Ch. 18 Pedretti -- Motor Control Theory and Neuroplasticity

Question 1

How does learning occur?

Answer 1

Learning theoretically occurs as a result of neuroplasticity, and it is assumed that new neuronal connections and axonal sprouting occur within the CNS through multisensory input

Question 2

Current OT trends to ameliorate UE hemiparesis as a result of UMN lesions

Answer 2

Current trends in OT to ameliorate UE hemiparesis as a result of UMN lesions are varied, but research suggests including occupations and how a person interacts with their task and environment is beneficial. This is supported by basic and applied neuroscience concepts that imply that skilled interaction associated with a client’s task performance in an environment may direct cortical changes and facilitate neuromuscular recovery.

Question 3

Task-oriented approach (TOA)

Answer 3

Dynamic interaction between person, task, and environment is consistent with framework provided by the task-oriented approach (TOA). Application of the TOA directs OTs to address the performance skill deficits while simultaneously incorporating current understandings of neuroscientific concepts

Question 4

Client factors

Answer 4

The OTPF identifies client factors and performance skills as two separate elements. To understand how client factors influence occupational performance, OT must thoroughly determine how these components affect performance skills during occupational performance.
Identify strategies that maximize performance skills.

Question 5

Why are client factors related to body and structure function important?

Answer 5

Client factors related to body and structure function are important because they inform the OT process and contribute to how these functions contribute to evaluation proves and development of intervention plan

Question 6

What do client factors identified at the level of person include?

Answer 6

Client factors identified at the level of person include neuromusculoskeletal functions related to strength, muscle tone, motor reflexes, and voluntary/involuntary movement

Question 7

Global and specific mental functions are important client factors that support what?

Answer 7

Global and specific mental functions are important client factors that support incorporation of input gained by interactions between person, task and environment. These mental functions (deemed cognition) are required to make sense of sensorimotor input from environment and are important to overall functional ability. As they relate to UMN cortical lesions, these client factors may result in peripheral soft tissue changes, hypertonia, spasticity, and ROM changes.

Question 8

How do client factors differ from performance skills

Answer 8

Client factors differ from performance skills in that they represent responses to system control

Question 9

What are some examples of what client factors?

Answer 9

Client factors often can be measured/quantified and include strength, ROM, visual acuity, muscle tone, and attention.

Question 10

What do client factors represent?

Answer 10

Client factors represent bodily functions and what the body does, rather than what the person does. AKA client factors are the actual body structures and basic body functions. They also represent what a person can utilize to perform a particular task (or in other words, can facilitate performance skills) but merely assessing client factors is not predictive of occupational performance

Question 11

What do performance skills include

Answer 11

Includes the motor and praxis, sensory-perceptual, emotional regulation, and cognitive and communication/social skills required to perform specific tasks. Therefore, must be assessed while client is engaged in an occupation

Question 12

Motor and praxis skills are required for what?

Answer 12

Motor and praxis skills along with sensory-perceptual skills are required in adequate and appropriate amounts for an individual to interact with an object in the environment during performances of a task in an accurate and timely manner

Question 13

The ability to _____ is an aspect of cognitive performance skills linked to overall occupational performance.

Answer 13

The ability to judge/respond to task demands is an aspect of cognitive performance skills linked to overall occupational performance

Question 14

Another way of looking at client factors and performance

Answer 14

Another way of looking at client factors and performance skills is that a person might present with specific deficits (client factors) that affect performance skills, which may then affect occupational performance

Question 15

Research on TOA

Answer 15

Research indicates that the TOA is more likely to be effective when compared with treatment that addresses client factors only. Neuroscientific research is pointing toward the possibility that the CNS is organized in such a way that tasks can be addressed through interaction with the environment rather than with specific muscle groups meant to perform specific tasks. This is consistent with TOA.

Question 16

What is motor control theory?

Answer 16

Motor control theory is the ability to make dynamic changes in/responses of body and limb to complete a purposeful activity. Interaction among task, person, and environment represent aspects of motor control

Question 17

What leads to more efficient movement patterns?

Answer 17

Sources indicate that multisensory input will provide the nervous system with input, which ultimately leads to improved quality of movement performance and decreased error → more efficient movement patterns

Question 18

How do multi-sensory inputs contribute to understanding of the environment?

Answer 18

These multisensory inputs to learning/relearning, whether intact or not, work together to contribute to our understanding of interaction with the environment. When one is impaired, others may need to compensate. Poor/inefficient movement patterns may result from compensatory strategies → overuse patterns/syndromes may emerge, and the net result is potentially poor efficacy with occupational performance

Question 19

Is repetition alone effective for cortical reorganization?

Answer 19

Repetition alone as part of a neuromuscular rehab approach is insufficient to create/reinforce cortical organization. Must utilize meaningful activities as well as intense task-oriented training of the sensorimotor cortex in order to result in cortical reorganization

Question 20

How hard is it to change movement/behavior of a person?

Answer 20

Motor learning concepts indicate that the degree to which a task is learned is positively correlated with the depth of the “well” in which it is kept. In other words, the more ingrained a task is to a person, the more challenging it may be to change the movement/behavior

Question 21

What is a control parameter?

