Motor Control Flashcards
What is motor control?
Understanding the neural, physical, and behavioral aspects of biological movements
(stimulus, stimulus identification, response selection, response programming, movement output)
What is a motor skill?
Coordinated movement strategies with a goal or attaining and action
(require voluntary control so reflexes are not motor skills)
What are 2 categories of motor skills?
- Mobility
- Stability
What is mobility?
requires the individual to move the body from one posture to another in a controlled manner
BOS and COG are moving
What is stability?
Static postural control (maintain a posture with unchanging COM and BOS) and dynamic postural control (adjust and maintained while UE/ LE are moving
What are gross motor skills?
Large muscle groups and body parts, acquired in early childhood
Ex: rolling, crawling, standing, walking, running
What are fine motor skills?
Require control of small muscles, smaller movement with precision
Ex: ADLs, eating, buttoning, writing
What are discrete motor skills?
Have a recognized beginning and end
Ex: sit to stand, lying down, throwing a ball
What are serial motor skills?
Series of discrete skills with a specific order
Ex: transfers bed to w/c
What are continuous motor skills?
No recognizable beginning or end
Ex: swimming, running
What are closed motor skills?
Stable and predictable environment
Ex: walking in a quiet hall, brushing teeth
What are open motor skills?
In a constantly changing unpredictable environment
Ex: shopping in grocery store or mall, crossing a busy street
What is a simple motor skill?
Simple that produces an individual movement response
Ex: kicking a ball
What are complex motor skills?
Involve multiple actions and motor programs combined to create coordinated movement
Ex: gymnastics, running and kicking a ball
What are dual task skills?
Motor skills that also involve a cognitive or physical task
Ex: walking while talking, walking while holding objects
What are the 3 stages of motor learning?
- Cognitive stage
- Associated stage
- Autonomous stage
What is the cognitive stage?
Understanding the task
What is the associated stage?
Practice movements, refine motor programs
What is the autonomous stage?
Practice movement and refine motor processes
What is intrinsic feedback?
Information given by the body
What is extrinsic feedback?
External source (timers, sensors, therapist)
What is knowledge of results?
Information about the movement outcomes
What is knowledge of performance?
Information about the nature or quality
What are interventions for flexibility?
- Preventative: ROM and stretching exercises
- Limits range due to tone/contracture may require low load prolonged stretching through splinting or bracing
- Include a warm up period to enhance stretching
- Cold may help reduce spasms if they are limited motion
- FES, PNF, botox, baclofen help reduce spasticity if it is present and limiting function
What are intervention strategies for strengthening/neuro re-ed?
- Isometrics used for stability and maintaining postures and positions
- Concentric and eccentric help initiate movement
- Electromyographic feedback used with severe weakness and used to assist in recruitment of muscles and re-education
- May need to move to gravity delimited positions
What is Ataxia?
Inability to coordinated muscles, joints, and limbs for smooth and accurate movement
Usually due to cerebellar lesions
What are intervention strategies for balance and postural control?
- First attain postural alignment and static stability upright followed by COM control training
- Begin with WS and exploring limits of stability
- Weight bearing on the MORE affected side is encouraged and activity/WB on the unaffected is discouraged
- Can change difficulty of the task: BOS, support surface, UE support, UE movements, LE movements, trunk movements, functional activities, walking, dual task, modify environment
- Posturla strategies training needs to be incorporated (ankle or hip strategy, stepping)
What are intervention strategies for task specific training?
- Treatment for neurological patients need to be meaningful, effortful, and task specific
- Task specific based on motor learning principals along with exercise and the core for rehabilitation for patients either neurological deficits
- When choosing tasks, make sure you understand the task demands and consider the above impairments (strength, coordination, flexibility)
- Challange the patient (not too easy, not to hard)
- Structure the environment, schedule practice, provide feedback, does the intervention, progress, and encourage problem solving
What are intervention strategies for task specific, structuring the environment?
- Stationary person in stationary environment (sitting on stable mat)
- Moving person in stationary environment (sitting on ball)
- Stationary person in moving environment ( sitting in a w/c)
- Moving person in moving environment (moving in w/c)
What is the dosage for intervention for motor control?
- High intensity to achieve neuroplastic changes
- Use the FIIT principle ( frequency, intensity, time, type)
- Add difficulty by changing environment, moving from stability to mobility, and adding manipulation
What is the use of PNF?
Intervention that uses the facilitation of total patterns of movement to promote motor learning
What is the motion of PNF?
based on the idea that normal movements are spiral and diagonal
What is the emphasis of PNF?
Emphasis on recovery of function vs compensation
How has PNF evolved?
Evolved over the years to integrate principles of motor learning
What does PNF facilitate?
Hands-on treatment to facilitate movement patterns
What does resistance help with PNF?
Improves coordination, motor control, strength, and motor learning
-Resistance facilitates muscle contraction
-Appropriate resistance allows for smooth and coordinated contraction
What is irradiation and reinforcement of PNF?
Response to stimulus spread to adjacent muscle
For PNF what manual contacts help with?
