Neurological and Cognitive-Perceptual Approaches Flashcards
Contemporary Task-Oriented Approaches to Motor Control
Reject assumptions of reflex-hierarchical model of motor control and traditional neuro theories
Movement is controlled by the integration and interaction of multiple systems (enviroment, sensorimotor, musculoskeletal, behavioral/emotional goals)
Includes motor learning principles
Believes continued practice of compensatory methods limits functional recovery
Stages of Motor Learning
- Skill Acquisition/Cognitive stage
- Skill Retention/Associated stage
- Skill Transfer/Autonomous stage
Cognitive Stage
of Motor Learning
Develops an understanding of task.
Strategies
Highlight purpose of task
Demo ideal performance of task
Have pt verbalize task components/requirements
Select appropriate feedback- (high dependence on vision; focus on errors as they become consistent; focus on success of movement outcome)
Learner self-eval (id problems/solutions)
Organize initial practice
Assess, modify arousal lvls
Structure environment
Associated Stage
of Motor Learning
Learner practices movements, refines motor program
Dependence on visual feedback decreases; proprioceptive feedback increases
Strategies
Select appropriate feedback- continue to focus on consistent errors and success of outcome; assist learner with self-eval and decision-making
Organize feedback schedule
Organize practice- encourage consistency of performance
Structure environment
Autonomous Stage
of Motor Learning
Learner practices movements; continues to refine motor responses; movements are largely error-free
Strategies
Assesses need for conscious attention, automaticity of movements
Select appropriated feedback- occasional feedback when errors are evident
Organize practice- high lvls of practice are appropriate
Structure enviroment
Focus on competitive aspects of skills as appropriate
Motor Learning Practice
Random practice- practice of several tasks that are presented in a random order, encouraging reformulation of the solution to the presented motor problem
Blocked practice- repeated performance of the same motor skill
Variable conditions- practice of skills in various contexts to improve transfer of learning and retention
Mental practice- cognitive rehearsal of a skill w/o actually moving
NDT Treatment
Inhibit abnormal patterns of movement and posture via handling, positioning, use of key points of control
Goal is to replace the abnormal movement patterns with normal patterns of movement. Secondary result will be more normal sensory input to reinforce the normal movement patterns
PNF Approach
Stimulation of the proprioceptors (in the joints)
Use of reflexes to stimulate normal movement
Focus is on correcting imbalances between the antagonists
Facilitate stronger muscles to stimulate the weaker ones
Use of sensory cues to facilitate normal motor movement (touch, vision, auditory)
Use of diagonal and circular patterns of movement to reinforce normal patterns of movement
Brunnstorm Approach
there is belief to use whatever the patient may have.
Sees the use of synergies as being ok and if used over and over then ultimately they get integrated into more normal patterns of movement
Rood Approach
Felt sensory stimulation assisted with the development of normal muscle tone and motor responses
Treatment uses a lot of vibration, stroking, slow rolling from side to side, brushing, rubbing, followed by a functional motor movement
Assessment of Glenohumeral Joint Subluxation
Allow pt’s arm to dangle into gravity
Palpate the space underneath the acromion process w/index finger
Compare to intact side and document width of space in terms of finger breadths
Direct Intervention (Bolus) Oral Motor Dysfunction
Mod if consistency, amount, and pacing of solids and liquids
Postural interventions to increase swallowing efficiency during meals (chin tuck, head tilt, head turn)
Specific swallowing adaptions
Indirect Intervention (No Bolus) Oral Motor Dysfunction
Thermal (cold) stimulation via chilled dental examination mirror to elicit a swallow reflex
Reflex facilitation
Strengthening, facilitation, and coordination of oral movements
Airway adduction procedures
Positioning
Goals of Orthotic/Splinting Interventions for Neuromotor Dysfunction
Prevent/correct deformity
Control spasticity by aligning joints and providing stretch
Position hand in functional posture
Compensate for weakness
Support painful joint
Promote distal joint mobility
Immobilize to promote healing
Prevent/reduce scarring
Types of Inhibitory/Tone Normalizing Orthoses
Bobath finger spreader- soft splint positions digits/thumb in abd to reduce tone
Rood cone- reduce flexor spasticity in hand
Orthokinetic splints- utilizes tactile input to facilitate and/or inhibit muscle groups
Spasticity reduction splint- places the spastic distal extremity on submaximal stretch to reduce spasticity
Cock-up Splint
Supports the wrist in 10-20* of ext to prevent contracture
Allows digits to function
Ayres Sensory Integration Approach
Assumes:
Neuroplasticity of the CNS allows for its modifications
Sensory integration occurs in a developmental sequential manner
Tactile Modulation for Tactile Defensiveness; Hypo/Hypersensitivity; Sensory Seeking
Self-applied more tolerable than passive application
Apply controlled sensory activities that simultaneously provide tactile and vestibular-proprioceptive info
Begin w/slow linear movements and deep touch-pressure (visible)
Apply tactile stimuli in the direction of hair growth
Follow tactile stimuli w/joint compression
Monitor and adjust stimuli
Assess the child’s behavioral responses
Tactile Discrimination Intervention
Provide deep-touch pressure to the hands/body
Tx for tactile discrimination is usually performed simultaneously when providing tx for deficits in motor planning
Provide graded activities req tactile discrimination activities using a mix of textures/items (rice,sand)
Proprioception Intervention
Deficits in modulation demonstrated by hypersensitivity and sensory seeking
Provide firm touch, pressure, joint compression, or traction
Provide resistance to active movement to help child learn approp amount of force to perform tasks
Provide actv in various positions combining vestibular proprioceptive info (yoga)
Provide slow linear movement, resistance, deep pressure
Use adaptive techniques (weighted vest)
Vestibular Interventions
Deficits in modulation include hyposensitivity, hypersensitivity, sensory seeking, and gravitational insecurity
Grade for type and rate of movement, and for amount of resistance
Slowly intro linear movement w/touch pressure in prone and provide resistance to active movements
Use linear vestibular stimuli to increase awareness of spatial orientation
Provide rapid rotary and angular movements w/freq starts/stops and acceleration/deceleration to increase ability to distinguish the pace of movement (semicircular canals)
