Interventions of Neuro 1 Flashcards
Recovery
- Ability to do what they want to do the way they did it before
Compensation
- Still get to do what they want to do, but they do it differently
Neural adaptation
- is the foundation of learning.
- Learning or relearning occurs through establishing and strengthening neural connections
- Maximizing neural adaptation requires attention, repetition over time, positive feedback, goal direction, motivation and commitment
Plasticity
= neural recovery
-New research using fMRI has reinforced that the adult brain has more potential for plasticity than previously thought
-Resolution of edema allowing resumption of nerve conduction
-Regeneration of axonal sprouts or
Development of collateral sprouts
Plasticity - cortical representation
- Active movement and sensory input result in an expansion of the cortical representation
- Studies have shown differentiation in cortical representation secondary to motor experience and practice in typical adults and in response to treatment after brain injury
- Cortex is mapped according to body part but also by function or activity performed
Mental imagery
- 30% of the neurons that fire while performing a task also fire when mentally visualizing performing the task
- Neurons not active when taken passively through the task
- Studies have shown significant gains in performance from mental imagery alone
- Not as good as mental and physical practice together
ICF
Health Condition
- -> Body functions/ structures
- -> Activity
- ->Participation
- Environmental factors
- Personal factors
OTPF
Health Condition
- ->Client factors
- ->Performance skills
- ->Performance in areas of Occupation
- ->Performance patterns
- Activity Demands
- Context
Compensation for weakness
Decrease object weight Decrease energy - Assistive or Adaptive Equipment - power tools - use both hands
Compensation for low endurance
- Pacing Slow down Rest breaks - Assist/AdaptEquipment - power tools - decrease environmental stressors
Compensation for limited ROM
- Long-handled AE
- Build-up handles
- Strategic placement
Compensation for Incoordination
- Stabilize object
- Distal Mobility___
Proximal Stability - Assistive Devices
Dycem
shelf liner
shelfs/ledges - Weighted utensils, tools, etc.
Compensation for One sided use
- Devices
- Strategies
Compensation for Decreased Sensation
- Protect affected areas
- Promote intact structures
Compensation for Memory & Organization Skills
Devices Strategies
Compensation for Blindness
- Organization
- Voice/Auditory activation
- Tactile feedback
Compensation for Low Vision
- Color contrast
- Lighting
- Magnification
- Simplicity
- Scanning Techniques
Motor control
- Study of the nature, cause, and mechanisms of posture and movement control
- Purpose to the movement has a lot to do with motor control
- Basal ganglia –> automatic movement (Parkinson’s, tremors, bradykinesia)
- Voluntary movement –> primary sensory cortex –> CST (stroke, lose initiation of voluntary movement)
- Important to check out sensory & motor to see if just one or the other
Motor control theory:
-Understanding how movement is governed, organized and executed
- Physiological: the neuromuscular processes that lead to movement
- That is: how do humans control their muscles and joints so as to produce an action involving movement?
- Psychological: the behaviors that promote the movement skill
- That is: what does a human do to gain skill?
- Understanding how injury/disability leads to movement impairment
Why learn motor control theory?
- Understanding the neuromotor processes underlying motor skill will enable you to, for a client with poor motor control,:
- Set appropriate LTG and STGs
- Choose appropriate therapy activities
- Then, in combo with motor learning theory…
- Design the best sequence of therapy activities
- Provide the best type of feedback on the best schedule
- Choose the best type of and amount of practice
Process of Intervention
- First therapist generates hypotheses of why the client is having problems based on their knowledge of the client, the condition and theories of motor control
- Then hypotheses are tested during intervention and modified according to results
Reflex chaining & Hierarchical Models
-Have influenced the “traditional” OT/PT motor control interventions (e.g., Brunnstrom, NDT etc.)
Motor Program & Systems Models
-Have influenced “contemporary” OT/PT motor control interventions (e.g., CIMT, robotic assisted therapy, Saebo etc)
Reflex Model
- Sherrington (1947)
- Motor control as reactions to sensory input
- Reflexes can be elicited through sensory stimuli
- He said movement was in response to sensory input
- i.e. Might use flexor withdrawal by pinching the palm of their hand to see if can elicit that very basic withdrawal reflex to get muscles to contract
Hierarchical Model
- Top down motor control – higher cognitive centers control lower
- Assumes linear neuromaturation as the basis for development
- Assumes damage to controlling influences of higher level cortex (“king”) resulting in release of lower level reflexes.
- Many practice frameworks based on this model, NDT, SI, Bruunstrom, PNF, Rood
- Synergistic pattern – UE flexion & LE extension/adduction
Neurological injury/disease (Hierarchical)
- Damage to higher centers leads to the liberation of reflexes controlled at lower centers
- Damage to the government (“king”)
- Evidence = “spasticity”
- Because normal movement requires constant cortical modifications to reflex patterns, loss of the integration leads to the patient locked into a few combinations of stereotypical reflexive movement patterns
Commonalities of OT treatment approaches based on traditional motor control models
- All movement impairment can be traced to CNS damage as its cause
- Treatment is aimed at re-establishing the cortical control of movement (based on neuroplasticity)
- Normal movement is facilitated via sensory stimulation (facilitation of or inhibition of reflex behaviors)
- Motor recovery follows a developmental sequence:
- Cephalocaudal
- Proximodistal
- (These are somewhat limiting – not an always statement – if don’t have proximal stability, but provide proximal stability, get distal mobility)
- Any deviation from normal movement was considered abnormal/variable.
