Strategies to Improve Motor Function Flashcards
Motor control
Area of study dealing with the understanding of the neural, physical, and behavioral aspects of movement
Motor control sequence
stimulus –> stim identification –> response selection –> response programming –> movement output
Who’s associated with Reflex theory?
Sherrington.
What is reflex theory?
stimulus –> response sequence of events
Limitations of reflex theory
Voluntary movements can be activated without sensory input
Speed of movements; some so fast that no feedback
Variety of motor responses to same stimulus
Who is associated with Hierarchical theory?
Hughlings Jackson
What is Hierarchical theory?
CNS organized into 3 levels: high, middle, and low centers. Control proceeds in a descending direction from higher to lower centers, “top-down”
Modern model of Hierarchical theory highest level
association cortex; elaborating perceptions, and planning strategies
Modern model of Hierarchical theory middle level
sensorimotor cortex along with basal ganglia, brainstem, cerebellum
Modern model of Hierarchical theory lowest level
spinal cord, resulting in execution of movement
Who is associated with Systems Theory?
Bernstein
What is systems theory?
Cooperative actions of many systems; internal and external factors; shifting locus of control: distributed model of control
Coordinative structures simplify control with coordinated patterns or synergies
(Central patterns generators (locomotion) &
Postural synergies - normal)
Who is associated with Systems Model?
Vereijken
What is systems model?
3 levels:
Novice: learner simplifies the movement to reduce the degrees of freedom
Advanced: learner begins to release additional degrees of freedom; muscle synergies used to produce coordinated movement
Expert: learner has released all degrees of freedom, optimizes efficiency of movement
Open loop control system
absence of peripheral feedback and error detection
Closed loop control system
Feedback, reference for correct movement, can initiate corrections
Motor learning
A set of internal processes associated with practice or experience leading to relatively permanent changes in the capacity for skilled behavior
Aspects of motor learning
performance, retention, generalizability/adaptability, resistance to contextual change
Basic learning principles
- need to be able to problem solve & practice solutions for independent ADL
- must be possibility of success
- revert to safer/familiar patterns to solve the problem if task is difficult or unfamiliar.
- learning occurs in multiple parts of CNS
- motivation to experience the unknown is necessary
- success in learning is essential to retain motivation
Who is associated with Closed loop theory?
Adams
What is closed loop theory?
Sensory feedback compared with perceptual trace (stored memory of intended movement)
Provides reference of correctness and error detection
Practice enhances perceptual trace
Who is associated with Schema Theory?
Schmidt
What is Schema theory?
Slow movements: feedback-based
Fast movements: program-based
Schema: rule, concept, or relationship formed on the basis of experience
Initial conditions
Relationships between movement parameters
Environmental outcomes
Sensory consequences
Recall schema
used to select, define initial movement conditions
Recognition schema
used to evaluate movement responses based on expected sensory consequences/outcomes
Who is associated with the 3 stages of motor learning?
Fitts and Posner
What are the three stages?
Cognitive
Associative
Autonomous
Cognitive stage
finding appropriate strategy, overall understanding of skill, cognitive map, What to do
Associative Stage
refining a movement pattern, use of proprioceptive rather than visual cues; How to do
Autonomous Stage
skilled at movement, automatic, less attention needed for task, motor program runs itself, highly coordinated, focus on success, can perform equally well in closed skill or open skill; How to succeed
Who is associated with the Two-stage theory of motor acquisition?
Gentile
What is the Two-stage theory of motor acquisition?
1) getting the idea of the movement
2) fixation/diversification
What does “getting the idea of the movement” consist of?
Understanding goal of task
Develop appropriate movement strategies
Understanding the environmental features critical to the organization of movement
learn to distinguish constraining (regulatory) features of the environment from non-regulatory
What does “fixation/diversification” consist of?
refining movement patterns
developing the capability of adapting the movement to changing task and environmental demand
performing task efficiently, consistently from trial to trial.
Strategy development
Help learner develop an internal cognitive map or reference of correctness
DEMONSTRATION
Clear, concise instructions
Allow for trial and error learning
Guidance
Active decision making
Strategy refinement
Motor plans specific to activity
Context in which the pt practices
Sequence of activities has an outcome measurement perspective
Drawing cognitive attention off the task and to perform the activity as a “procedure”
Intrinsic feedback
comes from proprioception and kinesthetic senses
Extrinsic feeback
Augmented sensory cues
Concurrent feedback
Given during the performance of task
Terminal feedback
Given at end of performance of task
Knowledge of performance
(KP) feedback about the quality of the movement pattern
Knowledge of results
(KR) feedback about the end result or outcome
Clinical decisions around feedback
What type (mode), how much (intensity), when (timing/scheduling)
Modes of feedbacl
Visual, auditory, tactile
What intensity feedback is better for improved retention?
