Motor Control and Coordination Flashcards
Motor Deficits include
- Motor control/coordination (“Motor Contol”)
- Balance/Proprioception (“Motor Control”)
- Muscle Strength (“Force”)
- Muscle Endurance (“Energy”)
abarrent movement
abnormal movement
Phase 1 we don’t gain motion but improve ____. We maintain muscle atrophy by providing ____.
quality of movement
isometric exercises.
These will all help in maintaining proximal and distal function.
Phase 1 Presentation
Poor motor coordination/activation
Use functional movement screens
Phase 1 Goal
- Improve movement coordination and muscle activation
- Prevent muscle atrophy
- Movement strategies to decrease pain
Exercises for Phase 1
Submax isometrics
Phase 2 Presentation
Strength and endurance deficits (Impaired muscle force production)
MMT, Set weight and do as many reps as possible, VO2max
Phase 2 Goals
- Restore/improve motion, strength, balance and function
- Enhance ideal movement patterns by enhancing force production of muscle
- Progress to performing more advanced ADL’s
Phase 3 Presentation
Strength and Endurance deficits of mm and limited ability to perform specific FUNCTIONS
Phase 3 Goals
- Enhance neuromuscular control during “high level activities” (based on pt’s goals)
- Enhance endurance, dynamic stability, power, speed, etc.
Phase 3 Strengthening Exercises
- Functional strengthening
- Higher level isotonics
- Exercise to enhance endurance
- OKC and CKC Rhythmic Stabilization
- Continued core stabilization
- Endurance
Usual Examination findings associated with Early Poor Motor Control/Coordination
Subjective:
* History of either acute or chronic pain or any other condition that affects quality of motion (ex: surgery)
* Or: neurological condition affecting motor control (Ex: Stroke, Peripheral Nerve injury, Concussion)
AROM:(CASSS: Control, Amount, Symmetry, Speed, Symptom reproduction)
* QUANITY of motion is variable
* QUALITY of motion especially with functional motions is altered. “ABERRANT MOTION”
Motor:
* Compensations noted during any motor assessment.
Dissociated (“Fractioned”) Movement
Break down motor patterns by facilitating body segments moving independently.
Loss of dissociated movement examples
Examples of abnormality:
* Upper quarter: Dissociated scapular movement; scapular and humeral move in conjunction together such as when they can’t properly do a lateral raise
* Lower quarter: Dissociated pelvic movement
Why do changes occur in acute pain with motor control?
- Protective mechanism; preventing joints to prevent further injury or pain
- Short term benefits by minimizing movement but can lead to long term consequences if it becomes habitual which leads to abberant movement
Examples:
* Antalgic gait; sprained ankle or knee injury
* observe someone turning head with acute neck pain (rotate through their trunk vs. their neck)
Why do changes occur in CHRONIC pain with motor control?
- Pain leads to redistribution of activity within and between muscles
– Increase activation of large superficial, biarticular muscles (leads to muscle tone “tightness”)
– Decrease activation of deep stabilizing muscles (multifidus, gluteus medius, piriformis, deep hip flexors, lower trapezius, transverse abdominis) - Pain and redistribution muscle activity leads to biomechanical changes. In other words…People move differently (more subtle than acute)
- Occurs centrally in the cortical levels in the brain
Basic movement and posture is controlled by
- Basal ganglia
- Vestibular nuclei
- Reticular Formation
New theory of motor adaptation to pain
variability: amount of segments moving
Is this a Sensory Input Processing Error or Motor Output Processing Error?
Input from periphery and output of the brain (both motor and sensory). As a result of chronic pain, results in smuding of the homonculus.
