Exam 1 Flashcards
What 3 components make up Motor Behavior?
Motor Control
Motor Learning
Motor Development
What is motor control?
The study of the neural, physical, and behavioral aspects of movement (typically LE and gait)
What is motor learning?
Refers to the relatively permanent gains in motor skill capability associated with practice or experience (usually UE function; CVA)
What is motor development?
Refers to the continuous, age-related process of change in movement
Motor Control Definition
Ability to regulate or direct the mechanisms essential to movement
Benefits of Motor Control Theories?
Provides philosophy about how the brain controls movement (predicts how behavior should turn out)
Framework for interpreting behavior (use theory to hypothesize how it will develop)
What are the Motor Control Theories?
Reflex Theory Hierarchical Theory Motor Programming Theories Systems Theories Ecological Theory
What are control parameters?
Factors that impact attractor state (speed that forces you to run)
Infant Behavior and Development Reflex
When submerged in water, stepping pattern reappears
Added fat mass prevents the step from occurring
Older infants stop stepping when weight is added to the limbs
As the mass is taken away in water, the stepping motion reappears
Dynamical Systems Theory
Movement emerges from the interactions between the individual, the task, and the environment in which the task is being carried out
Movement is not solely the result of the muscle - specific motor programs, or stereotyped reflexes, but results from a dynamic interplay between perceptual, cognitive, and actions systems (neuromuscular and musculoskeletal system)
Systems Theories Clinical Implications
Stresses understanding body as mechanical system
Movement is emergent property
Retraining movement in patients with neural pathology
What components make up the Nature of a Movement?
Task
Individual
Environment
What factors impact the Task?
Mobility
Postural Control
Upper Extremity Function
What factors impact the Individual?
Cognitive
Sensory/Perception: essential to
Motor/Action:
What factors impact the Environment?
Regulatory
Nonregulatory
Motor/Action (Individual)
Study of the neuromuscular and biomechanical systems that control functional movements
Sensory/Perceptual Systems (Individual)
Essential to control of functional movement
Perception: integration of sensory impressions into psychologically meaningful information
Provide information about the state of the body
Integral to ability to act effectively within an environment
Cognitive Systems (Individual)
Essential to motor control
Attention, planning, problem-solving, motivation, and emotional aspects of motor control that underlie establishment of intent or goals
Have patients walk and cross over an obstacle
Categories of Movement (The Task)
Discrete vs Continuous
Stability vs Mobility
Manipulation
Closed vs Open Movement Tasks
Categories of Movement (The Environment)
Regulatory Factors (ball, BOS)
Non-Regulatory Factors (lights, cheering)
Open vs Closed
What are the phases of the Integration of Movement Analysis?
Initial conditions: Posture; Ability to interact with the environment; Environmental Context
Preparation: Stimulus Identification; Response Selection; Response Programming
Initiation: Timing; Direction; Smoothness
Execution: Amplitude; Direction; Speed; Smoothness
Termination: Timing; Stability; Accuracy
Outcome: Outcome Achieved?
Body functions
Physiological functions of body systems
Body Structures
Anatomical parts of the body
Impairments
Problems in body function or structure such as a significant deviation or loss
Activity
Execution of a task or action
Participation
Involvement in a life situation
Activity Limitations
Difficulties in executing activities
Participation Restrictions
Problems in involvement in life situations
Environmental Factors
Make up the physical, social, and attitudinal environment in which they live
Phases of Motor Plan
Preparation for motor plan (somatosensory and visual system)
Customization of the motor plan (frontal lobe, basal ganglia, cerebellum which continuously communicates with the brain stem and thalamus)
Execution of the motor plan (Primary motor area of precentral gyrus, pyramidal cells in cortocospinal and corticobulbar tracts, skeletal muscles
What is a Task Oriented Approach?
Integrates a systems theory approach with concepts from rehabilitation science
What are the assumptions of a Task Oriented Approach?