Varied feedback. But slows initial acquisition.
What intensity feedback helps correct early performance but slows retention?
Frequent/constant
Types of scheduling of feedback
summed, faded, bandwidth, delayed
Summed scheduling
Given after set number of trials
Faded scheduling
Given after every trial initially, then progressively less frequently
Bandwidth scheduling
Given only when performance outside given error range
Delayed scheduling
Given after brief delay (allows for self-reflection)
Closed practice environment
Stable, predictable
Open practice environment
changing, variable
Which practice distribution has less rest time than practice time?
Massed practice.
What person is massed practice good for?
high motivation, good concentration, and good endurance/energy level
What is a distributed practice distribution?
rest time equal to or longer than practice time. MOST LEARNING PER TRAINING TIME.
What is a blocked practice order?
Repeated practice in a predictable order (111222333)
What is blocked practice good for?
Early acquisition of skills
What is practice in a predictable but non-repeating order called?
Serial. (123123123)
What practice orders are good for retention and generalizability
Serial and Random.
What is a non-repeating and unpredictable practice order?
Random. (123321231)
Does mental practice facilitate motor skill acquisition?
Yes. & it activates similar areas of brain as actual task, very good when combined with physical practice (increase accuracy and efficiency of task faster)
Transfer of learning
the gain (or loss) of task performance as a result of practice or experience on some other task.
Parts-to whole transfer
Practicing component parts of a motor activity in order to learn the whole activity
Bilateral transfer
the patient practices movement on unaffected side first, then progresses to practice with the affected side
Speed-accuracy tradeoff
the accuracy of a movement is decreased as its speed is increased
Regenerative synaptogenesis
sprouting of injured axons to innervate previously innervated synapses
Reactive synapytogenesis
[collateral sprouting] reclaiming of synaptic sites of injured axon by dendritic fibers from neighboring axons
Synaptic plasticity
Improvement in neurotransmitter release and receptor sensitivity
What is function induced recover also known as?
Use-dependent cortical reorganization
- Vicariance
- Substitution
Who is associated with NDT
(neurodevelopmental treatment)
Karl and Berta Bobath
What is NDT?
Postural control is foundation for all skill learning.
Control movement through the use of developmental sequence promoting “normal” selective movements.
Facilitate through the use of handling and key points of control to improve postural alignment and control/stability
How does NDT work?
Excessive tone inhibited through dynamic reflex inhibiting patterns
Sensory stimulation used to facilitate normal movement experiences
Activities are varied in terms of difficulty and environmental context
Compensatory strategies are avoided
What are Carr and Shepard associated with?
Motor relearning programme for stroke
What is motor relearning programme for stroke
Task performance analyzed and activities selected for practice.
Environment modified to create appropriate setting to promote learning and goal-directed behaviors.
Complex movements are broken down into discrete parts and then practiced as a whole.
Motor learning training strategies are used, visual guidance of movement and verbal feedback (corrections) are stressed.
Manual guidance of movements limited to essential assistance to movement.
What is Signe Brunnstrom associated with?
Recovery Stages in Patients with Stroke & abnormal synergistic control in patients with stroke
What are the Recovery Stages in Patients with Stroke ?
Stages 1 - 6
Brunnstrom stages 1-2
1) presence of flaccidity
2) emergence of basic limb strategies
Brunnstrom stages 3-4
3) voluntary performance of all or part of basic limb synergies
4) beginning of controlled movement outside of synergistic pattern
Brunnstrom stages 5-6
5) Relative independence of basic limb synergies
6) Isolated, coordinated joint movement
What are Kabat, Knott and Voss known for?
PNF!
What is PNF?
Functional patterns that are spiral and diagonal, based on normal movements
Developmental emphasis was added later to include practice in the various different patterns of the developmental sequence. Motor learning strategies: practice, repetition, visual guidance of movement
What is Margaret Rood associated with?
Neuromuscular/Sensory stimulation techniques.
What are neuromuscular/sensory stimulation techniques
Phasic stimuli [quick ice, quick stretch]
Tonic stimuli [approximation, steady resistance]
Facilitatory or inhibitory stimuli used to achieve desired outcome
Reciprocal innervation
reflex activation for movement patterns in developmental sequence
Coinnervation
cocontraction of agonist and antagonist to stabilize body from head to feet
Heavy work
movement superimposed on cocontraction
Skill
Skilled work, with emphasis on distal portions of body segment
