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10 - Rehabilitation > 10-01 Motor Control, Motor Learning, and Stages of Motor Control > Flashcards

10-01 Motor Control, Motor Learning, and Stages of Motor Control Flashcards

1
Q

Three parts of Motor Function (3)

A
  • Motor Control
  • Motor Recovery
  • Motor Learning
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2
Q

Motor Control

A
  • Area of study dealing with the understanding of the neural, physical and behavioral aspects of movement
  • How brain communicates with rest of body on everything related to movement
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3
Q

Motor Skill

A
  • Purposeful and functionally-based motor skill

- Learned through interaction and exploration of the environment

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4
Q

Motor Plan (Complex Motor Program)

A
  • Idea or plan for purposeful movement
  • Brain creates plan of action over time
  • Concept –> brain, neuron, neurotransmitter –> movement
  • Takes in sensory input and creates motor output
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5
Q

Motor Program

A
  • A set of commands that results in production of coordinated movement
  • Possible contributions: synergistic component parts, force, direction, timing, duration, extent of movement
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6
Q

Motor Memory (Procedural Memory)

A
  • Recall “sub-routines” of the motor program
  • Recall = Performing movement without thought (muscles remembering)
  • Ex: Typing
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7
Q

Components of Motor Memory (4)

A
  • Initial movement conditions
  • Sensory input: How movement felt, looked, sounded
  • Specific movement parameters (Ex: force needed to guide movement)
  • Outcome of the movement
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8
Q

Neuroplasticity

A
  • Ability of the CNS to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections
  • Ability of brain to change or repair itself
  • Ex: Learning new task, recovery from damage/injury
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9
Q

Occurrences of neuroplasticity

A
  • During development
  • Response to environment
  • Support learning
  • Response to disease
  • Relationship to therapy
  • Ex: Re-routing of neuron synapses, chemical changes
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10
Q

Adaptive neuroplasticity

A
  • Good, positive change
  • What PTs/PTAs want to see
  • Re-routing occurs (creates new routes in brain)
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11
Q

Mal-Adaptive neuroplasticity

A
  • Does not generate new route

- Allows compensation/change to complete task vs. doing task properly

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12
Q

Damages to CNS

A
  • Interferes with motor function processes
  • Lesions produce specific, consistent, recognizable deficits
  • Individual differences in CNS plasticity, recovery, functional outcomes (patients will prevent differently, although same affected area)
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13
Q

Motor Learning

A
  • CNS integrates vast amount of sensory and motor information to produce motor action
  • “Perfect practice makes perfect” (Not perfect can lead to mal-adaptive neuroplasticity)
  • Leads to permanent change for skilled behavior (retention)
  • Ex: riding a bike
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14
Q

PTA Requirements for motor learning

A
  • Determine that skill is important to patient (desirable and realistic for pt to learn)
  • Demonstrate task exactly as it should be done
  • Relate skill to skill/situation that pt is familiar; pt uses past experiences as subroutines
  • Clear and concise verbal instructions and VC
  • Allow for trial and error
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15
Q

Feedback

A
  • Response-produced info received during or after a movement used to monitor output for corrective actions
  • Intrinsic (inherent) - as natural part of movement (visual, proprioception)
  • Extrinsic (augmented) - info received from outer influences (verbal/tactile cues, visual, biofeedback)
  • Concurrent - occurs during movement
  • Terminal - occurs after movement`
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16
Q

Feedforward

A
  • Sending of signals in advance of movement to ready sensorimotor system
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17
Q

Dynamical Systems Control Theory

A
  • Organized around specific task demands
  • Larger areas of CNS needed for complex tasks
  • Higher CNS levels not used for simple (or discrete) tasks
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18
Q

Hierarchical Control Theory

A
  • Organized top-down (High to low)
  • High: organize sensory info, decision-making (association cortex, basal ganglia)
  • Middle: Define specific motor programs, initiate commands (sensorimotor cortex, cerebellum, basal ganglia, brainstem)
  • Lower: Execute movement (spinal cord)
  • Inital skill acquisition: Higher levels needed
  • As motor learning develops, only lower levels activated for motor programming
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19
Q