Movement is organized around behavioral goal and environmental constraints
Movement is the result of interaction of different systems
Focus on functional task rather than on movement patterns just for the sake of movement
Patient should be involved in problem solving
Adaptability is key
Task Oriented Approach to Evaluation
Integrates with the ICF model to give a rounded view of the patient
Evaluate functional activities and participation restrictions
Describe the strategies used to accomplish the tasks
Quantify underlying impairments
Acknowledge contextual factors = environmental and personal factors
Task Oriented Approach to Intervention
Resolve, reduce or prevent impairments @ Body Structure/Functional Level
Effective and Efficient Task-Specific Strategies: find ways to really teach patients so they learn best
Change Task and Environmental Conditions to maximize participation and independence
All steps occur simultaneously
Task Oriented Approach to Exam
Evaluate functional activities and participation restrictions
Describe the strategies used to accomplish the tasks
Quantify underlying impairments
Acknowledge contextual factors: environmental and personal factors
What are the 4 main concepts of motor learning?
A process of acquiring the capability of skilled action
Results from experience or practice
Cannot be directly measured but is inferred from behavior
Produces permanent changes in behavior (short term changes are not thought of as learning)
Motor Learning vs Performance
Performance: temporary change in motor behavior following practice (needs more practice to be permanent changes)
Motor Learning: permanent changes in motor behavior
What is the Retention Test?
Slower treadmill belt has shorter step length compared to faster, but move to symmetrical strides when tempos are moved back to the norm
What is the Transfer Test?
Able to get symmetrical stride on the treadmill, but once they walk on the ground, they lose the symmetry
What are the two types of long-term memory?
Non-declarative (Implicit)
Declarative (Explicit)
What are the 3 types of non-declarative learning?
Non-associative
Associative
Procedural
Non-associative Learning
Animals given stimulus repeatedly
Habituations: decrease in responsiveness as result of repeated exposure to non-painful stimulus
Sensitization: increased responsiveness following threatening or noxious stimulus
Associative Learning
Predicts relationships through classical or operant conditioning
Classical and operant
Classical Conditioning
Learning to pair two stimuli (Pavlov’s Dog)
Operant (Instrumental) Conditioning
Trial-and-Error learning
Procedural Learning
Learning tasks automatically without attention or conscious thought
Declarative (Explicit) Learning
More reflexive, automatic, or habitual
Frequent repetition for its formation
Knowledge that can be consciously recalled
Processes as awareness, attention, and reflection
Ability to remember factual knowledge
4 Types of Declarative Learning Processing
Encoding
Consolidation
Storage
Retrieval
Schmidt’s Schema Theory
Emphasis on generalized motor programs
Based on Motor Programming Theory of Motor Control Theories
Focused on closed-loop processes
Newell’s Ecological Theory
Emphasis on integration of perceptual/motor systems
Based on Systems and Ecologic Theory
Focus on dynamic exploration workspace/task in order to create optimal movement strategies
Augmented feedback
What is a Schema?
An abstract representation stored in memory following multiple presentations
Schmidt’s Schema Theory Info Storage
Stored in short-term memory following completion of movement
Initial movement conditions (positions of the body, weight of the object)
Parameters used in the generalized motor programs (temporal and spatial information)
Outcome of movement (knowledge of results)
Sensory consequences
What are the 2 types of Schema?
Recall
Recognition
Recall Schema
Used to select movement responses
Adds parameters of movement as data point reference
Recognition Schema
Used to evaluate response
Focuses on sensory consequences
Schema is modified as a result of sensory feedback and knowledge of results
Schema Theory Clinical Implications
Optimal learning occurs with variable practice conditions
Schema Theory Limitations
Too vague to test
Inconsistent experimental support
Cannot account for one-trial learning (in the absence of schema)
What is practice?
Improved coordination between patient perception and action that is consistent with the task and the environment
What is the goal of Newell’s Ecological Theory?
Identify the optimal strategy: perceptual information or action-based
What is a Regulatory Cue?
Perceptual cue that is critical for completion of the task
Perceptual information includes feedback
Ways to augment learning?
