopped

involuntary oscillatory movement resulting from alternate contractions of opposing muscle groups

• intention tremor
• postural tremor

• Akinesia
• athetosis
• bradykinesia
• chorea
• choreoathetosis
• dystonia
• hemiballismus
• hyperkinesia/hypoknesis
• rigidity
• tremor

• coordination &/or balance problems will be exaggerated in poorly lit areas or when eyes are closed
• typically over-step or over-reach

• equilibrium and motor control disturbances due to lack of proprioception
• wide based gait
• swaying uneven gait with excessive lateral displacement

• decreased ability to execute smooth accurate and controlled motor responses
• slowed reaction time
• decreased ROM
• postural changes
• impaired balance

• decreased strength
• sarcopenia
• loss of alpha motor neurons
• loss or atrophy of fast twitch fibers (type IIb)
• reduced number and diameter of muscle fibers
• diminished oxidative capacity of exercising muscle
• reduction in ability to produce torque

• forward head
• rounded shoulders
• altered lordotic curve
• increased hip & knee flexion
• wide BOS

• body posture
• balance
• extremity movements involving large muscle groups

utilizing small muscle groups that involve skillful, controlled manipulation of objects

• assess the ability to maintain the body in equilibrium with gravity both statically and dynamically
• BALANCE

consists of limb movements/coordination activities

• motor movements
• coordination tests
• movement capabilities with nonequilibrium coordination examination
• progress of difficulty of coordination tests

• alternate or reciprocal motion
• movement composition
• movement accuracy
• fixation or limb holding

• unilateral tests
• bilateral symmetrical tasks
• bilateral asymmetrical tasks
• multi-limb tasks

• static, mobile components of movements in supine/prone, supported sitting
• tests done with eyes open

• quality of movements
• precision
• easily reversed
• speed
• bilateral control
• affects of fatigue
• extraneous movements

the max distance an individual is able/willing to lean in any direction withouth LOB or changing the BOS

• Right Reactions
• Equilibrium reactions
• fixed support strategies
• change in support

orient the head in space and the body in relation to the head and support surface

• tilting
• protective reactions
• muscles closest to the BOS are important in maintaining balance

• ankle strategy
• hip strategy

• stepping strategy
• reaching movements

• Berg Balance Scale
• Performance-Oriented Mobility Assessment
• Reach Tests
• Timed Get Up and Go Test
• Timed Walking Test
• Dynamic Gait index
• Dual-task test
• Perceived Balance Confidence
• Activities-Specific Balance Confidence Scale
• The Balance Efficacy Scale

• Mobility
• Stability
• Controlled Mobility
• Skill

initial movement with a functional pattern

Steady position in a weight bearing position, antigravity posture

Maintain balance with weight shifting and changes in position

highly complex coordinated activity or movements that allow interaction with the environment