Coordination & Skill
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8/8/2019 Coordination & Skill http://slidepdf.com/reader/full/coordination-skill 1/3 COORDINATON AND SKILL 1-General discussion: Coordination and gross or fine motor skills are a highly complex aspect of normal motor function. 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 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 that mechanism. 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, ranging from locomotion to writing, will be impaired. 2-Therapeutic exercise approaches to the improvement of neuromuscular coordination: a.General principles of coordination 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 pf the activity over time b.Mny different approaches to therapy have been developed. These include: (1) Frenkel’s exercises (2) Proprioceptive Neuromuscular Facilitation (Knott and Voss) (3) Neurodevelopmental Treatment (Bobath) (4) Neurophysiological Basis of Developmental (Rood, Randolph) (5) Sensory Integrative Therapy (Ayres) * FRENKEL’S EXERCISES Dr. H.S.Frenkel was a Medical Superintendent of the Sanatorium ‘Freihof’ in Switzerland towards the end of the last century. He made a special study of tabes dorsalis and devised a method of treating the ataxia, which is a prominent symptom of the disease, by means of systematic and graduated
Transcript of Coordination & Skill
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COORDINATON AND SKILL1-General discussion:Coordination and gross or fine motor skills are a highly complex aspect of normal motor function. Coordination refers to using the right muscles at theright time with correct intensity. Extensive organization within the centralnervous system is necessary to guide motor patterns. Coordination is the
basis of smooth and efficient movement, which often occurs automatically.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 controlledmovements 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 havean intact neuromuscular system. A balance of normal reciprocal innervation
and co-contraction, leading to smooth reciprocal movements and appropriatestability, is necessary in carrying out a motor skill. Sensory input andsensory feedback are an essential part of that mechanism. Lesions of thecentral nervous system, such as cerebrovascular accidents, cerebral palsy,and multiple sclerosis, and a wide range of other neurologic disorders, willobviously interrupt coordination. Normal movements needed in gross andfine motor activities, ranging from locomotion to writing, will be impaired.2-Therapeutic exercise approaches to the improvement of neuromuscular coordination:a.General principles of coordination 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 pf the activity over time
b.Mny different approaches to therapy have been developed. These include:(1) Frenkel’s exercises(2) Proprioceptive Neuromuscular Facilitation (Knott and Voss)(3) Neurodevelopmental Treatment (Bobath)(4) Neurophysiological Basis of Developmental (Rood, Randolph)
(5) Sensory Integrative Therapy (Ayres)* FRENKEL’S EXERCISESDr. H.S.Frenkel was a Medical Superintendent of the Sanatorium ‘Freihof’in Switzerland towards the end of the last century. He made a special studyof tabes dorsalis and devised a method of treating the ataxia, which is a
prominent symptom of the disease, by means of systematic and graduated
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exercises. Since then his methods have been used to treat the in-coordinationwhich results from many other diseases, e.g. disseminated sclerosis.He aimed at establishing voluntary control of movement by the use of any
part of the sensory mechanism which remained intact, notably sight, soundand touch, to compensate for the loss of kinaesthetic sensation. The processof learning this alternative method of control is similar to that required tolearn any new exercise, the essentials being:
a. Concentration of the attention b. Precisionc. Repetition
The ultimate aim is to establish control of movement so that the patient isable and confident in his ability to carry out these activities which areessential for independence in everyday life.Technique:
1- The patient is positioned and suitably clothed so that he can see thelimbs throughout the exercise.
2- A concise explanation and demonstration of the exercise is given before movement is attempted, to give the patient a clear mental picture of it
3- The patient must give his full attention to the performance of theexercise to make the movement smooth and accurate.
4- The speed of movement is dictated by the physiotherapist by means of rhythmic counting, movement of her hand, or the use of suitablemusic.
5- The range of movement is indicated by marking the spot on which thefoot or hand is to be placed.
6- The exercise must be repeated many times until it is perfect and easy:It is then discarded and a more difficult one is substituted.
7- As these exercises are very tiring at first, frequent rest periods must beallowed. The patient retains little or no ability to recognise fatigue, butit is usually indicated by deterioration in the quality of the movement,or by a rise in the pulse rate.
Progression
Progression is made by altering the speed, range and complexity of theexercise. Fairly quick movements require less control than slow ones. Later,alteration in the speed of conservative movements and interruptions whichinvolve stopping and starting to command, are introduced. Wide range and
primitive movements, in which large joints are used, gradually give way tothose involving the use of small joints, limited range and a more frequentalteration of direction. Finally, simple movements are built up into
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sequences to form specific actions which require the use and control of anumber of joints and more than one limb, e.g. walking.According to the degree of disability, re-education exercises start in lyingwith the head propped up and with the limbs fully supported and progress ismade to exercises in sitting, and then in standing.Examples of Frenkel’s Exercises
a. lying (Head raised); Hip abduction and adductionThe leg is fully supported throughout on the smooth surface of a plinth or on a re-education board.
b. lying (Head raised); one Hip and Knee flexion and extensionThe heel is supported throughout and slides on the plinth to a positionindicated by the physiotherapist.