Help learner understand nature of the workspace
Understand the normal search strategies utilized by performers
Provide the learner with information to facilitate the search of environment/task
Ecological Theory Clinical Implications
Patient must learn to distinguish perceptual cues important to organizing action
Visual cues: look at the environmental cues that help them with that task
Ecological Theory Limitations
New theory that is yet to be applied to specific examples of motor skill acquisition in any systematic way
Fitt’s and Posner 3 Stage Model of Motor Learning
Cognitive Stage: Requires high degree of cognitive activity (attention)
Associative Stage: less cognitive contributions as focus is on refining the movement
Autonomous Stage: Low degree of attention with skill being automatic
Bernstein’s 3 Stage Model of Motor Learning
Novice Stage: Learner constrains degrees of freedom in order to simplify task
Advanced Stage: Releasing degrees of freedom at additional joints
Expert Stage: All joints are released to produce the most efficient and coordinated movement
Bernstein’s Approach Clinical Implications
Explanation for presence of coactivation of muscles during early stages of acquiring motor skill
New rationale for using developmental stages in rehabilitation
Importance of providing external support during early phases of learning motor skill
Gentile’s 2 Stage Model of Motor Learning
Based the goal of the learner
Stage 1: understand the task dynamics
Stage 2 (fixation/diversification stage): refine movement
What is the Stage of Motor Program Formation?
Based on hierarchical control of motor programs
A lot of small motor programs: one large motor program
Early, middle, and late stages
Types of Feedback
Intrinsic
Extrinsic
Intrinsic Feedback
Received through various sensory systems during normal movement
Extrinsic Feedback
Provided from an external source
Knowledge of Results
Terminal feedback on outcome of the movement
Knowledge of Performance
Feedback related to movement patterns used to achieve the goal
Fading Schedule of Feedback
More knowledge of results early on followed by a gradual decrease in feedback
Summary Knowledge of Results
Feedback provided after a block of practice trials
Characteristics of Feedback and Learning
External feedback is good for impaired sensory systems
Performance is better with constant feedback
Learning is better with fading of feedback and summary knowledge of results
# of trials to include in a summary knowledge of results is based on complexity of task (Complex: 5 trials; Simple: 15 trials)
What are the 4 types of practice conditions?
Massed
Distributed
Constant
Variable
What is massed practice?
Amount of practice time is greater than rest time
Better learning on transfer test for continuous tasks
What is Distributed Practice?
Rest time =/> practice time
Constant Practice
Task practiced under constant conditions
Variable Practice
Task practiced under variable conditions
Initially has a poorer performance but better able to generalize info
Random Practice
Tasks practiced in random order
Better performance on transfer task
Contextual interference may be reason initial performance is poor
Blocked Practice
Practice 1 task in a block trial before moving to next task
Better performance during skill acquisition
Whole training
Practice entire task at once
Better for promoting carry over
Part Training
Practice a part of the task
Transfer Training
Training transfers to new skill or environment
Mental Practice
Mentally practicing a skill using imagination and no active movement
Guided Learning
Learner is physically guided through the task
Discovery Learning
Allowing trial and error to learn the task
What is the key for rehabilitation when it comes to learning?
Preparing the patient to perform the task in their home and community
Recovery vs Compensation
Recovery: achieving the goal in the same way as pre-injury
Compensation: behavioral strategies learned to complete a task in an altered way
Clinical factors to consider when developing a plan of care
Type and severity of injury
Age
Promoting independence vs forced use
Chronological Age
Calendar age based on date of birth
Corrected Age (Adjusted)
Calculated if the infant was earlier than 38 weeks gestation
Remember to use 40 weeks when determining prematurity
Gestational Age
Number of weeks spent in utero
Why would you do a screen?
Development follows a progressive timeline
Used with typically developing children (identify delays)
Quick and cost effective (no diagnosis, but hints at delays)
Alberta Infant Motor Scale Snapshot
Purpose: identify delays in motor development and maturation over time
Age: 0-18 months
Test Components: Observation-based on 4 developmental motor categories (Prone, supine, sitting, standing)
AIMS Strengths and Weaknesses
Strengths: Short test, no materials needed
Weaknesses: small age range
AIMS Scoring
Less than 1 year old and was born before 38 weeks gestation
Window created for least and most mature
Write “O” or “NO” for items between the windwon
What is the Developmental Direction?
Cephalocaudal
Proximodistal
Reflex => Cortical Control
Generalized => Localized
Key Factors of Developmental Direction
Strength of key muscle groups
Anthropometric characteristics
Stage Progression
Sensitive periods of development
Established ages and stages of development
What are the stages of the 1st year of life?
