Test 1 Flashcards

0
Q

Symptoms

A

Subjective findings

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1
Q

Signs

A

Objective findings

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2
Q

Positive symptoms

A

Release of abnormal behaviors

Spasticity

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3
Q

Negative symptoms

A

Loss of normal behaviors

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4
Q

Motor cortex deficits

A

Motor weakness
Abnormal synergies
Coactivation
Abnormal muscle tone

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5
Q

Neural aspects of strength

A

Number of motor units recruited
Type of motor units recruited
Discharge frequency

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6
Q

Weakness

A

Inability to generate normal levels of force

Major impairment in those with UMN lesions

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8
Q

Paresis

A

Mild or partial loss of muscle captivity
From lesion in descending motor pathways
Interferes with central excitatory drive to the motor units

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9
Q

Paralysis or paresis

A

Decreased voluntary motor unit recruitment

Inability to recruit skeletal motor units to generate torque or movement

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10
Q

Reduced descending drive is associated with…

A

Failure to recruit high threshold motor units
Reduced ability to increase motor unit discharge to increase voluntary forces
More distally than proximally

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11
Q

Reduced excitatory input to the spinal motor neurons…

A

Reduces maximal voluntary power

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12
Q

Lesions to corticospinal centers

A

Can lead to loss of ability to recruit a limited number of muscles controlling movement
Inability to control individual joints
Mass movements called abnormal synergies

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13
Q

Abnormal synergies

A

Stereotypical patterns of movement that cannot be changed or adapted to changes in task or environmental demands
Reflect lack of fractionation
Muscles so strongly linked, movement outside of fixed pattern not possible

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14
Q

Fractionation

A

Ability to move single joint without simultaneously generating movements in other joint

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15
Q

Co activation

A

Common characteristic of unskilled early stages of learning

Not necessarily a result of impairment of function but rather a primitive form of coordinating

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16
Q

Spasticity

A

A motor disorder characterized by a velocity dependent increase in tonic stretch reflexes with exaggerated tendon jerks resulting from hyper excitability of the stretch reflex
- abnormalities within segmental stretch reflex

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17
Q

Lesion in the descending motor systems result in…

A

Increase in alpha motor neuron excitability with a resulting increase in muscle tone and exaggerated tendon jerks
- I.e hypertonicity

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18
Q

Spasticity is a combination of

A

A decrease in stretch reflex threshold

Reflex hyper excitability

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19
Q

Enhanced stretch reflex can occur because…

A

The alpha motor neuron pool at the segmental levels is hyper excitable
The amount of excitatory afferent input is increased
Or both

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20
Q

Hyper excitability of alpha motor neuron pool can be due to

A

A loss of descending inhibitory input
Post synaptic denervation hyper sensitivity
Shortening of the motor neuron dendrites
Collateral sprouting of dorsal root afferents

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21
Q

Behavioral indications of spasticity can include:

A

Change in the resting position of a limb

Presence of characteristic movement patterns

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22
Q

Pendulum or drop test for what?

A

Spasticity

Hypotonicity

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23
Q

Impairments associated with cerebellar pathology

A

Hypotonia
Coordination
Intention tremor
Impaired error correction affecting motor learning

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24
Q

Lesions of the vermis and fastigial nuclei

A

Disturbances in axial and postural control, balance, speech deficits
Medial- axial
Lateral- distal

