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Neuromanagment > Motor Control > Flashcards

Motor Control Flashcards

1
Q

Upper Motor Neuron (UMN)

A

Carries motor messages from the primary motor cortex to either the CNS nuclei (located in brainstem) or to the interneurons in the ventral horn. UMN travel up too but do not actually enter the ventral horn. UMN are considered to be part of the CNS

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2
Q

Lower Motor Neuron (LMN)

A

Carries motor messages from motor cell bodies in ventral horn to skeletal muscles in the periphery. LMN are considered to be part of the PNS. Includes central nerves, peripheral spinal nerves, conus medullaris, cauda equina, and ventral horn

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3
Q

What can cause a motor problem?

A

1) Neurological problem
2) Musculoskeletal problem

Sometimes something can start as a neurological problem and become a musculoskeletal problem

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4
Q

Motor Control

A

Ability to regulate and direct the mechanisms essential to movement. Motor control comes after acquiring control of movement (motor learning)

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5
Q

What does a person use to regulate and direct movement?

A

Neurological systems collaborate to make motor control possible. If there is damage to one system then it will affect an individual’s movement

Cerebral cortex: motor, visual, auditory, cognition, intellect
Basal ganglia: coordination, tone, equilibrium
Cerebellum: coordinated movements
Brain stem: righting reactions

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6
Q

Is motor control just about muscles and nerves?

A

No! Motor control results when the individual is able to complete a task in an environment

Movement = person, task, environment

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7
Q

Components of Motor Control

A 
Selective movements
Tone
Postural control and mechanisms
- balance
- reflexes: primitive, equilibrium, righting reactions
Coordination
- types
- involuntary movements
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8
Q

Tone

A

Resistance of a muscle to passive elongation or stretching

Neurological insult can impact tone

Flaccid - feels different from someone who has normal tone. Feels heavy and moves like jello

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9
Q

Characteristics of Normal Tone

A

1) Effective co-activation of axial and proximal joints
2) Ability to move against gravity and resistance
3) Can maintain position of limb passively placed and released
4) Balanced agonist and antagonist muscle tone
5) Ease of shifting from stability to mobility and vice-versa
6) Ability to use muscles in groups or separately
7) Resilience or slight resistance in response to passive movement

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10
Q

Muscle Tone Continuum

A

High Tone/Rigidity > Spasticity > Normal Tone > Hypotonia > Low Tone/Flaccidity

Flexor spasticity in UE occurs first and extensor spasticity in LE returns first

Extensor tone is easier to break than flexor tone

Encourage voluntary movement, ROM, meds, splinting to normalize tone following an insult

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11
Q

Flaccidity

A

Complete loss of muscle tone

People are usually flaccid the first 48 hours following a stroke, followed by increasing resistance to PROM

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12
Q

Hypotonia

A

Reduction in muscle stiffness

Characterized by low tone, weak neck and trunk control, poor muscular co-contraction, limited stability

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13
Q

Spasticity

A

Hypertonicity

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14
Q

Rigidity

A

Hypertonicity with heightened resistance to passive movement

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15
Q

Modified Ashworth Scale

A

6-point scale
Lower scores represent normal muscle tone and higher scores represent spasticity or increased resistance to passive movement

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16
Q

Clonus

A

Uncontrolled oscillations in spastic muscle groups
Repetitive contractions in the antagonistic muscles in response to rapid stretch
Actively weight-bearing can stop it

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17
Q

Cogwheel Rigidity

A

Jerky resistance

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18
Q

Clasp Knife Syndrome

A

Severe rigidity - sustained stretch will relax muscle group and give way (like when you’re returning the blade on a pocket knife

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19
Q

Postural Control

A

Ability to maintain a steady position in weight-bearing, antigravity posture. Ability to center self vertically

Not formally assessed by OTs

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20
Q

What influences postural control?