Answer 21

Control parameter is a motor control term that pertains to anything that shifts a motor behavior from one manner of performance to another type of performance. Control parameters can be internal to the person (such as strength, vision) or external (such as location of an object, lighting).

Question 22

What happens when a control parameter is a client factor?

Answer 22

When the control parameter is a client factor, the OT may attempt to address/remediate it. This approach to the OT process (bottom-up approach), assumes the fundamental client factors will allow the OT to interact with the client to improve performance. Yet, unless it is a meaningful activity, the intervention will likely be unsuccessful

Question 23

Fundamentals of experience-driven neuroplasticity include what?

Answer 23

Fundamentals of experience-driven neuroplasticity include the adaptive capacity of the CNS to make fundamental changes and alterations on the cellular and eventually systems level, which can lead to new behavior. Key critical “signals” can facilitate such recovery

Question 24

Maladaptive behavior s/p insult to brain

Answer 24

The brain constantly reorganizes itself, with or without damage. This process of learning will occur spontaneously, with no explicit rehab. Lack of therapeutic intervention may lead to maladaptive responses. It is skilled learning that occurs through the use of strategies and adaptations to facilitate this adaptive response. This has been shown to occur with TOA. Focus on the performance skill in therapy allows the opportunity for skilled learning to occur

Question 25

Modifying a task or environment includes what 10 principles that fit the process?

Answer 25

1. Use it or lose it, 2. Use it and improve it, 3. Specificity, 4. Repetition matters, 5. Intensity matters, 6. Time matters, 7. Salience matters, 8. Age matters, 9. Transference, and 10. Interference
   These principles come from basic and applied neuroscience concepts and can influence outcomes and support evaluation/treatment

Question 26

Effective evaluation of a client who presents with upper limb hemiparesis should be based on what?

Answer 26

Effective evaluation of a client who presents with upper limb hemiparesis should be based on a thorough understanding of the specific impairments (client factors) that affect the performance of occupation-based, client-centered tasks. Focus should be on performance skills and patterns. Observation of the client strategy with use of remaining abilities as it relates to overall function is important part of evaluation process

Question 27

Comprehensive evaluation with respect for the TOA requires a thorough assessment of _____, ______, and ____.

Answer 27

Comprehensive evaluation with respect for the TOA requires a thorough assessment of impairment, strategy and function

Question 28

Specific impairments are those that occur as a result of an UMN lesion

Answer 28

Impairments include (but not limited to) weakness (of the agonist), coordination, decreased in-hand manipulation, inability to manage agonist/antagonist efficiently, impaired/absent sensation, proprioception, impaired vision, and decreased overall cognitive ability. These can be measured via MMT, ROM testing, grip strength, etc.

Question 29

The benefit derived from the use of the TOA with respect for current nonscientific concepts such as cortical neuroplasticity is what?

Answer 29

The benefit derived from the use of the TOA with respect for current nonscientific concepts such as cortical neuroplasticity is that OT practices a top-down approach rather than bottom up

Question 30

Cortical reorganization

Answer 30

Cortical reorganization is the concept that the adult brain has a neuroplastic ability to alter or modify its synaptic connections in the context of performance of a skilled activity – whether or not the brain and the CNS are intact

Question 31

Northstar Neuroscience Phase III Clinical Trial

Answer 31

A study that investigated potential benefits of sub-threshold cortical stimulation in combination with skilled learning via a therapy protocol grounded in the TOA. Offers promising future benefit as clients demonstrated improvement in COPM measures

Question 32

Task-specific training study of squirrel monkeys

Answer 32

One study demonstrated that applying skilled learning principles, it is possible to create topographical cortical map changes that directly correspond to specific distal forelimb tasks after focally induced cortical lesions appear in these particular representative areas in squirrel monkeys. Task specific training can lead to increased cortical representation of the trained areas, along with decreased representation of the previously post-infarct compensatory areas. The net result was acquiring performance skills in the primates was improved quality of movement. Applying this theory to humans should be done with caution as some variables still need to be clarified

Question 33

Adaptive plasticity

Answer 33

Adaptive plasticity is the innate ability of the CNS to adapt or modify behavioral responses after exposure to a challenge to the system

Question 34

Contrived activities

Answer 34

Contrived activities are those that are artificially created often in an attempt to re-create real scenarios. If a task is too contrived, it may affect performance and corresponding measurement of performance. Real performance of activities leads to difference and better results

Question 35

Plateau

Answer 35

Plateau is a common term in the realm of rehab practice with persons with upper limb hemiparesis. The clinical reasoning process may affect how performance plateaus are determined in clinical practice

Question 36

The way in which therapists frame the upper limb hemiparetic population

Answer 36

The way in which therapists frame the upper limb hemiparetic population may need to be reconsidered, so what defines 1. Motor recovery plateau, 2. Ability to recover motor function, and 3. When to used different modalities may have to be reconsidered

Question 37

Best practice

Answer 37

As a guide for best practice, principles to be used include tasks relevant to the client, be randomly assigned, be repetitive and involve massed practice, aim towards reconstruction of the whole task, and be reinforced with positive and timely feedback