Current Modifications to Hierarchical Model
- Reflexes may not be ‘abnormal’
- Flexor withdrawal, tonic labyrinthine
- Hierarchical control is not just top down
- Each level can act upon other levels
- Reflexes are just one of many processes important to generation and control of movement
- i.e. Go into synergistic pattern to stand on top of a small peg (doesn’t mean have brain damage)
- Abnormal reflexes & synergistic patterns can be helpful sometimes
- If control degrees of freedom, can have more control sometimes
Motor Programming Theories
- Studies show that motor movement can occur even when sensory input or reflexive activity is not available (sensory nerve cut)
- This movement is referred to as a central pattern generator (spinally initiated)
- Cortical motor programs store rules for movement so that similar movements can be produced by different parts of the body
Systems Theory
- Bernstein (mid 1900s) – output of nervous system thru mechanical system of body
- Body is mechanical system with mass, subject to both external forces, such as gravity, and internal forces including both inertia and movement dependent forces.
- Same central command could result in different movements because of interplay between external forces and variation in initial conditions
- Degrees of freedom problem – variety of joints & planes of movement make for multiple degrees of freedom.
- Hypothesizes hierarchical control simplifies degrees of freedom by activating lower levels of control which activates muscle synergies (muscles working together as a unit)
- i.e. Parameters of the system project how hold remote for example
- Weight, lever arm, purpose, attention, etc.
Dynamical Action Theory
- 1980 …
- Based on chaos theory or principles of self organization
- Suggests movement can emerge as a result of interacting elements without the need for specific commands or motor programs within the nervous system
- Motor control is dependent on numerous properties within the system, not just structures and functions of the body
- i.e: 14 y/o boy –> at 12 y/o he was a basketball star, but now at 14 y/o he can’t hit the broadside of a barn
- Has to learn how to adjust motor learning due to changed parameters (lever arms have changed)
Control Parameters
These are called control parameters
- Eg. Horse: Velocity – walk until you reach a certain velocity at which point you break into a trot until you reach a certain velocity and then break into a gallop
- Attractor states are preferred patterns of movement
- The degree of flexibility from these attractor states is diagrammed as an attractor well
- Shallow = flexible
- Deep = stable
Pattern stability
- Pattern becomes less stable just before change
- Intervention – may see more variability before change
- What parameter will need to change to make that movement pattern more effective? (A lot of trial & error in this)
- In book, shallow wells & deep wells - how stable is that pattern? When first learning, a lot of variability. As become better, less variability occurs.
- i.e. Stroke –> deep or stable well –> get stuck in synergistic pattern (pick up stuff the same no matter what the object is) have to come up with big changes to come up with a new movement pattern
Dynamical Systems Theory
Blending of the dynamical action theory and systems theory = Dynamical systems theory
Ecological Theory
- Motor control is goal oriented
- Organization of action is specific to the task and the environment in which the task is being performed
- Instead of viewing the nervous system as sensory- motor system reacting to environmental variables it is seen as a perception action system that actively explore the environment to satisfy its own goals.
- Organism – environment interphase
- More psychology theory
- Meaning matters
- People are more inclined to do a purposeful movement if have goal in mind
- Organism interacts with the environment and will produce best results
Motor control theory directing current evidence based OT
- Synthesizing aspects of these theories you get:
- Movement emerges from an interaction between the individual, the task, and the environment
- The OTPF says: Occupational performance emerges from an interaction between the individual, the task, and the environment
- Current therapeutic views incorporate learning and contextual issues using functional tasks.
- Dynamical systems theory is most current –> movement pattern emerges from all factors involved (environ, task, person)
- Take all factors from activity analysis & figure out which one to manipulate to get ‘er done better
Motor Development
- Acquisition of motor skills through maturation and learning
- A strictly neuromaturational theory of motor development minimizes the effects of environment and learning
- Therapy based on specific developmental sequence and motor development starts at the client’s current level.
- Drawbacks include long periods of therapy without development of functional skills and social incompatibility
- Current theory incorporates context for a more varied (less linear) view of development
Motor Learning or Relearning
-The study of the acquisition and/or modification of movement
-Process of acquiring capability for skilled action
-Results from experience or practice
-Inferred, based on behavior, not measured directly
-Produces permanent changes in behavior
(Schmidt and Lee, 1998)
-Newel (1991) broadened definition = search for a task solution that emerges from an interaction of the individual with the task and the environment to provide new strategies for perceiving and acting.
-Learning = relatively permanent change
-Involves retention or saved proficiency after a period of no practice
-Inferred through observed performance over time
-Performance = temporary change seen during practice sessions
-Observed performance
Nonassociative learning
Habituation
Sensitization
Associative Learning
Classical conditioning
Operant conditioning
Declarative
Procedural