Validity

A
  • Test measures the parameter that it says it measures
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20
Q

Reliability

A
  • Consistency of results obtained by a tester
  • Intra-rater: single examiner over repeated trials
  • Inter-rater: several examiners over repeated trials
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21
Q

Sensitivity

A
  • True positive

- Proportion of times a method of analysis identifies present abnormality

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22
Q

Specificity

A
  • True negative

- Proportion of times a method of analysis identifies absent abnormality

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23
Q

Stages of Motor Control (4)

A
  • Mobility
  • Stability
  • Controlled mobility
  • Skill
  • Can develop levels in order, but should work on simultaneously
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24
Q

Mobility

A
  • Transitional mobility
  • Ability to move from one position to another (Ex: supine –> sidelying, supine –> prone)
  • Ability to initiate movement through functional ROM (Ex: CVA pt ability to move arm)
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25
Q

Stability

A
  • Static postural control
  • Ability to maintain position/posture through co-contraction and tonic holding around a joint with COM over BOS with body not in motion
  • Ex: unsupported sitting in midline, alternating isometric contractions
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26
Q

Controlled mobility

A
  • Dynamic postural control
  • Ability to move within WB position or rotate around long axis (move COM away from BOS and back)
  • Ability to maintain postural stability and orientation with COM over BOS while parts are in motion
  • Ex: POE activities, quadruped WS
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27
Q

Static-dynamic control

A
  • Static-dynamic controlled mobility

- Maintain posture while moving one or more limbs

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28
Q

Skill

A
  • Ability to consistently perform functional tasks and manipulate environment with normal postural reflex mechanisms/balance reactions
  • Consistently doing activity in uncontrolled environment
  • Ex: community locomotion
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29
Q

Elements of Motor Function (10)

A
  • Consciousness and arousal
  • Cognition
  • Sensory integrity and integration
  • Joint integrity, postural alignment and mobility
  • Tone
  • Reflex integrity
  • Cranial nerve integrity
  • Muscle performance
  • Voluntary movement patterns
  • Postural control and balance
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30
Q

Consciousness

A
  • Ascending reticular activating system: brainstem
  • Arouse, awaken, sleep-wake cycles
  • 5 levels: consciousness, lethargy, obtundation, stupor, coma
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31
Q

Consciousness (Level)

A
  • State of alertness and awareness of surroundings
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32
Q

Lethargy

A
  • Slow motor processing
  • Drowsy, but opens eyes and responds briefly
  • Easily falls asleep, impaired focus
  • Requires constant stimulation
  • Speak loudly, ask simple questions
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33
Q

Obtundation

A
  • Dull or blunted sensitivity
  • Difficult to arouse, slow responses
  • When aroused, appears confused and demonstrates little interest or awareness
  • Longer period of time than lethargy
  • Little awareness of environment
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34
Q

Stupor

A
  • Semi-consciousness
  • Lacks responsiveness
  • Requires strong stimulus (often painful) to arouse
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35
Q

Coma

A
  • Unconscious patient, unable to arouse
  • Eyes open
  • No sleep-wake cycle
  • No response to painful stimuli
  • Generally time-limited
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36
Q

Minimally conscious (vegetative) state

A
  • Return of irregular sleep-wake cycles
  • Normalization of vegetative functions: respiration, digestion, BP
  • Aroused, unaware of environment
  • No purposeful or cog responsiveness
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37
Q

Persistent vegetative state

A
  • Vegetative state for 1 year or more
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38
Q

Cognition (4)

A
  • Orientation
  • Attention
  • Memory
  • Executive or higher cog functions
39
Q

Focal deficits

A
  • Only one or a few cog deficits
40
Q

Diffuse (profuse) or multifocal or global deficits

A
  • Deficits across many areas of cog function
41
Q

Orientation

A
  • Time, place, person, circumstance
  • A + O x3: time, place, person
  • A + O x4: time, place, person, circumstance
42
Q

Attention

A
  • Capacity of the brain to process info from environment or from long-term memory
  • 4 types: selective, sustained, alternating, divided
43
Q

Selective attention

A
  • Screen and process relevant info while screening out irrelevant info
  • Can function in busy environment; focus on specific conversation and block others
44
Q

