Lecture 4: POC for neuroMSK diagnoses Flashcards
treatment plans are based on:
-Plan of care
-Treatment approach
-Motor control theory
-Patient’s personality
-Setting
POC is based on:
-Diagnosis
-CLINICAL PICTURE
-Evaluation results
-Reason for referral
-Patient/family goals
a well developed plan of care is the vehicle to to greater ___ and _____for children with neurological and non-
neurological disorders
functional
independence and participation
what are two early theories of motor control (major in late 1950s to early 1970s)
reflex theory
heirarchical theory
What is reflex theory?
-Sensory (afferent) input causes motor (efferent) output between the peripheral
**Reflex is the basic unit of movement
What is hierarchical theory?
-Considers the reflex a primitive behavior
-Motor control is achieved from a top-down fashion
from the cerebral cortex to the spinal cord
***Primitive reflexes were thought to be
suppressed with the development of higher
control
Where did NDT, PNF, SI (main neurofacilitation approaches) originate?
from the early theories (reflex and hierarchical theory)
What is Motor Programming Theory?
-Networks of neurons within the spinal cord-
central pattern generators (CPGs)
work together as a whole to produce
rhythmic, patterned motor commands, such as
commands for repetitive stepping
(locomotion)
-More complex programs developed at the cortex level result from motor
learning and are used to simplify the production of movement
What is systems theory?
movements emerged from interaction of many systems (not just reflexes or centrally/peripherally driven…)
emphasizes CONSTRAINTS of msk system and environment on movement
*contractures, maybe the environment, etc.
systems theories says that the control shifts among systems depending on ___, ___, and ____
internal state (fear?)
specific motor task (ice skate, walking?)
environmental conditions (dark, bumpy road?)
What are the 3 automatic postural responses to perturbations when standing?
- ankle
- hip strategy
- stepping strategy
ankle strategy involves what muscles?
Gastrocsoleus, hamstrings, paraspinals
hip strategy involves what muscles?
abs, quads, tib ant
(prox to distal activation)
What is the dynamic systems theory?
variability within and
between individuals is considered an
essential component of motor
development
control shifts among among systems following principle of self organization between components that make up individual and surrounding environment
automatic postural responses to backwards perturbations of floor surface occur at ____ milliseconds from perturbation
80-100 milliseconds
*as opposed to spinal reflex response time of 30 milliseconds
What are the control parameters of dynamic systems theory?
-factors that promote change in movements produced (internal/external)
ex. speed of mvmt, degree of hip and pelvic stiffness
What are control parameters for example with toe walking?
-speed
-mm stiffness
- ROM
-surface
-selective motor control (swim fins)
example of control parameters with grip
- number of fingers
- size of objects
What are the three parts of the “triad of constraints?”
- person
- environment
- task
What is the difference between movement and action?
action: accomplished task, strategy to achieve goal
movement: change at mvmt level, involves coordination of mvmt patterns, allowing action goal to be achieved
CHANGE AT MVMT LEVEL ALONE IS NOT SUFFICIENT FOR ACTION
palmar grasp vs pincer grasp
qualitative or quantitative change?
qualitative
what is the difference between dynamic systems and information processing perspective?
dynamic: how mvmt behavior is organized and how it changes with ACTIVITY FOCUSED INTERVENTIONS
information-processing: emphasizes cognitive systems role in motor learning
motor learning is a _____ associated with practice or experience leading to a relatively permanent change in capability for a motor skill
set of internal processes
*repeated motions without active participation and info processing does not cause motor learning!!!
What are the cognitive aspects important to motor learning?
attention
memory
mental representation
stages of information processing
- stimulus identification
- response selection
- response programming
*memory and attention involved
Name the framework that has been used to
explain the slow information processing
times, poor visual, and spatial ability, and
timing deficits seen in children with DCD
information processing
children with DCD depend heavily on ____ bc they don’t have effective ______
depend on visual feedback
*not good anticipatory control
*also have force production deficits
it takes __ children longer to process feedback information
younger! (time to process info is age related)
*precision of info that can be used for feedback ALSO varies with age
What is the memory representation of a movement that can be retrieved when needed for a functional action?
motor program
- this is the main homie, but also interaction with sensory processes to refine movement and adapt it to environment!
What are the three motor learning principles?
- performance
- learning
- attention
Name the motor learning principle: change may or may not be permanent
performance
the variant or changeable features of a motor program
parameters
*variable practice of multi parameters is important!
name the motor learning principle: permanent change
learning
name the motor learning principle: allocation and focusing of info processing resources
attention
The decrement in performance associated with __ ___ is significantly greater for children with neuro conditions, such as DCD and CP
dual tasks
What are three strategies for attention?
- taking child to a high level of primary task performance before introducing competing tasks
- using dual tasks to evaluate level of learning of a primary task or development of postural control
- Practicing functional tasks in the natural
environment, which attention is divided
Kleim and Jones Principles of Plasticity!
- Use it or Lose it
- Use it and Improve it
- Specificity
- Repetition
- Training Intensity
- Time
- Salience
- Age
- Transference
- Interference
activity focused interventions stress ___ and ___ associated with practice to foster brain reorganization!
repetition and problem solving
3 steps for activity focused interventions
- develop activity related goals and objectives
- plan activity focused interventions
- integrate impairment focused interventions
Hippotherapy
Aquatic therapy
Manual guidance
Biofeedback
Partial weight-bearing treadmill training
Proprioceptive Neuromuscular Facilitation (PNF)
These are examples of…._____ focused interventions
activity impairment focused interventions!
joint mobs
passive ROM
orthoses
these are examples of
passive impairment focused interventions
Four stages of development of motor control: sensorimotor approach by margaret rood
◦ Reciprocal Innervation
◦ Co-contraction
◦ Stability superimposed on mobility
◦ Mobility superimposed on stability
