EVALUATIVE TEACHING TASK FT TOPIC 2 AND 3

FIRST AND SURNAME: DEYMAR DEL CARMEN JIMÉNEZ MONTESINOS

ID: 28,495,509
ASIC: VALERA

1. COORDINATION AND BALANCE

 Investigate assessment of coordination and balance.

Coordination and balance are of great importance to be able to function effectively

during both static and dynamic activities, which is why it is essential to know the
assessments you can use to better measure functional balance in the patients we
care for. Assessing the state of our coordination is very useful, as it has important
repercussions in academic settings to know if a student is going to have difficulties
taking notes or writing exams, in clinical settings to know if a patient can move
around their environment without help, In work environments, to know if an
employee can drive vehicles and heavy machinery without risk and in our daily
lives . Through a neuropsychological evaluation we can effectively and reliably
measure coordination and other cognitive abilities. For this, a set of tests are
available that evaluate some subprocesses of coordination, such as hand-eye
coordination and response time . To do this, we use various tests to measure
coordination, we also evaluate monitoring, cognitive flexibility, processing speed,
divided attention, inhibition, visual perception, naming, visual scanning, focused
attention, spatial perception, contextual memory, recognition, working memory.
There are different tools for assessing motor competence and coordination, such
as the Bayley-III or the Touwen Infant Neurological Examination or the Bruininks-
Oseretsky Test of Motor Proficiency , the Visual Motor Integration Test or the
Movement Assessment Battery for Children-2 .

Balance is defined as the process by which we control the center of mass of the
body with respect to the base of support, whether static or dynamic. The
somatosensory, visual and vestibular systems work together to provide us with
what we know as balance. Since what is not measured is very difficult to assess, it
is important to have tools on hand that allow us to evaluate and objectify data
regarding the monitoring and status of these parameters, in order to classify and
plan obtaining measurements within the process. reference, for this reason
numerous tests have been described that aim to evaluate balance. Likewise, it is
taken into account that age influences balance on one leg, due to the deterioration
in the vestibular systems and the loss of proprioception in elderly people. Likewise,
stabilometry, also known as posturography, currently constitutes the gold standard.
for the specific assessment of balance. One of these tools is the Berg scale,
developed in 1989, and which quantitatively measures balance, with validity,
reliability and high sensitivity for hemiplegic patients as well as the elderly. It
consists of a total of 14 items related to standing up and different movements once
up, scoring from 0-4. If the result obtained is 41-56 total points, it presents a low
risk of falling, while, if it is below 20 points, the risk is high. In addition, this scale
also serves as a reevaluation method to capture the progress of rehabilitation over
time.

Another of the most used tests is the well-known Tinetti test, described in 1986, in
order to detect balance and mobility problems, as well as determine the risk of
falls, especially in population groups of elderly people, and is made up of 2
subscales, which evaluate balance and gait respectively.

 Perform analysis on coordination and balance.

Every living being has the ability to maintain stability on each side of its axis, once
the person uses it when adopting and maintaining a position, righting reactions
occur, measured by the supply of visual, vestibular and proprioceptive information
integrated into the brain stem and cortex. Coordination can be defined as the ability
to efficiently carry out movements, in a precise, fast and orderly manner .
Coordination is what allows us to move all the muscles involved in an action in a
synchronized manner to perform it in the most adapted way possible. Although
motor skills and movement involve a large number of frontal brain areas , the main
structure responsible for coordination is the cerebellum. Poor coordination can
prevent us from living our daily lives normally; it is one of the abilities that
deteriorates the most with aging, making daily life activities difficult. Fortunately,
coordination can be trained through cognitive stimulation. We can also talk about
different types of coordination depending on the body parts involved in the
movement and the sensory organ that provides feedback. The main types are:
Motor coordination , refers to the coordination of the different muscles of the
body based on what we perceive from all our senses. It refers to all coordination as
a whole and is mainly related to gross motor skills and includes the two types that
we see below. Hand-eye coordination is known as visual-motor coordination and
hand-eye coordination. It refers to the ability to manipulate our hands based on
what we perceive with our eyes. Oculo-pedic coordination is the ability to
manage the feet based on what we perceive with the eyes. Coordination is an
essential capacity in much of our lives and in sports since it would be impossible
for us to run, swim, ride a bicycle, shoot a ball, shoot a basket or hit a ball without
the help of our coordination. Coordination is also defined as the ability to
synchronize the action of the movement-producing muscles, agonists and
antagonists, intervening at the precise moment and with the appropriate speed and
intensity. With balance, the person has the ability to maintain the center of gravity
within the base of support during static and dynamic motor activity. For this reason,
any change in position generates automatic postural adjustments in response to
the change in the center of gravity. Balance includes three important aspects:
Static stability, asymmetry and stability; Static stability refers to the ability to
maintain a posture with minimal sway or oscillation, the term symmetry describes
the equal distribution of weight between weight-bearing components, and dynamic
stability is the ability to perform a movement without losing balance. . In all
physical-sports activities, balance plays a very important role in body control.
Correct balance is the fundamental basis of good general dynamic coordination
and of any autonomous activity of the upper and lower limbs. Balance could be
defined as the adequate maintenance of the position of the different parts of the
body and of the body itself in the space encompassing all those aspects related to
the postural domain, allowing the set of organic systems to act effectively and with
maximum energy savings. Body balance is built and developed based on
visuospatial and vestibular information. A disorder in balance control will not only
produce difficulties for spatial integration, but will also affect postural control and
are distinguished into three groups of factors: Sensory Factors: Sensory-motor
organs, labyrinthine system, plantar system and sensations. kinesthetics.
Mechanical Factors: Force of gravity, center of gravity, base of support, body
weight and others Factors: Motivation, ability to concentrate, motor intelligence and
self-confidence, which is why the development of coordination and balance is of
great importance for the movement of the body.

