1. Overview of Motor System
   1. Motor Cortex
   2. Descending Motor Pathways
   3. Cerebellum
   4. Basal Ganglia
   5. Dorsal-Column-Medial Lemniscal Pathway
2. Feats. Coordination Impairments
   1. Cerebellar Pathology
   2. Basal Ganglia Pathology
   3. Dorsal Column-Medial Lemniscal Pathology
3. Age-Related Changes Impacting Coordinated Movement
4. Screening
   1. Examples of Screenings
5. ROM
6. Strength
7. Sensation
8. Feats. Coordination Tests
   1. Gross & Fine Motor Movements
9. Nonequilibrium & Equilibrium (Bal) Tests
   1. Motor Task Requirements
   2. Movement Capabilities
   3. Motor Task Requirements & Movement Capabilities Addressed During Examination of Coordination
10. Preparation for Administering Coordination Exam
    1. Testing Environment
    2. Pt. Preparation
    3. Preliminary Observation
11. Coordination Exam
    1. Recording Test Results
    2. Table 7.3: Nonequilibrium Coordination Tests p. 212:
       1. 1. Finger-to-nose
       2. 2. Finger-to-PT's finger
       3. 3. Finger-to-finger
       4. 4. Alternate nose-to-finger
       5. 5. Finger Opposition
       6. 6. Mass Grasp
       7. 7. Pronation/Supination
       8. 8. Rebound test
       9. 9. Tapping (hand)
       10. 10. Tapping (foot)
       11. 11. Point & Past Pointing
       12. 12. Alternate heel-to-knee; heel-to-toe
       13. 13. Toe to PT's finger
       14. 14. Heel on shin
       15. 15. Drawing a circle
       16. 16. Fixation or Position Holding
    3. Box 7.3 Equilibrium Coordination Tests p. 213
       1. 1. standing, comfortable posture with normal BOS
       2. 2. standing, feet together (narrow BOS)
       3. 3. standing in tandem position
       4. 4. standing on 1 foot
       5. 5. arm position may be altered in each of the above postures
       6. 6. perturbations: displays balance unexpectedly ( while carefully guarding pt)
       7. 7. standing, functional reach: forward trunk flexion with UE reach
       8. 8. standing, lateral flex trunk to each side
       9. 9. standing: eyes open to eyes closed; inability to maintain upright posture without visual input= positive Romberg sign
       10. 10. standing in tandem position eyes open to eyes closed (Sharpened Romberg)
       11. 11. tandem walking
       12. 12. walking along straight line drawn or tape to floor, or place feet on four markers while walking
       13. 13. walk sideways, backwards, or cross stepping
       14. 14. March in place
       15. 15. alter speed of ambulatory activities; observed pt. Walking at normal speed, as fast as possible & as low as possible
       16. 16. stop & start abruptly on command while walking
       17. 17. walk & pivot on command (90, 180, 360°)
       18. 18. walk in a circle, alternate directions
       19. 19. walk on heels or toes
       20. 20. walk with horizontal & vertical head turned on command
       21. 21. step over or around obstacles
       22. 22. stairclimbing with & without using hand rail; 1 step at a time, step overstep
       23. 23. jumping jacks
       24. 24. sitting on TherEx ball; alternate flexing & extending these (Chordata movement with upright balance)
    4. Table 7.4 Sample Tests for Selected Coordination Impairments: p. 214
       1. Dysdiadochokinesia
          1. • Finger to nose • Alt nose-to-finger • Pronation/supination • Knee flx/ext • Walking, alter speed or direction
       2. Dysmetria
          1. • Pointing & past pointing • Join a circle or figure 8 • Heel on shin • Placing feet on floor markers; sitting, standing
       3. Dyssynergia
          1. • Finger to nose • Finger to PT’s finger • Alternate heel to me • Toe to PT’s finger
       4. Hypotonia
          1. • Passive movement • DTRs
       5. Tremor (intention)
          1. • Observation during functional activities (tremor will typically increase as target is approached him movement speed increase) • Alternate nose to finger • Finger to finger • Finger to PTs finger • Toe to PTs finger
       6. Tremor (resting)
          1. • Observation of patient at rest; limb or jaw movements • Observation during functional activities (tremor will diminish significantly/disappear with movement)
       7. Tremor (postural)
          1. • Observation of steadiness abnormal posture; sitting, standing
       8. Asthenia
          1. • Fixation or position holding (UE & LE)) • Application of manual resistance to determine ability to hold
       9. Rigidity
          1. • Passive movement • Observation during functional activities • Observation of resting posture(s)
       10. Bradykinesia
           1. • Walking, observation of arm swing & trunk motions • Walking, alter speed & direction • Request that a movement or gate activity be stopped abruptly • Observation of functional activities: timed tests
       11. Disturbances of Posture
           1. • Fixation or position holding (UE & LE) • Displace balance unexpectedly in sitting or standing (perturbations) • Standing, altar BOS
       12. Disturbances of Gait
           1. • Walking along a straight line • Walk sideways, backwards • March in place • Alter speed & direction of ambulatory activities • Walk in a circle
12. Quantitative Coordination Testing & Specialized Testing Instruments
    1. CATSYS System
    2. Postural Sway Analyzer
    3. Choice Reaction Time Analyzer
    4. Dynamic Posturography
13. Standardized Instruments: UE Coordination