motor control and skill Flashcards
what is motor control?
-understanding of the neural, physical, and behavioral aspects of biological movement.
Stimulus, stimulus identification, response selection, response programming, movement output
what is motor skill
coordinated movement strategies with a goal or attaining and action.
Require voluntary control so reflexes are not motor skills
What are Categories of motor skills
-Mobility: requires the individual to move the body from one posture to another in a controlled manner. BOS and COG are moving
-stability: static postural control (maintain a posture with unchanging COM and BOS) and dynamic postural control (adjusted and maintained while UE/LE are moving)
gross motor skills are
Large muscle groups and body parts, acquired in early childhood
Rolling, crawling, standing
fine motor skills
Require control of small muscles, smaller movement with precision
ADLs, eating, buttoning, writing
what is discrete motor skills
Have a recognized beginning and end
Sit to stand, lying down, throwing a ball
Serial Motor skills
Series of discrete skills with specific order
Transfers bed to w/c
Continuous Motor skills
No recognizable beginning or end
Swimming, running
Closed Motor skills
Stable and predictable environment
Walking in quiet hall, brushing teeth
Open Motor skills
In a constantly changing and unpredictable environment
Shopping in grocery store or mall, crossing busy street
Simple Motor skills
Simple that produces an individual movement response
Kicking a ball while sitting
Complex Motor skills
Involve multiple actions and motor programs combined to create coordinated movement
Gymnastics, running and kicking a ball
Dual task skills
Motor skills that also involves a cognitive or physical task
Walking while talking, walking while holding objects
What are strategies for motor learning skill.
The Recall Stage of motor learning
-Cognitive stage: understanding of the task
-Associated stage: practice movements, refine motor programs
-Autonomous stage: practice movement and refine motor processes
Strategies for motor learning/skill
-Therapist should model the task exactly how it should be performed (smooth timing and ideal performance)
-Therapist can assist the patient through the movement (guided movements) which can have a positive effect on learning new skills
–It allows the patient to learn the sensation of the movement
-Verbal guidance can also help with improving and learning a task
-Limit verbal and guided movement to only the amount needed. Over guidance can result in over dependence on therapist
-Guidance is more effective in slower positional task and less effective in ballistic tasks
Strategies for motor learning/skill continue
Allow the patient to make errors and do not overload with feedback and cuing
As the patient progresses to associative and autonomous stages, the patient should now be focusing on more proprioceptive feedback rather than verbal or guided movements
Guided movements become counterproductive as they can limit active practice
Dual task can be initiated in the last 2 stages
Strategies for motor learning/skill
practice
-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
what is intrinsic feedback
information given by the body
what is extrinsic feedback
external sources (timers, sensors, therapist)
Knowledge of results is
information about the movement outcome
Knowledge of performance
information about the nature or quality
Frequent extrinsic
feedback can slow retention and foster dependence on an external source
New learners need more immediate feedback but as the learner improves they need less frequent feedback
Flexibility (Interventions for motor control/skill)
Preventative: ROM and stretching exercises
Limits in range due to tone/contracture may require low load prolonged stretching through splinting or bracing
Include a warmup period to enhance stretching
Cold may help reduce spasms if they are limiting motion
FES, PNF, botox, baclofen can help reduce spasticity if it is present and limiting function
Strengthening/neuro re-ed with(Interventions for motor control/skill)
-Isometrics used for stability and maintaining postures and positions
-Concentric and eccentric help initiate movement
-Electromyographic feedback used with sever weakness and used to assist in recruitment of muscles and re-education
-May need to move to gravity eliminated positions
what happens with Neuromuscular endurance and fatigue
Usually present after a neurological event (CVA) or with a neuromuscular disease (MS)
Patients may be able to generate muscle function but do not have the ability to sustain the contraction over time.