 Explain how coordination and balance are linked to the individual's daily
performance in different contexts.

When performing a movement, our central nervous system sends an order to the
muscles to get them into operation, that is, to contract. The movement will be
carried out precisely if each muscle contracts when it corresponds, not before nor
after, and with the appropriate intensity. Coordination intervenes in almost all parts
of our body as the physical quality that allows movements to occur with precision,
thanks to the appropriate order and intensity of muscle contractions, they are
mainly carried out with movements. This set of motor abilities and skills such as
coordination and balance are located at the same level, in the sense that they go
hand in hand in their work of strengthening the perceptual or motor substrate.
Coordination involves the development of a certain movement and is nourished by
feedback of visual, auditory, proprioceptive and tactile origin, in direct relation to
the knowledge of the result of the action and in parallel we verify the essential
function of controlling tonic or postural balance at the level of the parietal
associative cortex. When we talk about coordination, it is important to highlight that
it includes motor, cognitive, social and affective aspects. Therefore, it does not only
refer to the skill (or coordination) with which the movement is carried out, but also
contemplates the awareness of one's own body, laterality, spatial concepts, etc.
The repeated activation of this pattern can help promote the creation of new
synapses and the strengthening of existing ones, which would allow us to
strengthen and stimulate coordination and other cognitive abilities such as balance.
If we do not train our coordination, our brain will save resources. , weakening their
connections, which would lead us to be less effective in activities that require our
coordination, for this it is important to practice different mental games that can help
improve our cognitive abilities and motor activities to improve our balance.
 Assess the importance of coordination and balance in the performance of
an individual's daily activities.

The capacities and motor skills that nourish the richness of human motor skills and,
particularly, in the development of the first evolutionary ages corresponding to
primary education, coordination and balance constitute the perceptual or motor
base capacities, it is worth highlighting the value and importance of coordination
and balance as a means, not only of motor development, but also as an enjoyment
of daily activities and that improves the functionality of the body domain, involves
the acquisition of multiple motor behaviors of a utilitarian, playful or expressive
nature, which They are fundamental for the integral development of each
individual, it is that through the development of activities they acquire the greatest
number of possible patterns with which to be able to build new movement options
and correctly develop motor capabilities and basic skills, these produce the good
functioning of the central nervous system and skeletal muscles during exercise,
that is, the ability to generate movement in a controlled manner and adjusted to the
requirements they have generated. Any motor work needs a series of requirements
in terms of coordination and balance for the movements to be effective since
without the intervention of these two agents it is impossible to carry out a motor
action. All cognitive abilities can be trained to improve their performance, which is
why there is a battery of clinical exercises designed to rehabilitate deficits in this
cognitive ability, since the brain and its neuronal connections are strengthened with
the use of the functions that They depend on these, so that, if we frequently
exercise coordination, the brain connections of the structures involved in this
capacity will be strengthened. Coordination will facilitate more orderly and directed
movements, thus improving the technical gesture, complementing the basic
physical capabilities (strength, resistance, flexibility and speed) to make the
movements sporting gestures.

2. BRAIN DISEASES.

 Analyze the physiotherapy intervention in individuals with disease encephalic.

