Lecture 2 - Theoretical Frameworks Flashcards
Motor Control
Ability to regulate/direct mechanisms that are essential for movement
What are the 3 theories of motor control
1) Reflex Theory: Reflex chaining as a basis for action. A stimulus leads to a response which becomes the stimulus for the next response, which becomes the stimulus for the next response
2) Hierarchical Theory: The CNS is organized in a top down structure in which higher centers control the lower centers (prefrontal cortex -> motor cortex -> prefrontal cortex)
3) Distributed Control/Systems Theory: Need to understand characteristics of the system you are moving, the external and internal forces acting on the body, need to consider mass, gravity, inertial forces, muscles, skeletal systems, and many systems work together to achieve movement
What are some limitations to the reflex theory
What is a limitation to the hierarchical theory
Doesnt explain dominance of reflex behavior in certain situations in normal adults
What are some limitations to the distributed Control/Systems Theory
Explain movement in terms of the task, individual and environment
How do the motor control models play into the neurological rehabilitation models
What are the 3 neurological rehabilitation models
- Muscle re-education Approach: Based on polio where virus attacks CNS and loses innervation to peripheries. To compensate for loss, surviving motor neurons sprouted new nerve terminals to develop new large motor units and some recovery of movement
- Neurophysiological Approach: Bobath discovered through treating children with cerebral palsy that primitive reflexes must be inhibited and tone/sensation normalized to promote normal movement patterns. Bruunstrom discovered through stroke that a person’s ability to control movement depends on spasticity (need to decrease to promote movement). Rood unveiled that their is homeostasis/balance between systems (eg. sympathetic vs parasympathetic). Kabat used proprioceptive neuromuscular facilitation (PNF) to re-educate movement patterns. Temple Fay focused on teaching normal movement patterns to children by emphasizing practice and repetition.
- Motor Learning/Task oriented Approach
What is Brunnstrom’s 7 stages of recovery
What are 5 assumptions of the neurophysiological approach
What are 3 clinical implications of the neurophysiological approach
Combining the neurophysiological approach to the motor learning approach, what is our new focus with rehab of disorders
To strengthen the affected side as before we were only strengthening the unaffected side. So we need to focus on motor learning and task-oriented training of the affected side.
What are 4 assumptions of the motor learning/task-oriented approach
What are the clinical implications of the motor learning/task-oriented approach
Neuroplasticity
Practice dependent to cause persistent long-lasting changes by reorganizing the brain to accommodate new data
What happens to neuroplasticity after a stroke with no rehab
Nudo used monkeys to study this by giving them strokes
What happens to neuroplasticity after a stroke with rehab
Nudo with monkeys again
Does neuroplasticity increase or decrease from rehab following a stroke
Increases
Can circuitry after a stroke be spared?
YEs although some structural and functional changes may happen to the circuitry
What are the 6 steps of the model for development of learned non-use
Learned non-use is why the first 3 months of rehab post-stroke is crucial
Explain the 5 steps of the constraint induced movement therapy (CIMT)
What do you do in CIMT
What are the 10 principles off Experience Dependent Plasticity
Difference between learning vs performance in terms of neuroplasticity
Changes within a session do not reflect learning but rather to demonstrate new abilities it must be demonstrated over time
**Do many repetitive movements for neuroplasticity training following a stroke (see image)
T or F: you should always match exercises to what the patient can do to prevent them from feeling defeated and wanting to give up
T
What are 3 variations of practice that could impact motor learning
Blocked vs random organization of practice and when you should use them
Is true learning, retention, and resistance to decay better with blocked or random learning
Random is better for retention, true learning, and shows very little decay. Stage 2 and 3 (Fitt and Posner Theory) is best for random learning. In stage 1 you should use blocked practice to be able to learn the task and all its components
Compare the feed back methods of knowledge of results vs knowledge of performance
What are 3 types of feedback
Whole vs part-task training
How should the acute phase of rehab look post-stroke
-Early mobilization prevents or minimizes harmful effects of bedrest and deconditioning (minimized learned nonuse of hemiparetic extremities)
-Educate family and caregivers (about condition, risk factors, and recovery process)
-Control environment to enhance patient attention (be aware of visual field deficits and perceptual changes of the patient)
-Spend approx 5 days in acute care hospital , but too early of discharge can lead to complications/setbacks in the rehab setting
Interventions include:
1) Functional Mobility Training (bed mobility, sitting, transfers, locomotion)
2) ADL training
3) ROM
4) Splinting
5) Positioning
How should a therapist talk to a stroke patient
1) Talk slowly
2) Normal tone and volume
3) Giving adequate time to respond
4) Using simple yes/no questions
Gestures and tactile cues
How should the sub-acute phase of rehab look post-stroke
-Referred to inpatient rehab if can handle intensive therapy of 6 days per week for a minimum of 3 hours each day
-Referred to transitional care unit if they require less intensive therapy that are 5 days per week for 60-90 mins
-Shorter onset to admission to one of these units (within 20 days) is correlated to a greater prognosis of recovery
-Other factors that influence timing of rehab are: medical stability, severity of cognitive-perceptual deficits, motivation, patient endurance, and recovery
How should the chronic phase of rehab look post-stroke
-More than 6 months post-stroke in outpatient rehab setting, community, or at home
-use other interventions like constraint-induced movement therapy, bilateral training, VR training, and electromechanical assisted walking
-Interventions take place 2-3 times per week for 60-90 mins
-Interventions target to improve flexibility, strength, balance, locomotion, endurance, and UE function
-Need to examine and modify environment for return to home
-Patient should be assisted in resuming participation in community and recreational activities (eg. Monitoring endurance and using energy conservation techniques)
-Water based programs and community fitness programs shown to improve function post-stroke
-Services should be gradually phased out but follow-up visits should occur periodically for long-term maintenance of function