Guides movement
- Hand placement over active muscles to guide movement, facilitate strength and contraction, also can provide resistance
- Lumbrical grip is used to provide comfort
What therapist body position for PNF?
Helps control of motion
Positioned directly in line with desired motion to optimize resistance
What is the timing for PNF?
-Facilitates normal timing and activation of muscle
-Sequence of muscle activity for smooth and coordinated movement
-Normal timing is distal to proximal
What is verbal cues for PNF?
Gives direction for movement
Clear and concise
Focused on preparation, action, and correction
What is vision for PNF?
Guides movement
What is the approximation for PNF?
Compression of force to joints that stimulates nerves and facilitates extensor muscles and stabilizing patterns
- Can be applied manually or positions
What is traction for PNF?
Distraction force applied to facilitate flexor muscles mobilizing patterns
-Elongation of an extremity
-Applied throughout the arc of motion and is used to facilitate muscle v
What are the principles for PNF?
Patient position
Therapist position
Manual contacts
Verbal cues
Patterns of movements
Timing
Resistance
Approximation
Traction
Visual input
Irradiation and reinforcement
Quick Stretch
What is Patient position for PNF?
- As close to neutral alignment as possible and providing support to body segments as needed
- Muscle position at optimal range allows for maximal contractile response
- Changing the patient’s position can emphasize certain segments of a pattern and alter demands
What is the midrange during PNF?
Greatest tension
What is the shortened range during PNF?
Weak contractile forces
What is the lengthened range during PNF?
Optimal stretch for the spindle
What is irradiation and reinforcement of PNF?
-Overflow of neuronal excitation from stronger motor units to motor units that may be weaker or inhibited
-Spread of expansion of muscle response from stronger muscles to weaker muscles
What is stretch for PNF?
- Lengthened muscle and stretch reflex are used to initiate movements and to facilitate contractions
- Verbal cues should be synchronized with the stretch to enhance movements
What are the patterns of movement for PNF?
Normal functional synergistic patterns are facilitated
What is the visual input for PNF?
Patient uses vison as a source of feedback to guide movements
What are the different PNF techniques?
- Rhythmic initiation
- Combination of isotonics
- Stabilizing reversals
- Rhythmic stabilization
- Dynamic reversals
- Repeated quick stretch
- Contract relax
- Hold relax
What is rhythmic initiation?
Used to promote learning of new movements, improve coordination, and promote relaxation and independent movement
What are the 4 phases of movement for rhythmic initiation?
- Passive movement through the range
- Active assisted movement
- Independent movement
- Resisted movement
What are the 2 types of reversals of antagonists?
- Dynamic reversals (isotonic reversals)
- Stabilizing reversals
What are dynamic reversals (isotonic reversals)?
Use isotonic concentric contractions of agonists then antagonists performed against resistance
What are stabilizing reversals?
Alternating contractions with minimal movement (slow reversals) progressing to smaller ranges and stabilizing holds of first agonists then antagonists
What is rhythmic stabilization?
-Uses isotonic contraction of antagonist patterns with a focus on the contraction of muscles
-Start on one body part in one direction and another body part in the opposite direction
What is repeated stretch?
-Repeated contractions
-Repeated isotonic contraction directed to the agonist muscles, inhibited by quick stretch and using resistance
-Can ve used in lengthened range for weaker muscles of just in the range that is weaker
What is combination of isotonics?
-Uses concentric, isometric, and eccentric contraction of agonists muscles without loss of tension
-Limb is resisted moving through the range followed by stabilizing contraction (holding) and then an eccentric lengthening contraction, moving slowly back to starting position
-No relaxation between contraction
What is timing for emphasis?
-Alters the normal timing of a pattern using resistance to enhance more localized contraction
-Allow irradiation to occur
-Used for weak or poor coordination
What is contract relax?
-Stretching facilitation that is used at a limited point of ROM
-Therapist asks for a strong contraction in the range restricting (antagonist)
-Contraction is held for 5-8 seconds enhancing relaxation
-Voluntary relaxation and active movements then follows
-Works through reciprocal inhibition
What is hold relax?
-Stretching facilitation performed in a position of comfort and below level of pain
-Patient actively moves the limb to the pain free end ROM
-A strong isometric contraction of the antagonist is resisted followed by relaxation and passive movement into the new range
What is replication (hold-relax-active movement)?
-Stretching thechnique that is performed with the shortened range
-Isometric contraction is resisted followed by relaxation and passive movements to lengthened range then an isotonic contraction through the range into the end position again
-Goal is increasing ROM
How does practice help with motor learning/skill?
-Has a major affect on motor learning
-Increased practice = increased motor learning
-Therapist should prepare the patient for practice with the desired movement and insure enough time.
-Avoid negative learning situations where the patient is learning improper habits and postures
-When choosing practice, the therapist must consider motivation, attention span, concentration,
endurance, and type of task.
-Mass vs distributed practice
-Blocked vs random practice
-Blocked order vs random order vs serial order
-Mental practice
-Part-whole