Prepare a summary of the interventions for each brain disease.

pyramidal syndrome

It is one of the most important syndromes in nervous pathology, as it is found in

conditions of the spinal cord, brain stem or brain. Given that the functions of the
pyramidal pathway are voluntary mobility and the regulation of tendon tone and
reflexes, pyramidal syndrome stands out for: • Paralysis or paresis. • Hypertonia
and spasticity. • Exaggeration of tendon reflexes (clonus in foot and kneecap). In
treatment, what interests us most is fighting spasticity. Spasticity is a reflex
contraction that opposes movement and is closely linked to the exaggeration of the
myotatic reflex. Spasticity increases when standing and sitting, and decreases
when lying down. This spasticity predominates in the pectoralis major, elbow and
finger flexors and pronator muscles of the upper limb; while in the lower limb it
occurs mainly in the adductors, hamstrings and triceps. In general, the treatment of
spasticity should be carried out in a calm atmosphere, since the patient's
emotionality tends to increase this spasticity. We will use the following techniques:
• Facilitation techniques: Kabat and Bobath. • Mobilizations: slow and prolonged
tractions. • Cryotherapy, hydrotherapy and massage therapy. Other aspects of the
treatment are muscular and functional re-education, of course the fight against
deformations and the fight against synkinesis (Ability to evoke a movement in a
distant muscle group through the purposeful or involuntary activity of another
muscle group. Imitation synkinesis are known, which consist of the reproduction in
a contralateral member of the propositional activity carried out with the other
member).

vestibular syndrome

It is the consequence of an injury to the labyrinth, vestibular nerve or vestibular

nuclei and pathways. The symptoms are: vertigo with nausea, vomiting, nystagmus
(involuntary rhythmic and conjugate movement of the eyeball, balance disorders,
deviation of limbs and body towards the injured side, rotating vertigo, damage to
auditory perception, etc. Physiotherapeutic treatment is symptomatic and,
therefore, exactly the same as the treatment of ataxia; let us remember that this
can also be due to an alteration in the labyrinth, among other possibilities.

Encephalitis

Encephalitis is the inflammation of the brain parenchyma associated with a set of

neurological dysfunctions, and occurs due to viral or autoimmune reasons that
attack the central nervous system, the first being the most common. Thanks to the
structural protection of the brain in the bony skull, and its cellular protection by the
blood-brain and cerebrospinal fluid barriers, these infections are extremely rare,
although the organisms that cause the majority of these cases are not.

Due to this inflammation, nerve cells are affected and sometimes even destroyed.
The resulting damage is known as acquired brain injury.

The way encephalitis affects each patient is highly variable, so not everyone will
have the same result. The loss of brain function from this injury can have minor or
more significant consequences depending on the magnitude of the damage; This
will vary according to the cause of the inflammation and the severity, as well as the
parts of the brain affected and how effective and fast the treatment has been. We
can encompass the resulting problems by grouping them into cognitive problems,
physical difficulties, emotional consequences and behavioral changes.
Rehabilitation will obviously depend on the consequences left by the encephalitis.
The longer the infection has lasted and the more severe it has been, the greater
the damage and the less function that will be recovered over time.

The main objective will always be to improve physical condition by rebuilding motor
activity, postural control and motor control. Correct work on stability at a proximal
level will therefore be essential to achieve good support and balance, always with a
functional objective adapted to the needs of each patient.

One of the most frequent consequences after having had encephalitis is feeling
fatigue, so work on respiratory level and effort training will be one of the objectives
to take into account. Other physical difficulties may appear, such as problems
controlling movements due to motor deficits (such as ataxia and other movement
disorders, which is why motor control is altered, resulting in difficult tasks such as
walking or reaching. objects, etc.) In addition to the motor control problems
mentioned, sensory changes and paresthesias may appear for which we will carry
out a sensory stimulation approach, offering the nervous system experiences that
can normalize this sensory alteration as much as possible. Of note are possible
hormonal changes, changes in sexual functioning, body aches, seizures,
drowsiness and lethargy.

Alzheimer disease

Alzheimer's Disease is the most common cause of Dementia and is considered a

complex, progressive and irreversible neuropsychological syndrome. The
neurodegenerative processes that are involved in Alzheimer's Disease
progressively affect the mental and physical abilities of affected people.

The consequences of the deterioration of these abilities (cognitive, motor) influence

the possibility of functionally carrying out the basic and instrumental activities of
daily life, that is, a set of activities that are fundamental for the well-being and
autonomy of each person ( dressing, eating and drinking, using the telephone, etc.)

The Physiotherapist plays a fundamental role in interventions aimed at slowing

down the progressive physical and cognitive deterioration of patients with
Alzheimer's.

Among the physical conditions that harm the patient with Alzheimer's and that are
also typical of having an advanced age, it is worth highlighting: joint and muscle
conditions (arthritis, osteoarthritis, joint stiffness, muscle contractures) and the
ability to coordinate, especially during March.

In particular, the fundamental role of the Physiotherapist is to prevent the

maintenance of Motor Function through the use of specific therapeutic techniques
and strategies (maintenance of basic activities of daily living, transfer training and
basic transfers such as the bed to chair, prevention of incontinence, physical
exercise, prevention of deformities and pressure ulcers).

The preservation of Motor Function is, in fact, very important in order to preserve
for as long as possible the autonomy and independence of the patient with
Alzheimer's within the environment in which they live.