Phases 1-3 Triangle Progress
Start in the red and build into strength and endurance
Scapular and Humeral Dissociation
- Scapular dissociation: Ability for scapula to move independently of fixed humerus or spine (teach “Scapular clocks”)
- Humeral dissociation: Ability of humerus to move independent of fixed scapula (teach isolated humeral motion). Ex: Lateral Raise; can’t move humerus without scapula)
Femoral and Pelvic dissociation
- Pelvic dissociation: Ability to isolate pelvic motion with stable femur (teach “Pelvic tilts” and “pelvic clocks”)
- Femoral dissociation: Femur motion on stable pelvis (teach isolated hip motion)
Scapula Dissociation Exercise
Moving the Scapula in isolation
(ex: Scapular clocks)
Humeral Dissociation Exercise
Moving the humerus in isolation of a fixed scapula
(Ex: Prone Horizontal Extension “T”)
Examples of Patient Populations (“Indications”) - Upper
- Chronic Neck pain
- Neck injury following motor vehicle accident
- Chronic Shoulder pain
- Frozen shoulder
- Shoulder surgery esp. with prolonged immobilization
- Shoulder immobilization following trauma
- History of stroke
- Other neurological conditions that affect motor function
50% of outpatient are the top 4 conditions
Pelvic Dissociation Ex
“Pelvic Dissociation”: Moving the pelvis on a fixed femur
Supine:
* Pelvic tilts
* Pelvic clocks
Sit
* Pelvic tilts/clocks
* Hip hinging
Stand:
* “Hip hinging” (Cue: Use of stick – THREE POINTS OF CONTACT on head, thoracic and sacrum)
Implication of Inadequate Pelvic Dissociation
Rounded: Leads to over loading erector spinae
Hyperextended: Puts too much pressure on facets joints
Femoral Dissociation Ex
“Femoral Dissociation”: Moving the Femur on a fixed pelvis
Supine:
* Supine unilateral bent knee fall out
* Supine bilateral KTC with hip abduction/rotation
Side lying:
* Hip abduction/rotation: “clamshells”
* Hip IR/ER at 0 & 90 deg
WB:
* Hip flexion/Abduction/IR
Examples of Patient Populations Lower (“Indications”)
Chronic back and/or hip and/or knee pain
Back injury or pain
Back and/or hip and/or knee surgery
Knee injury
Pelvic floor dysfunction
Neurological conditions of the lower extremity especially with gait deviations
People with chronic pain with struggle with ____ cues. The use of ____ cues is needed.
- internal
- external
Which is best? Verbal, tactile or visual? Internal vs external?
Whichever leads to the desired outcome you are working toward.
internal cue def
Cues directed to the action itself
AND/OR
Cues directed to the mm activation that contriubute to the action
Integrate verbal, tacticle, and visual
external cue def
Cue/direction directed to the effect of the action
Integrate verbal, tacticle, and visual
Dosage for Motor Control
Must take into account ideal and realistic. More practice is better but the patient doing the exercise is more important.
Ideal:
1 Pelvic Clock Morning and Night, 1x every 1 hour 10-15-20 pelvic tilts
Addressing motor control deficits with strength will result in..
No changes. We must address motor coordination deficit specific interventions not strength. Motor control needs to be integrated early and then later when returning them back to their high levels of activity.
Patients that have fear of movement, hypervigalence of movement or other referral patterns will…
Result in alternate movement patterns and require a psychosocial education intervention to desensitise them and teach them that movement is good!
Intervention: Enhance Isolated Muscle Activation
Link between pain/injury and ability for muscle to contract in response to that injury/pain
EX: Lumbo-pelvic, Pelvic-LE comples, Cervico-thoracic complex
Mucles prone to motor control/coordination deficits
Cervico-thoracic syndrome: “Upper Cross Syndrome”
* Deep neck flexors
* Serratus anterior
* Mid and lower trapezius
* Shoulder external rotators
Lumbo-pelvic-hip syndrome: “Lower Cross Syndrome”
* Transversus abdominus
* Internal oblique
* Multifidus of lumbar
* Pelvic floor muscles
* Gluteus Maximus and hip medius and other hip ER
* Vastus Lateralis, medialis and intermedialis
Dysfunction typically is seen by activation of…
postural muscles first then phasic.
Proper mechanics are phasic muscles followed by postural.
Examples evidence of Patient Populations (“Indications”) - Poor activation patterns
- Chronic back and/or hip pain – Poor deep abdominal and multifidus activation
- Pelvic floor dysfunction – poor pelvic floor activation
- Knee surgery – poor quadricep and gluteal activation
- Neck pain following motor vehicle accident– poor deep neck flexor activation
- Shoulder pain – poor lower trapezius activation
