Interventions to Improve Motor Control and Motor Learning Flashcards

1
Q

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)

A

fyi

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2
Q
  • 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
A

Activity-based, task-oriented intervention

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3
Q
  • 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
A

Motor Control

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4
Q

* 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.

A

Response Selection Stage

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5
Q

neural control centers translate the idea for movement into actionmotor program

All steps occur very quickly

A

Response programming

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6
Q
  • “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
A

Motor Program

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7
Q
  • “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.
A

Motor Learning

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8
Q

Motor Learning
Retention

apply a learned skill to learning of a similar skill (i.e. transfer to multiple surfaces)

A

Generalizability

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9
Q

Demonstrate the skill that has been learned over time, after no recent practice (retention interval) - no recent practice and can still do it.

A

Motor Learning
Retention

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10
Q

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.

A

Resistance to contextual change

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11
Q

Stages of Motor Learning

develop understanding of the skill- what stage?

A

Cognitive

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12
Q

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
A

cognitive map

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13
Q

Stages of Motor Learning

  • Middle state of learning
  • Refine motor practice through continued learning
  • Proprioception is very important

what stage ?

A

Associative

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14
Q

Stages of Motor Learning

  • largely autonomic response from repeating the skill many times
  • Minimal cognitive monitoring

what stage?

A

Autonomous

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15
Q

Not Ready for Task-Oriented Training???

  • P14- box 2.2
  • Identifying threshold abilities is important to ensure that interventions will be successful and beneficial
A

built from the basics-

if no trunk controll you can’t work on standing. start with trunk contol first and work from there

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16
Q
  • 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

A

Degrees of Freedom Problem

17
Q

Identify lead up activities that each posture assists with (review together with your peers)- 5 minutes

A
  • Prone on elbows
  • Quadruped
  • Bridging
  • Sitting
  • Kneeling and half-kneeling
  • Modified plantigrade
  • Standing
18
Q

As therapists, how do we enhance motor learning???

A

Significant amount of practice
Feedback
Large amount of information processing

19
Q

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
A

Strategic development

20
Q

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
A

In cognitive stage of learning

21
Q

Guidance- treatment intervention

What is it?

A
  • 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
22
Q
  • 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.
A

Active Decision Making

23
Q

Strategies

Verbal Instructions and Cueing

Box 2.4- anticipating patient needs

Examples….????

A
24
Q

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
A

Parts-to-Whole Practice

25
Q

Strategy Refinement

In the associated and autonomous stages of learning……

A
  • 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
26
Q

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.

A

Late Stage Learning

27
Q
  • Helps promote motor learning
  • Can be intrinsic (due to the natural result of moving), or extrinsic
    • Intrinsic:
    • Extrinsic:
A

use of Feedback

28
Q

feedback that occurs while task is performed

A

Concurrent feedback

29
Q

feedback that is given at end of task

A

Terminal feedback

30
Q
  • Do you recall this?? Initially covered in PTA 105
    • Knowledge of Results
    • Knowledge of Performance
    • p20
A

Knowledge of Results:

Knowledge of Performance:

31
Q
  • 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)
A

feedback

32
Q

Varied Feedback- Box 2.6

  1. Summed feedback
  2. Faded feedback
  3. Bandwidth feedback:
  4. Delayed feedback:
A
  1. every 2nd or 3rd attempt
  2. give first at beginning of each trial and then spread out
  3. give only when outside certain parameters for error
  4. give after a brief time delay
33
Q

What is important About Practice?

A
  • Make sure that patient practices desired activity
  • Helps to increase the learning
  • Watch for faulty postures and habits
34
Q

Group 1: Massed versus Distributed Practice
Group 2: Blocked versus Random Practice
Group 3: Mental Practice
Group 4: Closed versus Open Environments

A

Group 1: Massed versus Distributed Practice

Group 2: Blocked versus Random Practice

Group 3: Mental Practice

Group 4: Closed versus Open Environments