Epilepsy

Epilepsy is a brain disorder in which a person has recurrent epileptic seizures.

Epileptic seizures are episodes of uncontrolled and abnormal activity of neurons
that can cause changes in attention or behavior. The cells fire rapidly, producing an
electrical storm that may be accompanied by motor or non-motor phenomena.

Physiotherapy can help patients with epilepsy, mainly with health education
programs: Reduction and elimination of triggering factors. Relaxation techniques.
Either through relaxing massage or through training in relaxation techniques.
Stress is a clear precipitating factor for seizures.

Respiratory physiotherapy. Promotes relaxation. It improves respiratory volumes,

which reduces the risk of suffering severe respiratory difficulties during future
crises. Treatment of injuries that occur during crises if there has been a fall:
bruises, contractures, fractures.

 Physiotherapeutic intervention. Assess physiotherapy intervention in

individuals with brain disease.

Neurological physiotherapy is a complex field of intervention, for which the

physiotherapist is required to maintain effective communication with the
interdisciplinary team and permanently reason about the scientific foundations on
which he bases his actions, in this way he will be able to propose with successful
therapeutic intervention strategies and techniques in clinical practice. In the field of
physical therapy, assessment refers to the collection of information necessary to
establish a conclusion about the patient's diagnosis and prognosis, and to decide
the most appropriate intervention. It consists of describing the patient's situation,
and the process involves an interpretation of the measurement results in the
context of other possible problems or existing defects. When evaluating the patient,
the physiotherapist must study the medical history and be aware of all the tests
that have been performed to reach the final diagnosis. It will also be important to
know their social history when setting goals and it will be good to know family
support and other factors such as personal tragedies that must be taken into
account, since they can affect the patient's emotionality and behavior. We must
pay attention, even before talking to the patient, about the figure, postural attitudes,
muscle atrophy, skin color, signs of poor health, neglect or malnutrition,
appearance of the skin, nails and hair; Also while carrying out the subsequent
anamnesis we will look at the mental state and functional activity. Anamnesis
Referring to the disease and any other aspect that concerns us in the patient such
as his family, work and social environment. During the interrogation we will not take
into account whether there is an alteration in language or hearing, as well as the
mental state to which we referred before Evaluation of sensory mechanisms
Hearing, vision, skin sensitivity, vibration (will be assessed with a tuning fork), joint
position ( see if the patient is able to recognize the position in which they have their
joints, of course without visual stimulation), body schema, perceptual problems or
stereognosia (ability to recognize objects through touch and manipulation). The
active and passive range of motion will be evaluated. Physiotherapeutic
assessment Clinical history and tests General impression History Assessment of
sensory mechanisms Joint and soft tissue mobility Variations in muscular activity
Functional assessment Assessment of voluntary muscle action Assessment of
speech Assessment of respiratory function. Electrical tests will be performed.
Physiotherapy in neurology of the Central Nervous System, variations in muscle
activity. The state of flaccidity, hypotonia, hypertonia will be assessed in passive
movements and through palpation. Functional evaluation We will evaluate the
possibility of performing movement combinations, balance in sitting and standing,
evaluation of coordination, smoothness and precision in movements. Evaluation of
voluntary muscle action The muscle balance will be scored from 0 to 5 as
described in topic 35 Kinesiology and Speech Evaluation It must be known if the
patient is able to speak and understand what is said to him, it would be It is good to
establish some common communication signs between therapists to understand a
patient who cannot speak. Respiratory function Thoracic mobility and respiratory
muscle strength will be evaluated. With electrical tests we can investigate the
intensity/time curves to see the degree of denervation of the muscles. And nerve
conductivity: we directly stimulate a nerve with short pulses and study its
responses. Electromyography: we record the electrical activity of muscle groups.
The first two tests can be performed by physiotherapists. Taking into account
physiotherapeutic objectives Brain and spinal cord injuries cannot be modified with
any treatment, but they give rise to a series of symptoms that can be relieved by
physiotherapy treatment; We can also establish various compensations or
neurological re-education that attempt to integrate the subject into their work and
daily activities. The main objective will be to restore the patient's maximum
functional capacity so that they can achieve independence. To do this we will try to:
Relieve disabling symptoms (especially spasticity); Train the functions that remain
in the patient to compensate for the lost functions; Prevent contractures and
deformities; Maintain and improve joint mobility and Teach the patient to live and
compensate for their disability.
The physiotherapy treatment of people with acquired brain damage is based on the
understanding and management of the body as a functional unit and the pathology
as a global, variable and individual organic response. That is, the treatment has a
holistic approach to the person, considering them globally.
Physiotherapy in this field seeks to prevent complications, improve strength,
coordination and joint ranges, as well as righting and balance responses.