1st Quarter: Head control
2nd Quarter: Arms and upper trunk
3rd Quarter: Lower trunk and pelvis
4th Quarter: Legs and feet
0-4 Months Milestones
0-3 months: head control
3 months: prone on elbows
4-6 months milestones
4-6 months: log rolling
5-7 months: segmental rolling
7-9 months milestones
7 months: belly crawling
8 months: sitting
9 months: creeping
9-12 months milestones
9 months: pull-to-stand
10 months: cruising
9-13 months: independent standing
12-24 months milestones
8-14 months: creeping UP stairs 15-23 months: creeping DOWN stairs 16 months: walking UP stairs with help 18 months: walking DOWN stairs with help 18 months: jump DOWN with help 24 months: jump FORWARD
2-3 years milestones
30 months: run
3 years: walking UP stairs (alternating)
3-5 years milestones
3-4 years: walking down stairs (alternating)
3-5 years: jumping OVER
5-6 years milestones
5-6 years: skip
0-4 months typical development
Fine: swipes, closed hands, midline
Cognitions: listens, smile, cries
Toys: mirrors, rattles, links, blankets, tactile books
4-6 months typical development
Fine: reaches, grasps rattle, hands open
Cognition: laughs, babbles, turns head, eats cheerios
Toys: play gym, prop sitting, large blocks, toys with music, press buttons
7-9 months typical development
Fine: prone reaching, rakes/scoops
Cognition: babbles, responds to familiar people, responds to name, shouts
Toys: take items out of container, bang blocks, board books, balls to push, cause/effect toys
9-12 months typical development
Fine: hold bottle/cup, picks up small objects, fine pincer grasp
Cognition: Patty cake, bye-bye, fear of strangers, “mama/dada”
Toys: Cruising toys, peek a boo, container play, kitchen items
12-24 months typical development
Fine: holds crayon in fist
Cognition: understands and follows simple commands, 3 body parts
Toys: catch, throw, kick ball, push toys, stepping games, jumping
2-3 years typical development
Fine: holds crayon in fingers, dress/undress
Cognition: states name, few vocab words, knows some colors
Toys: Beads, scissors, play-doh, puzzles, obstacle course
3-4 years typical development
Fine: cuts with scissors, puts shoes/pants on
Cognition: Speech clear, first and last name, recognize letters and numbers
Toys: obstacle course, trikes/bike
4-5 years typical development
Fine: independent dressing, comb hair, ties shoes, brush teeth
Cognition: address, full sentences, alphabet, 1-20, write name/words, read
Toys: bikes, simon says, hokey pokey, tag, kickball
6-8 years typical development
Fine: print name, cut food with fork and knife
Cognition: read, write, addition, subtraction, spell words
Toys: bikes, jump rope, hopscotch, rocker board, therapy ball, sports
Right Reactions
Orientation of head in space
Orientation of body in relationship to the head and ground
Balance and Protective Reactions
Equilibrium reactions that occur sequentially
What are the 3 developmental reflexes?
Primitive Reflexes
Righting Reactions
Balance and Protective Reactions
Rooting
Touch peri-oral area, turn head toward stimulus
Appears: 28 weeks gestation
Integrates: 3 months
Suck-Swallow
Touch inside of mouth; tongue rolls around mouth and then swallow
Appears: 28-34 weeks gestation
Integrates: 5 months
Concerns: problem for nutrition, CNS or sensorimotor dysfunction
Plantar Grasp
Pressure on plantar aspect of foot; flex toes
Appears: 28 weeks gestation
Integrates: 9 months
Palmar Grasp
Pressure on palm; flex fingers
Appears: 28 weeks gestations
Integrates: 4-7 months
Concerns: neurological problem (spasticity)
Moro
Arms abduct and extend, fingers splay when head tilted back
Appears: 28 weeks gestation
Integrates: 3-5 months
Concerns: CNS dysfunction, sensory motor problem if persisting, delay sitting and head control, injury to one side if assymetric
Symmetric Tonic Neck Reflex (STNR)
Flexion in UE and extension in LE when head flexed; extension of UE and flexion of LE when head extended
Appears: 4-6 months
Integrates: 8-12 months
Concerns: Persistence may impede other motor skills and cause spinal flexion deformities
Asymmetric Tonic Neck Reflex (ATNR)
Extension in face and arm, flexion in the skull, arm when head is turned
Appears: 20 weeks gestation
Integrates: 4-5 months
What are the 3 Righting Reactions?