A

1) Neuromuscular mechanisms (e.g. ROM, strength)
2) Musculoskeletal mechanisms (e.g. ROM, strength)
3) Sensory mechanisms (e.g. vision, vestibular, somatosensory)
4) Perceptual mechanisms (e.g. body image, laterality)
5) Cognitive mechanism (e.g. attention, judgement)

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21
Q

Postural Tone

A

Ability to react to gravity

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22
Q

Normal Postural Control Mechanisms

A

Autonomic movements: provide an appropriate level of stability and mobility
Automatic reactions develop early in life and allow for:
- Trunk control and mobility
- Head control
- Midline orientation
- Weigh-bearing and weigh shifting in all directions
- Dynamic balance
- Controlled voluntary limb movements
After illness or injury, the “automatic” nature of movement is lost

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23
Q

Balance/Postural Stability

A

Controlling the center of mass (COM) in relation to the base of support (BOS)
Maintaining an appropriate relationship between body segments and between the body, the environment, and task-orientation
Types of Balance:
1) Static balance (can be challenged with trunk rotation)
2) Dynamic balance

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24
Q

Reflexes/Reactions

A

Righting reactions
Equilibrium reactions
Protective reactions
Primitive reflexes

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25
Q

Components of Postural Mechanism

A

Must be integrated to be normal
Normal postural tone and control
Integration of primitive reflexes and mass patterns
Righting, equilibrium, and protective reactions
Selective voluntary movement

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26
Q

Coordination

A

Ability to produce accurate, controlled movement

27
Q

Coordination Problems

A

Synergy: abnormal or disordered motor control
Co-activation: agonist and antagonist muscles both fire, preventing functional movement
Problems with timing

28
Q

Features of Coordinated Movement

A 
Precision
Smoothness
Appropriate force of muscle tension
Rhythm
Speed
Minimum number of muscle groups recruited
29
Q

Precision

A

Accuracy of movement (ex: undershooting vs. overshooting)

30
Q

Smoothness

A

Quality of movement

31
Q

Appropriate Force and Muscle Tension

A

Force to pick up an egg vs force to pick up a cup

32
Q

Rhythm

A

How one transitions from one movement to another

33
Q

Speed

A

How quickly you complete a motion

34
Q

Minimum Number of Muscle Groups Used

A

Movement efficiency

35
Q

Incoordination

A

Extraneous, uneven, or inaccurate movements

Caused by trauma to muscles or peripheral nerve disease

CNS dysfunction:

  • Cerebellar
  • Posterior column dysfunction
  • Basal ganglia dysfunction
  • Frontal or postcentral cortex
36
Q

Cerebellar Incoordination

A

Ataxia/dyssynergia
Adiadochokinesis - inability to perform rapid alternating movements
Dysmetria - undershooting or overshooting of intended position with the hand, arm, leg, or eye. It is a type of ataxia
Nystagmus - vision condition in which eyes make repetitive, uncontrolled movements
Dysarthria - difficult or unclear articulation of speech

37
Q

Extra-Pyramidal Incoordination Disorders

A 
Chorea
Athetoid movements 
Dystonia
Ballism
Tremor
38
Q

Dystonia

A

Sustained muscle contractions that result in repetitive, abnormal postures. It can affect on muscle, a muscle group, or the entire body

39
Q

Ballism

A

Violent slinging of the limbs that may only affect one side of the body

40
Q

Chorea

A

Rapid complex movements that look purposeful but are really involuntary movement

41
Q

Athetoid Movements

A

Usually a rhythmic writhing of the head, tongue, toes, or fingers.

42
Q

What are secondary effect factors that may impair purposeful, coordinated movement

A 
Contractures
Pain
Edema
Subluxation
Decreased endurance - both muscular and cardiovascular
43
Q

Motor Learning

A

The study of the acquisition and/or modification of movement
A set of processes associated with practice and experience that leads to permanent change in behavior or capacity to respond

44
Q

What is the difference between motor control and motor learning?

A

Motor control studies movement already acquired. Motor learning studies how movement is acquired

45
Q

When does motor learning occur?

A

1) During normal motor development as the nervous system matures
2) Re-learning motor skills post injury or disease
3) During novel situations

Motor learning requires practice and feedback

Therapeutic intervention: instruction, feedback, opportunities for practice, and encouragement/feedback

46
Q

How is training different from learning?

A

Training: temporary change that occurs when the performer is provided with solutions to problems. Examples: therapist encourages pt to memorize specific set of exercises or when a teacher provides student with an answer to a question. Training results in short term performance capabilities

Learning: relatively permanent change in capability to respond occurs as a result of practice or experience. Example: performer is encouraged to develop solutions when problems are encountered. Learning allows persons to transfer knowledge or adapt to a new situation

47
Q

What factors influence motor learning? Which are most potent?

