Co-ordination Exercises
Coordination or fine motor skills are a
highly complex aspect of normal motor
function. is the basis of smooth and
efficient movement, which often occurs
automatically.
Definition: Coordination refers to using
the right muscles at the right time with
correct intensity.
Development:
Extensive
organization
within the central nervous system is
necessary to guide motor patterns.
Coordination develops from the fetal
period throughout the early years of life.
Motor skills are initially dependent on
primitive reflex activity and later evolve
into refined movement. Voluntary and
cortically controlled movements can
develop into automatic reactions through
motor learning, which involves constant
repetition and reinforcement of those
movements.
It is assumed that in order to
acquire a normal coordination one must
have an intact neuromuscular system.
A
balance
of
normal
reciprocal
innervation and co-contraction, leading
to smooth reciprocal movements and
appropriate stability, is necessary in
carrying out a motor skill.
Sensory input and sensory feedback
are an essential part of motor skills and
coordination.
Lesions of the central nervous system,
such as cerebrovascular accidents,
cerebral palsy, and multiple sclerosis,
and a wide range of other neurologic
disorders, will obviously interrupt
coordination.
Normal
movements
needed in gross and fine motor
activities
G eneralprinciples ofcoordination
exercises involve:
(1) Constant repetition of a few motor
activities
(2) Use of sensory cues (tactile, visual,
(proprioceptive) to enhance motor
performance
(3) Increase of speed of the activity
over time
Therapeutic exercises used to im prove
coordination
(1) Frenkels exercises
(2) Proprioceptive Neuromuscular
Facilitation
(3) Neurophysiological Basis of
Developmental techniques
(4) Sensory Integrative Therapy
FREN KELS EXERCISES
Frenkel aimed at establishing
voluntary control of movement by the
use of any part of the sensory
mechanism which remained intact,
notably sight, sound and touch, to
compensate
for
the
loss
of
kinaesthetic sensation. The process of
learning this alternative method of
control is similar to that required to
learn any new exercise, the essentials
being:
Concentration of the attention
Precision
The ultimate aim is to establish
control of movement so that the
patient is able and confident in his
ability to carry out these activities
which are essential for independence in
everyday life.
Technique:
The patient is positioned and suitably clothed so
that he can see the limbs throughout the
exercise.
A concise explanation and demonstration of the
exercise is given before movement to give the
patient a clear mental picture of it
The patient must give his full attention to the
performance of the exercise to make the
movement smooth and accurate.
The speed of movement should be rhythmic through counting.
The exercise must be repeated many times until it is perfect and
easy.
Frequent rest periods must be allowed between exercise to
prevent fatigue The patient retains little or no ability to
recognise fatigue
Progression
Progression is made by altering:
1- speed of exercise: quick movements
require less control than slow ones.
2- range of exercise: Wide range of
movements, in which large joints are
used.
3- complexity of the exercise: exercise
should be starting with very simple
movements and gradually advance
to more complicated ones.
Special tests for
coordination
Non-equilibrium coordination
Finger to nose: The shoulder is abducted to 90o with
the elbow extended, the patient is asked to bring tip of
the index finger to the tip of nose.
Finger to therapist finger: the patient and the therapist
site opposite to each other, the therapist index finger is
held in front of the patient, the patient is asked to touch
the tip of the index finger to the therapist index finger.
Finger to finger: Both shoulders are abducted to bring
both the elbow extended, the patient is asked to bring
both the hand toward the midline and approximate the
index finger from opposing hand .
alternate nose to finger: the patient alternately touch the
tip of the nose and the tip of the therapist's finger with
the index finger.
Equilibrium coordination tests:
Standing in a normal comfortable posture.
Standing with feet together (narrow base of
support)
Standing with one foot exactly in front of
the other in tendon (toe of one foot
touching heed of opposite foot).
Standing on one foot.
Arm position may be altered in each of the above
postures (that is arm at sides, over head, hands on
waist) .
Displace balance unexpectedly (with carefully
guarding patient).
Standing and then alternate between forward trunk
flexion and return to neutral.
Standing with trunk laterally flexed to each side .
Standing to test the ability to maintain an upright
posture without visual feedback.
Standing in tandem position from eyes open to eyes
closed.
B - M echanical test
Instrumentation used to assess
coordination
Frenkle's mat
Side turning mat Pivot turning mat
frenkel's exercises from
supine
Flex and extend one leg by the heel sliding
down a straight line on the table.
Abduct and adduct hip smoothly with knee
bent and heel on the table.
Abduct and adduct leg with knee and hip
extended by sliding the whole leg on the table .
Flex and extend hip and knee with heel off the
table .
Flex and extend both legs together
with the heel sliding on the table.
Flex one leg while extending the
other.
Flex and extend one leg while taking
the other leg into abduction and
adduction.
Frankle's Exercises for the legs in
sitting :
One leg is stretched to slide the
heel to a position indicated by a
mark on the floor.
The alternate leg is lifted to place
the heel on the marked point.
From stride sitting posture patient is
asked to stand and them site.
Rise and site with knees together.
Frenkle's Exercises for the legs in
standing:
In stride standing weight is transferred
from one foot to other.
Place foot forward and backward on
straight line.
Thank you
