Ch. 18 Pedretti -- Motor Control Theory and Neuroplasticity Flashcards
How does learning occur?
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
Current OT trends to ameliorate UE hemiparesis as a result of UMN lesions
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.
Task-oriented approach (TOA)
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
Client factors
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.
Why are client factors related to body and structure function important?
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
What do client factors identified at the level of person include?
Client factors identified at the level of person include neuromusculoskeletal functions related to strength, muscle tone, motor reflexes, and voluntary/involuntary movement
Global and specific mental functions are important client factors that support what?
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.
How do client factors differ from performance skills
Client factors differ from performance skills in that they represent responses to system control
What are some examples of what client factors?
Client factors often can be measured/quantified and include strength, ROM, visual acuity, muscle tone, and attention.
What do client factors represent?
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
What do performance skills include
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
Motor and praxis skills are required for what?
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
The ability to _____ is an aspect of cognitive performance skills linked to overall occupational performance.
The ability to judge/respond to task demands is an aspect of cognitive performance skills linked to overall occupational performance
Another way of looking at client factors and performance
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
Research on TOA
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.
What is motor control theory?
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
What leads to more efficient movement patterns?
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
How do multi-sensory inputs contribute to understanding of the environment?
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
Is repetition alone effective for cortical reorganization?
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
How hard is it to change movement/behavior of a person?
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
What is a control parameter?
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).
What happens when a control parameter is a client factor?
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
Fundamentals of experience-driven neuroplasticity include what?
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
Maladaptive behavior s/p insult to brain
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
Modifying a task or environment includes what 10 principles that fit the process?
- 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
Effective evaluation of a client who presents with upper limb hemiparesis should be based on what?
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
Comprehensive evaluation with respect for the TOA requires a thorough assessment of _____, ______, and ____.
Comprehensive evaluation with respect for the TOA requires a thorough assessment of impairment, strategy and function
Specific impairments are those that occur as a result of an UMN lesion
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.
The benefit derived from the use of the TOA with respect for current nonscientific concepts such as cortical neuroplasticity is what?
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
Cortical reorganization
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
Northstar Neuroscience Phase III Clinical Trial
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
Task-specific training study of squirrel monkeys
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
Adaptive plasticity
Adaptive plasticity is the innate ability of the CNS to adapt or modify behavioral responses after exposure to a challenge to the system
Contrived activities
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
Plateau
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
The way in which therapists frame the upper limb hemiparetic population
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
Best practice
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