Sustained attention

A
  • Length of time pt maintains attention
45
Q

Alternating attention

A
  • Switching attention between two different tasks (adding 2 numbers, then subtracting 2 numbers)
46
Q

Divided attention (dual task)

A
  • Perform 2 tasks simultaneously

- Ex: Walk and talk or walk and text

47
Q

Elements of Memory (3)

A
  • Acquisition/Learning (Registration)
  • Storage/Retention
  • Retrieval/Recall
  • Memory is like card catalog, store info till you need to recall
48
Q

Short-term memory

A
  • Capability to remember day to day events, learn new material and retrieve after minutes, hours or days
49
Q

Long-term memory

A
  • Recall facts or events such as birthdates or anniversaries
50
Q

Amnesia

A
  • Memory deficits

- Usually no long-term memory

51
Q

Anterograde (Post-traumatic) amnesia

A
  • Inability to learn new info
52
Q

Retrograde amnesia

A
  • Inability to remember previously learned info prior to insult to brain
53
Q

Higher cognitive functions (4)

A
  • Info and vocabulary
  • Calculations (time, measurements)
  • Abstract thinking (problem solving)
  • Constructional ability (ability to copy figures)
54
Q

Dysarthria

A
  • Speech articulation deficits

- Speech errors, timing, vocal quality, pitch, volume, breath frequency

55
Q

Receptive aphasia

A
  • Wernicke’s aphasia = fluent aphasia
  • Pt can talk, but does not understand
  • Left-sided damage (CVA, TBI)
56
Q

Expressive aphasia

A
  • Broca’s aphasia = non-fluent aphasia
  • Pt has difficulty talking, but understands
  • Left-sided damage (usually not TBI)
57
Q

Global aphasia

A
  • Worst of both worlds

- Receptive + Expressive aphasia

58
Q

Sensory integrity and integration

A
  • Sensory info is necessary for motor function
  • Provides feedback for initial movement
  • Detects errors during movement
  • Provides outcome info that can assist in learning for future movement
59
Q

Tone (4)

A
  • Resistance of muscle to passive elongation or stretch
  • Hypertonia (Spasticity, Rigidity)
  • Hypotonia (Flaccidity)
  • Dystonia (Disordered, impaired)
  • Decorticate and Decerebrate Rigidity
  • Document type of tone present, affected body segments, activity that caused tone to change
60
Q

Spasticity

A
  • Velocity-dependent
  • Upper Motor Neuron (UMN) sign: lesion on corticospinal segment of brain
  • Clasp-knife response
  • Clonus
  • Positive Babinski sign
61
Q

Rigidity

A
  • Increase tone through ROM regardless of velocity (fast or slow)
  • Lead pipe rigidity - Not going to move
  • Cogwheel rigidity (Ratchet-like) - Give-hold, give-hold
  • Lesions of Basil Ganglia (i.e., Parkinson’s)
62
Q

Hypotonicity

A
  • Lack of resistance to passive stretch
  • Flaccidity (no tone) or very low tone
  • Lower motor neuron (LMN): Anterior horn, peripheral nerves affected
63
Q

Dystonia

A

Hyperkinetic, disordered tone and involuntary movements

64
Q

Decorticate posturing

A
  • Abnormal flexor pattern; sustained contraction and posturing; pretty severe brain damage (globally)
  • UE in flexion (elbows, wrist, fingers, flexed with shoulder adduction)
  • LE in extension (extension, IT, plantarflexion)
65
Q

Decerberate posturing

A
  • Abnormal extensor pattern; sustained contraction of trunk and extermities (except wrist flexion)
66
Q

Reflex integrity (3)

A
  • Deep tendon reflexes (DTRs)
  • Superficial cutaneous reflexes
  • Primitive reflexes
67
Q

Deep Tendon Reflexes (DTRs)

