EXAMINATION OF COORDINATION AND BALANCE TEPII

NONEQUILIBRIUM COORDINATION TESTS NONEQUILIBRIUM COORDINATION TESTS

FINGER-TO-NOSE  shoulder is abducted to 90° c elbow extended. TAPPING (HAND)  With the elbow flexed and the forearm pronated, the px is asked to “tap”
 Px is asked to bring the tip of the index finger to the tip of his or her the hand on the knee.
nose.
 Alterations may be made in the initial starting position to observe TAPPING (FOOT)  The patient is asked to “tap” the ball of one foot on the floor without
performance from different planes of motion. raising the knee; heel maintains contact with floor.

POINTING AND PAST  Px and PT are opposite each other, either sitting or standing.
FINGER–TO–PT’s FINGER  PT and px sit opposite each other. POINTING  Both px and PT bring shoulders to a horizontal position of 90° of flexion
 PT’s index finger is held in front of the px. with elbows extended.
 Px is asked to touch the tip of his or her index finger to the PT’s index  Index fingers are touching or the px’s finger may rest lightly on the PT’s.
finger.  Px is asked to fully flex the shoulder (fingers will be pointing toward
 position of PT’s finger may be altered during testing to observe ability to ceiling) and then return to the horizontal position such that index fingers
change distance, direction, and force of movement. will again approximate.
 Both arms should be tested, either separately or simultaneously. A
normal response consists of an accurate return to the starting position.
FINGER-TO-FINGER  Both shoulders are abducted to 90° with the elbows extended.  IN AN ABNORMAL RESPONSE, there is typically a “past pointing,” or
 px is asked to bring both hands toward the midline and approximate the movement beyond the target.
index fingers from opposing hands.  Several variations to this test include movements in other directions
such as toward 90° of shoulder abduction or toward 0° of shoulder
flexion (finger will point toward floor). After each movement, the patient
ALTERNATE NOSE-TO-  px alternately touches the tip of his or her nose and the tip of the PT’s is asked to return to the initial horizontal starting position.
fiNGER finger with the index finger.
 position of the PT’s finger may be altered during testing to observe ALTERNATE HEEL-TO-KNEE;  supine position, the px is asked to touch the knee and big toe
ability to change distance, direction, and force of movement. HEEL-TO-TOE alternately with the heel of the opposite extremity.

FINGER OPPOSITION  px touches the tip of the thumb to the tip of each finger in sequence. TOE TO PT’s FINGER  supine position, the patient is instructed to touch the great toe to the
 Speed may be gradually increased. examiner’s finger. The position of finger may be altered during testing to
observe ability to change distance, direction, and force of movement.

MASS GRASP  An alternation is made between opening and closing fist (from finger
flexion to full extension). HEEL ON SHIN  From a supine position, the heel of one foot is slid up and down the shin
 Speed may be gradually increased. of the opposite LE.

PRONATION/ SUPINATION  With elbows flexed to 90° and held close to body, the px alternately DRAWING A CIRCLE  Px draws an imaginary circle in the air with either UE or LE (a table or
turns the palms up and down. the floor also may be used).
 This test also may be performed with shoulders flexed to 90° and  This also may be done using a FIGURE-EIGHT PATTERN.
elbows extended.  This test may be performed in the supine position for the LE.
 Speed may be gradually increased.
 The ability to reverse movements between opposing muscle groups can
be examined at many joints. FIXATION OR POSITION  UE: px holds arms horizontally in front (sitting or standing).
 Examples include active alternation between flexion and extension of HOLDING  LE: px is asked to hold the knee in an extended position (sitting).
the knee, ankle, elbow, or fingers.

REBOUND TEST  px is positioned with the elbow flexed.

 PT applies sufficient manual resistance to produce an isometric
contraction of biceps.
 Resistance is suddenly released. Normally, the opposing muscle group
(triceps) will contract and “check” movement of the limb.
 Many other muscle groups can be tested for this phenomenon, such as
the shoulder abductors or flexors and the elbow extensors.