A

1) Stages of learning
2) Type of task
3) Feedback - most potent
4) Practice - most potent

48
Q

Stages of Motor Learning

A

Cognitive (verbal) stage:
- Info gathered about task demands (learn elements of task)
- Movement is slow and has a lot of errors
- Explanations and demonstrations are valuable
Associate stage:
- Distinguish between correct performance and error
- Attention to finer details
Autonomous stage:
- Skill is automatic and does not require attention
- Performance is stable

49
Q

Types of Tasks

A

1) Activity demands determine the kind of motor response
2) Tasks may be classified on continuums
3) Serial, discrete, and continuous tasks

50
Q

Feedback

A

Provides guidance, reference for correction, and motivation.

Feedback can be given through sensory information - tactile feedback or demonstrate and verbally explain

51
Q

Concurrent Feedback

A

Offered continuously throughout movement

52
Q

Terminal Feedback

A

Offered at the end of movement

53
Q

Intrinsic Feedback

A

Feedback from individual’s sensory systems as a result of movement

54
Q

Extrinsic Feedback

A

Feedback from the environment (e.g. therapist or device)

  • Knowledge of Results (KR): knowledge of what the movement produces (outcome) in terms of achieving a goal or result. Correcting errors during movement.
  • Knowledge of Performance (KP): knowledge about the movement pattern or process used during task performance (e.g. biofeedback, verbal comments, or mirror)
55
Q

What evidence is there about the different types of feedback?

A
  • Nothing has been published on concurrent vs terminal
  • Excessive concurrent feedback can be distracting to the learner
  • Frequent, accurate, immediate KR promotes improved performance during acquisition phase but poorer performance during retention and transfer stages of learning
  • Immediate KR helps prevent patient frustration
  • KR provided within a certain “bandwidth” leads to better generalization of learning
  • Feedback on performance should focus on external environmental factors and not on internal performance
56
Q

What is practice?

A

Effort to become proficient

Practice should be active and accurate. Motor skill increases directly in relation to the amount of practice. Effect varies depending on the age, dx, amt/type of practice and task specificity

57
Q

Types of Practice

A

1) Physical

2) Mental (i.e. motor imagery)

58
Q

Types of Practice Conditions

A

1) Massed: practice time is greater than the amount of time between trials
2) Distributed: rest time between trials equals or is greater than the time in trial
3) Constant: performance of task in same way (may improve performance but can be fatiguing and less effective)
4) Variable: perform task in different ways by varying characteristics of the task. This improves ability to generalize to various situations
5) Blocked: practicing each task in a block before progressing to a new task. This is better for cognitive impairment
6) Random: practicing a series of tasks in random order
7) Part practice: practicing a subset of task component
8) Whole practice: practicing the entire task
Massed and distributed are related to endurance

59
Q

Evidence on Practice Conditions

A
  • Physical practice is the best type but mental practice can be an effective way to enhance learning when physical practice is not possible
  • Blocked practice increases the speed of improvement
  • Random practice improves learning and recall
  • Practicing whole tasks is more effective than practicing parts of tasks
  • Variable practice increases generalizability in novel situations
60
Q

Skill Acquisition

Feedback, Practice, Cueing

A

The initial learning of a new skill

Feedback: frequent extrinsic, concurrent
Practice: physical and mental, repetition, consistency
Cueing: manual and verbal

61
Q

Retention and Transfer

Feedback, Practice, Cueing

A

The long-term learning of a skill and the ability to generalize the skill to new contexts

Feedback: less frequent, terminal
Practice: promote entire patter, encourage problem solving, variable
Cueing: allow for error and refinement, do not over cue

62
Q

What things should be considered in order for therapeutic motor learning to be successful?

A
  • Therapeutic environment
  • Arousal and attention
  • Motivation and meaning
  • Instruction
  • Feedback
  • Practice

Therapy should be individualized to the person and not the diagnosis

63
Q

What is the therapeutic intervention process?

A

1) Select tasks/activities to use during session
2) Provide instruction
3) Provide feedback about performance
4) Structure opportunities for practice
5) Provide encouragement

64
Q

What are OT treatment assumptions with neurological insult?

A

1) Healing is cephalo to caudal, proximal to distal and medial to lateral
2) Mobility should be established first, then proximal stability, next controlled mobility, and finally distal skilled movement
3) Mass patterns are replaced by selective voluntary movement
4) Gross motor to fine motor movement
- Large mass movements come before discrete movements
5) Undifferentiated to specific movement
6) Asymmetry to symmetry and then symmetry to voluntary asymmetry
7) Midrange before end range
8) Vertical to horizontal in rotary movements
9) Movement should be relearned in purposeful patterns rather than specific actions
10) Motor control is gained via repetition

Neuromanagment (22 decks)

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