Coordination
Interventions for motor control/skill
Ataxia: inability to coordinate muscles, joints, and limbs for smooth and accurate movement. Usually due to cerebellar lesion
Usually require hands on support or Ads
Proprioceptive loading, core stability, intense functional training
Balance and postural control
-First attain postural alignment and static stability upright followed by center of mass control training
-Begin with weight shifting 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, sensory inputs, UE support, UE movements, LE movements, trunk movements, functional activities, walking, dual task, modify environment
-Postural strategies training needs to be incorporated (ankle strategy, hip strategy, stepping)
Task specific training consistent of
-Treatment for neurological patients need to be meaningful, effortful, and task specific
-Task specific based on motor learning principals along with exercise are the core for rehabilitation for patients with neurological deficits
-When choosing tasks, make sure you understand the task demands and consider the above impairments (strength, coordination, flexibility)
-Challenge the patient (not too easy, not to hard)
-Structure the environment, schedule practice, provide feedback, dose the intervention, progress, and encourage problem solving
examples of 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 wheelchair)
-Moving person in moving environment (moving in the wheelchair)
what is dosage
-High intensity to achieve neuroplastic changes
-Use the FITT principle (frequency, intensity, time, type)
-Add difficulty by changing environment, moving from stability to mobility, and adding manipulation
what is Proprioceptive Neuromuscular Facilitation (PNF)
-Intervention that uses the facilitation of total patterns of movement to promote motor learning
-Based on the idea that normal movements are spiral and diagonal
-Emphasis on recovery of function vs compensation
Hands on treatment to facilitate movement patterns
Evolved over the years to integrate principles of motor learning
Elements of PNF
Resistance:
improves contraction, motor control, strength, and motor learning
Irradiation and Reinforcement
response to stimulus spread to adjacent muscles
Manual contacts
guides movement
Body position
helps control of motion
Timing:
facilitates normal timing and activation of muscles
Verbal cues
gives direction for movement
Vision
: guides movemen
Approximation
: compression of force to joints that stimulates nerves and facilitates extensor muscles and stabilizing patterns
Traction
distraction force applied to facilitate flexor muscles mobilizing patterns
Patient position
-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
–Midrange = greatest tension
–Shortened range = weak contractile forces
–Lengthened = optimal stretch for spindle
-Changing the patient’s positon can emphasize certain segments of a pattern and alter demands
Therapist position
Positioned directly in line with the desired motion to optimize resistance
Manual contacts
-Hand placement overactive muscles to guide movement, facilitate strength and contraction, also can provide resistance
-Lumbrical grip is used to provide comfort
Verbal cues
Clear and concise
Focused on preparation, action, and correction
Patterns of movement
Normal functional synergistic patterns are facilitated
Timing
Sequence of muscle activity for smooth and coordinated movement
Normal timing is distal to proximal
Appropriate resistance
Resistance facilitates muscle contraction
Appropriate resistance allows for smooth and coordinated contraction
Approximation
Joint compression used to facilitate muscle responses in extensor patterns during stabilization
Can be applied manually or positions
Traction
Elongation of an extremity
Applied throughout the arc of motion and is used to facilitate muscles
Visual Input
Patient uses vision as a source of feedback to guide movements
Irradiation and reinforcement
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
Stretch
Lengthened muscle and stretch reflex are used to initiate movements and to facilitate contractions
Verbal cues should be synchronized with the stretch to enhance movement
Rhythmic Initiation
Used to promote learning of new movement, improve coordination, and promote relaxation and independent movement
4 phases of movement:
1. passive movement through range 2. active assisted movement
3. independent movement
4. resisted movement
reversals of Antagonists
Dynamic reversals (isotonic reversals): use isotonic concentric contractions of agonists then antagonists performed against resistance
Stabilizing reversals: alternating contraction with minimal movement (slow reversals) progressing to smaller ranges and stabilizing holds of first agonists then antagonists
Rhythmic stabilization
Uses isometric contractions of antagonist patterns with focus on contraction of muscles
Start on one body part in one direction and another body part in opposite direction
Repeated stretch
Repeated contractions
Repeated isotonic contraction directed to the agonist muscles, initiated by quick stretch and using resistance
Can be used in lengthened range for weaker muscles of just in the range that is weaker
Combination of Isotonics
Uses concentric, isometric, and eccentric contractions 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 contractions
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
contract-relax (CR)
Stretching facilitation that is used at a limited point of ROM
Therapist asks for a strong contraction in the range restricting (antagonists)
Contraction is held for 5-8 seconds enhancing relaxation
Voluntary relaxation and active movement then follows
Works through reciprocal inhibition
Hold-relax (HR)
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
Replication (Hold-relax-active movement)
Stretching technique that is performed with the patient in the shortened range
Isometric contraction is resisted followed by relaxation and passive movement to lengthened range then an isotonic contraction through the range into the end position again
Goal is increasing ROM