A
  • Tapping over tendon
68
Q

Superficial cutaneous reflexes

A
  • Light touch to skin elicits muscle activation
69
Q

Primitive Reflexes

A
  • Appears at infancy

- Integrate into CNS early on

70
Q

Cranial Nerve Integrity

A
  • 1, 2, 8 = Sensory
  • 3, 4, 6, 11, 12 = Motor
  • 5, 7, 9, 10 = Mixed
71
Q

Muscle Performance

A
  • Capacity of m to generate force
72
Q

Muscle Power

A
  • Amount of work produced per unit of time
73
Q

Muscle Endurance

A
  • Ability of muscle to contract over a period of time
74
Q

Atrophy

A
  • Lack of LMN innervation

- Disuse “Use it or lose it”

75
Q

Synergy

A
  • Movement patterns
  • Voluntary, used functionally
  • Abnormal mass synergies: Obligatory, stereotypical
76
Q

Synergies

A
  • Based on Hierarchial Control Theory
  • Damage to brain –> higher centers damaged
  • Higher centers control complex motor patterns, Inhibition of massive gross motor patterns; higher centers lose control, middle and lower centers emerge
77
Q

Postural Control

A
  • Ability to maintain body in equilibrium or to control body’s position in space for stability and orientation
  • COM over BOS
78
Q

Postural Orientation

A
  • Ability to maintain normal alignment relationships between various body segments, and between body and environment
  • Aligns to environment
79
Q

Postural Stability Control

A
  • Static equilibrium, static balance or stability

- Ability to maintain stability and orientation with the COM over the BOS with body at rest

80
Q

Dynamic Postural Control

A
  • Dynamic equilibrium, dynamic balance or controlled mobility
  • Ability to maintain stability and orientation with the COM over the BOS while parts of the body are in motion
81
Q

Goals of Postural Control

A
  • Improve static balance
  • Improve dynamic balance
  • Improve adaptation of balance skills for varying task and environmental conditions
  • Improve sensory function
  • Improve safety awareness and compensatory strategies to effect fall prevention
82
Q

Causes of Static (stationary) Balance Deficits (6)

A
  • Decreased strength
  • Tonal imbalances (Spasticity in one area can affect balance)
  • Impaired voluntary control
  • Hypermobility (ataxia, athetosis)
  • Sensory hypersensitivity (tactile defensive)
  • Increased anxiety or arousal
83
Q

Signs of Postural Instability (5)

A
  • Excessive postural sway
  • Wide BOS
  • High guard hand position
  • Requires hand hold assistance
  • LOB
84
Q

Strategies for Intervention (3)

A
  • Guidance
  • Feedback
  • Practice
85
Q

Recovery of Function (3)

A
  • Spontaneous recovery
  • Function-induced recovery
  • Compensation
86
Q

Spontaneous Recovery

A
  • Occurs immediately after insult to CNS
  • Neuronal changes due to repair processes of brain
  • Can result in function being restored in neural tissue initially lost
87
Q

Function-induced Recovery (9)

A
  • Challenge pt to get benefit of exercise
  • Use it or lose it
  • Repetition is important - need significant amount of repetition
  • Intensity is important
  • Use and shape to pt ability (modify with progress)
  • Enhance selection of behaviorally important stimuli
  • Enhance attention and feedback
  • Target goal-directed skills (As pt or family what goals are for PT)
  • Timing is important
  • Age
88
Q

Compensation

A
  • Using alternate strategies to complete a task
  • New motor patterns appear from adaptation of remaining motor elements or substitution or alternate motor strategies and body segments
  • Mal-adaptative neuroplasticity may kick in
89
Q

Guidance

A
  • Physically assist only as much as is needed
  • PTA provides missing “piece”
  • Tactile and kinesthestic input (guide movement, where you touch pt matters)
  • Decrease guidance as proficiency increases
90
Q

Practice

A
  • Must correctly perform
  • Plan breaks strategically
  • Blocked practice vs. random practice
  • Practice order
  • Mental practice
  • Transferring to other situations or environments
91
Q

Blocked practice

A
  • One task performed repeatedly, uninterrupted by repeated task
92
Q

Random practice

A
  • Tasks practiced, order of test is random
93
Q

Neurodevelopmental postures and potential treatment benefits (7)

A
  • POE
  • Quadruped
  • Bridging
  • Sitting
  • Kneeling and half kneeling
  • Modified plantargrade
  • Standing

10 - Rehabilitation (25 decks)

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