Head Orientation
Landau Reaction
Body Orientation
Head Orientation
Optical righting reaction
Labyrinthine righting reaction
Body-on-head righting reaction
Landau Reaction
Head, upper trunk, and legs extend when suspended in prone
Appears at 3-4 months
Integrates at 12-24 months
Body Orientation
Neck-on-body righting reaction
Body-on-body righting reaction
Prone Balance Reflex
Spine curves so head and pelvis move in opposite direction
Appears: 5-6 months
Integrates: persists
Sitting Balance Reflex
Spine curves so head and pelvis move in opposite direction
Appears: 7-8 months
Integrates: persists
Forward Balance reflex
Infant reaches toward surface with elbows extended and bears weight on arms on surface in response to forward plunge
Appears: 6-9 months
Integrates: persists
Sideways Balance Reflex
Shoulder abduction and elbow extension to put hand down in response
Appears: 7 months
Integrates: persists
Backward Balance Reflex
Hands placed behind to prevent fall backward
Appears: 9 months
Integrates: persists
0-3 months atypical development
Unable to lift head
Stiff legs with little movement
Pushes back with head
Keeps hands fisted with little arm movement
6 months atypical development
Poor head control
Rounded back
Arches back/arms held back and stiffens legs
9 months atypical development
Uses only one hand
Poor use of arms sitting
Difficulty crawling
Only one side of body
12 months atypical development
Difficulty standing due to stiff legs
Needs to use hands to sit
Sits with weight to one side
15 months atypical development
Unable to take steps independently
Falls frequently/poor standing balance
Walks on toes
Components of sensorimotor processing
Constraints to the individual: age; experience with the task; presence/absence of pathology
Type of task: degrees of freedom; complexity
Environmental Constraints: properties of the object, standing/sitting surface
Key Elements of Reach/Grasp
Locating a target/visual regard
Reaching
Grasping
In-hand Manipulation
Musculoskeletal Contributions
ROM
Spinal flexibility
Muscle Properties
Biomechanical relationships among linked segments
Motor aspects (muscle tone, strength, coordination)
Neurological Contributions
Motor processes
Sensory processes (visual, somatosensory, cognitive/motivation)
Internal Representations
Higher level processes
Components of Target locating
Eye-Head-Trunk coordination
Interactions between eye movements and hand movements
Kinematics: pointing and reaching
Reach vs Grasp
Reach: reach and point/bat at an object
Grasp: reach and then grasp the object (shorter duration)
Types of control
Anticipatory
Reactive
Anticipatory
Feed-forward: plan for future action
Reactive
Feedback: regulate in order to create a successful catch
Roles of the brain in a reach and grasp
Parietal lobes and pre-motor cortex: develop motor plan
Cerebellum and basal ganglia: modification and refinement of movement
Grip types
Power (hook, spherical, cylindrical)
Precision (pinch type)
4 hand shapes
Poke
Pinch
Clench
Palm (raking, post-CVA)
Succesful Grasp
Hand adaptation
Times finger movements
Development of Reach and Grasp
Continues through 8-10 years compared to manipulation development at 10-12 years
Move from less efficient and slow pathways for reach/grasp to more efficient and faster grasps
Reach and Grasp in aging
Reduction in reach velocity
Increased time to manipulate small objects
Reasons for decreased reach/grasp ability
Vision changes
Musculoskeletal changes: OA, joint changes
Able to stop/slow with strength and fine motor control
Purdue Pegboard
50 holes; 2 columns
Pegs, washers, collars
3 times, score averaged
PD
9 Hold Peg Test
Put pegs in one at a time and remove
3 trials, best analyzed
CVA, RA, JA
Minnesota Rate of Manipulation Test
2 boards, 60 pegs
Placing, Turning, Displacing, One-hand turning/placing, Two-hand turning/placing
Not highly sensitive for fine dexterity
Chedoke Arm and Hand Inventory
More functional, 13 skills with encouragement for bilateral
Peabody Developmental Motor Skills
Ages: 0-6
Norm-referenced
0-2 rating scale
Gross and fine motor (grasping and visual motor integration)
Task analysis for reach/grasp/manipulation
Internal factors: patient’s perspective (ROM, strength, postural control)
External Factors
Task complexity
Postural effects
Exceptions to typical reach/grasp/manipulation
Neuromuscular dysfunction Musculoskeletal dysfunction (robotic technology)
Future reach/grasp considerations
Children with DS aged 6-12
Anticipatory deceleration of hand transport
Orientation of the hand in preparation for object contact
Onset of preparatory grasp
Reach trajectories
What is vestibular rehabilitation?
Exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls
What are the components of balance?
Sensory input
Integration of Input
Motor Output
What systems make up sensory input?
Vestibular: equilibrium, spatial awareness, rotation, linear movement
Visual: sight
Proprioceptive: touch
What components make up Integration of Input?
Cerebellum: coordinates and regulates posture, movement, and memory
Cerebral cortex: contributes higher level thinking and memory
Brainstem: integrates and sorts sensory information
What components make up Motor Output?
Vestibulo-ocular Reflex
Motor Impulses: control eye movements
Motor Impulses: to make postural adjustments
What are the roles of the internal ear?
Process signals in the middle ear
Detection of position and motion
Utricle: vertical acceleration
Saccule: acceleration in planes
3 Semicircular Canals
Anterior/Superior: nodding
Posterior: frontal-plane rotation (lateral flexion)
Horizontal: horizontal plane rotation (30° upwards)
What is included in the Peripheral Vestibular System?
Anything distal to the vestibular nerve
What is the ampulla?
Hair cells activated and move within the semicircular canals
Contain the cupula
Detect angular velocity
Neuroanatomy of canals
Horizontal canal tilted 30° superiorly
Clinical implications for testing positions (dynamic acuity)
Utricle and Saccule
Otoliths
Detects acceleration and static tilt
CN VIII
Vestibulocochlear Nerve
What all is involved with central vestibular processing?
Vestibular Nuclear Complex
Cerebellum
Integrates with the somatosensory and visual systems
Children at risk for vestibular dysfunction
Sensorineural Hearing Loss (SNHL)
Learning Disabilities
Recurrent and chronic ear infections
What complaints are common in Vestibular dysfunctions?
Non-specific (hard to get to explain headache/dizziness as a 3 y/o)
May have nausea and some vomiting, but hard to describe those feelings
Often seen as clumsy (yellow flag)
What are the signs of vestibular involvement?
“Trails” the wall: run hand along wall while walking
unable to separate head/eyes/body: everything moves as a unit and can’t disassociate
Eye strain/fatigue: child rubs eyes, push eyes, close eyes more often, headaches
Headaches
Unsteady gait/Clumsy
Nystagmus
Avoids/Seeks out movement activity: goal is to be in the middle
Behaviors associated with Hypo-functioning Vestibular Systems
May seek out/limit movements that stimulate the vestibular system
Patient response more slowly/with delays to movements that stimulate the vestibular system
Instability with or without dizziness
Tripping, “clumsiness”, poor coordination
Behaviors associated with Hyper-Functioning Vestibular Systems
Sensitivity to sensory input: light, sound, motion
Increase negative behaviors
Headaches
Avoidance of movements that stimulate the vestibular system
What are the 3 categories of vestibular interventions?
Vestibulo-ocular exercises
Postural Control
Combo of the two
What is a grading activity in vestibular dysfunctions?
Working only within the patient’s limits of tolerance
What are the signs of over stimulation?
Worsening of symptoms
Decreased quality of exercises
Increased behavioral issues
What are other environments/surfaces to utilize for individuals with vestibular dysfunctions?
Sand Grass Stairs/Steps/Curbs Scooters/Bikes/Skates Water
What is the Sensory Profile?
Assess how well they process various senses
Completed by the caregiver/teacher
Allows identification of strengths and challenges
Looks at: auditory, visual, touch, vestibular, multisensory, oral, modulation, and behavioral/emotional
Appropriate screening for 6 month old
Touch: response to tickle, carpet vs. hardwood
Taste: ask caregiver what they like
Sound: Rattles, do loud sounds startle them, do any sounds bother them
Vision: tracking a toy/parent, contrasts (reds and yellows)
What is the goal of activities for individuals with vestibular dysfunctions?
Improve awareness of body in space Improve ability to process visual information Improve safety Improve independence with mobility Improve participation with family/peers
