Interventions to Improve Motor Control and Motor Learning Flashcards
Objectives
Compare and contrast theories of motor control, motor learning and common principles of therapeutic interventions.
Identify the purposes and components of a motor control assessment
Define: spasticity, clonus, decerebrate rigidity, decorticate rigidity and flaccidity
Identify common causes of motor control impairments (discussed last lecture & throughout course)
fyi
- Components discussed previously (various components of a PT examination)
- An assessment of impairments, activity limitations and functional restrictions
- Plan of care is formulated
- is often the basis of the POC
- breaking a task into subtasks; an activity down into components
Activity-based, task-oriented intervention
- Deals with “the understanding of neural, physical and behavioral aspects of movement.” And….
- Processing of human motor behavior:
- Stimulus identification
- Response selection stage: develop a plan for movement
Motor Control
* Plan for purposeful movement- MOTOR PLAN
- Made up of components
- A prototype is chosen
- Choose what fits the situation best
ex: log rolling -using the strategy of something you’ve done before and your body remembers.
Response Selection Stage
neural control centers translate the idea for movement into actionmotor program
All steps occur very quickly
Response programming
- “Abstract representation that, when initiated, results in production of a coordinated movement sequence.”
- Considers synergistic component parts
- Force
- Direction
- Timing
- Duration
- Extent of movement
- Feedforward and Feedback
Motor Program
- “Internal processes associated with practice or experience leading to relatively permanent changes in the capability for skilled behavior.”
- Don’t observe change in CNS directly, but will see change in motor behavior
- Practice: determines improvements in performance
- Learning: does not always occur when increase in performance is observed.
Motor Learning
Motor Learning Retention
apply a learned skill to learning of a similar skill (i.e. transfer to multiple surfaces)
Generalizability
Demonstrate the skill that has been learned over time, after no recent practice (retention interval) - no recent practice and can still do it.
Motor Learning Retention
Motor Learning Retention
ability to perform a measured task in altered environmental situations (i.e. walking with a cane inside/ walking outside) -really just change the environment.
Resistance to contextual change
Stages of Motor Learning
develop understanding of the skill- what stage?
Cognitive
Stages of Motor Learning
- What do I need to do?
- How do I do it well?
- Uses sensory motor skills, discard strategies that you don’t find useful
- When learning, rely heavily on vision
cognitive map
Stages of Motor Learning
- Middle state of learning
- Refine motor practice through continued learning
- Proprioception is very important
what stage ?
Associative
Stages of Motor Learning
- largely autonomic response from repeating the skill many times
- Minimal cognitive monitoring
what stage?
Autonomous
Not Ready for Task-Oriented Training???
- P14- box 2.2
- Identifying threshold abilities is important to ensure that interventions will be successful and beneficial
built from the basics-
if no trunk controll you can’t work on standing. start with trunk contol first and work from there
- Occurs when postures progress to more challenging circumstances for the body
- Higher COM
- More narrow BOS
- More coordination between body segments
Where does the problem lie?
Box 2.3- treatment benefits of various postures and activities
Degrees of Freedom Problem
Identify lead up activities that each posture assists with (review together with your peers)- 5 minutes
- Prone on elbows
- Quadruped
- Bridging
- Sitting
- Kneeling and half-kneeling
- Modified plantigrade
- Standing
As therapists, how do we enhance motor learning???
Significant amount of practice
Feedback
Large amount of information processing
As therapists, how do we enhance motor learning???
- Facilitate task understanding and practice
- Determine level of skill
- Make sure that skill is functionally relevant
- Show pt how it is similar to something else they have done
Strategic development
Strategy Development
- Demonstrate the task for the patient
- _________________________ p18
- Point out similarities to other motor tasks
- Have patients who have graduated demonstrate what they can do
- Have a patient with C-6 quad. demonstrate for other patients with quad.
- Instructions need to be clear and concise
- Therapist should NOT correct all errors
- Allow for some trial and error
In cognitive stage of learning
Guidance- treatment intervention
What is it?
- Helps when learning an unfamiliar skill
- Use touch to guide patient toward correct movements
- Have pt practice actively with appropriate guided movements
- Increase verbal guidance as tactile assistance is decreased
- Best used for slow, postural responses
- Pt becomes more involved in analyzing and self correcting
- Clinician can ask questions guiding the patient in correcting the activity
- When ask questions, confirm that patient is answering and trouble shooting correctly
- Use of augmented cues
- Tapping, light resistance, etc.
Active Decision Making
Strategies
Verbal Instructions and Cueing
Box 2.4- anticipating patient needs
Examples….????
Strategies
- Task breakdown to assist with learning
- More effective with transfers versus walking; the task should have independent parts that can be practiced
- DO NOT DELAY practice
Parts-to-Whole Practice
Strategy Refinement
In the associated and autonomous stages of learning……
- Focus on refinement of skills
- Should have very consistent movement
- Focus on proprioceptive feedback
- Patient should “feel the movement”
- Movement patterns should become more adaptable and be able to change with the change in environment
- Dual-task training- two tasks at once
- Use distracters at this stage to identify how much autonomous control is present
There will be times that patients do not reach this level of learning: they may be able to perform well within a structure environment (the back yard), but are not capable of consistently performing in an open environment (the front yard)
example of front yard : more stimulus in front yard
back yard: more closed environment so pt can focus.
Late Stage Learning
- Helps promote motor learning
- Can be intrinsic (due to the natural result of moving), or extrinsic
- Intrinsic:
- Extrinsic:
use of Feedback
feedback that occurs while task is performed
Concurrent feedback
feedback that is given at end of task
Terminal feedback
- Do you recall this?? Initially covered in PTA 105
- Knowledge of Results
- Knowledge of Performance
- p20
Knowledge of Results:
Knowledge of Performance:
- Always consider what type of _________, how much and when it should be given
- Frequent- has shown to help performance, but slow retention
- Varied- “slows initial acquisition while improving performance on a retention test”
- Do not give too much
- What sensory deficits does the patient have? Use a form of sensory input that the patient can use effectively
- Easier to harder (visual to proprioceptive)
feedback
Varied Feedback- Box 2.6
- Summed feedback
- Faded feedback
- Bandwidth feedback:
- Delayed feedback:
- every 2nd or 3rd attempt
- give first at beginning of each trial and then spread out
- give only when outside certain parameters for error
- give after a brief time delay
What is important About Practice?
- Make sure that patient practices desired activity
- Helps to increase the learning
- Watch for faulty postures and habits
Group 1: Massed versus Distributed Practice
Group 2: Blocked versus Random Practice
Group 3: Mental Practice
Group 4: Closed versus Open Environments
Group 1: Massed versus Distributed Practice
Group 2: Blocked versus Random Practice
Group 3: Mental Practice
Group 4: Closed versus Open Environments