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25
Damage to intermediate cerebellum or imposed nuclei
Action tremor in limbs
26
Lateral cerebellar lesions
Delay in initiating movement | Impaired control of multi joint movements
27
Hallmark sign of cerebellar pathology
Coordination problems
28
Coordination problems
Movement trajectories uneven and lack a bell shaped profile | - because of the loss of coordinated coupling between synergistic muscles and joints
29
Paralysis
Total or severe loss of muscle activity
30
Coordination problems could present as
Delayed reaction time Errors in range and direction of movement Inability to sustain regular rhythmic movements Decomposition- moving one joint at a time bc cannot time or scale multi joint movements Inability to terminate movement and change direction - stop agonist and generate force in antagonist - rebound phenomena
31
Dysmetria
Problems judging the distance or range of a movement | Scale forces appropriately for a task performance
32
Intention tremor
Occurs during performance of a voluntary movement | Most marked at the end when the person attempts to brake the movement
33
Impaired error correction affecting motor learning
Cerebellum provides internal feedback reporting intended movement and external feedback that report actual movement Creates a feed forward signal to reduce subsequent errors Lesions affecting error reporting contribute to motor learning deficits
34
Dysmetria and intention tremor result from
Disruption of feed forward mechanisms
35
BG pathology include
Hypokinetic Hyperkinetic Dystonia Dyscoordination
36
Parkinson's disease
Flexed posture and impaired gait and balance From degeneration of dopamine Akinesia, bradykinesia, rigidity, resting tremor
37
Akinesia
Reduced ability to initiate spontaneous movement
38
Bradykinesia
Slow and reduced amplitude voluntary movements
39
Rigidity
Increased muscle tone regardless of velocity Hyperactivity in fusimotor system Predominantly in flexors of the trunk In motor impairments as well
40
Resting tremor
Tremor occurring in a body part that is not voluntarily activated and is supported against gravity Amplitude increases during mental stress or movement of another body part (gait)
41
Action tremor
Produced by voluntary contraction of a muscle - postural: voluntarily maintaining position against gravity - kinetic: during a voluntary movement
42
Akinesia and bradykinesia coordination problems seen in...
Handwriting because of a reduced capacity for coordinating wrist and finger movements
43
Frontotemporal dementia
Inappropriate behaviors Language problems Difficulty with thinking and concentration Movement problems
44
Hyperkinetic disorders
Excessive and involuntary movements and decreased muscle tone Chorea Athetoid
45
Chorea
Involuntary rapid irregular jerky movements
46
Athetoid
Slow involuntary writhing and twisting movements usually involving UE>LE May also involve neck, face, and tongue
47
Dystonia
``` Sustained muscle contraction Twisting and repetitive movements of abnormal posture Diverse; can be slow or quick Cocontraction of agonist and antagonist Focal, hemi, multi focal Idiopathic, symptomatic ```
48
Lesion of medial lemniscus
Loss of discriminative touch | - light touch, kinesthetic sense
49
Lesion of lateral spinothalamic
Pain Temperature Course touch Kinesthetic discrimination
50
Lesion of somatosensory cortex/ DC
Loss of discriminative sensations; proprioception, 2 point discrimination, stereognosis, and localization of touch Contralateral to side of lesion
51
Visual deficits following unilateral damage to cerebral cortex
Homonymous hemianopsia
52
Vestibular deficits
Gaze stabilization Blurred vision due to disruption of vestibuloocular reflex Posture and balance Vertigo and dizziness
53
Body imaging disorders associated with parietal and temporal lobe lesions
Parietal lobe damage present with deficiencies related to body image and perception of spatial relations
54
Body scheme
Awareness of body parts and their relationship to one another and the environment Difficulty dressing and unsafe transfers
55
Somatagnosia
Lack of awareness of the body structure and relationship of body parts to one another
56
Unilateral spatial neglect
Inability to perceive and integrate stimuli one one side of the body Temporoparietal junction and posterior parietal cortex Looks like lack of attention to the left side
57
Perceptual impairments
Body image Spatial relation disorders Apraxia
58
Anosognosia
Denial of presence or severity of ones paralysis Unsafe functional activities Perceptual deficit
59
Spatial relation disorders
Difficulty perceiving oneself in relation to other objects or other objects in relation to oneself Topographic Figure ground Position in space
60
Topographic disorientation
Inability to remember the relationship of one place to another
61
Figure ground perception
Inability to distinguish foreground from background
62
Apraxia
Inability to carry out purposeful movement in the presence of intact sensation, movement, coordination Usually in left sided brain damage
63
5 types of apraxia
``` Verbal Buccofacial Limb Constructional Dressing ```
64
Limb apraxia 2 types
Ideomotor: cannot carry out command Ideational: purposeful movement not possible automatically or on command
65
Perception
Integration of sensory impressions into psychologically meaningful information
66
Deficits in cognitive and perceptual systems
Affect patients ability to move effectively and efficiently throughout their environment
67
Impairment in association cortices- gershman
Right hand dominant with lesions in left angular gyrus - confusion between right and left - difficulty naming fingers - difficulty writing although sensory and motor are intact
68
Primary motor cortex lesions
Weakness or paralysis | Change in tone
69
Sensory cortex lesion
Loss of sensation, perception, proprioception | Problems with motor control
70
Premotor cortex lesions
Weakness from disuse | Difficulty with planning motor tasks,purposeful movement, apraxia
71
Supplemental motor region lesion
Weakness | Difficulty with complex motor tasks
72
BG lesion
Absence of movement Weakness Abnormal movement Abnormal tone
73
Cerebellar lesion
Incoordination Weakness Balance
74
Corticospinal tract lesion
Weakness
75
Alpha motor neuron lesion
Weakness | Atrophy
76
Afferent sensory input impairment
Loss of sensory awareness Uncoordinated movements Balance
77
Frontal lobe
``` Personality Behavior Emotions Judgement Planning Problem solving Intelligence Speaking Writing Self awareness ```
78
Parietal lobe
``` Interpretation of language Sensation of touch, pain, and temperature Vision Hearing Memory and visual/ spatial perception ```
79
Temporal
``` Understanding language (Wernickes) Memory Hearing Sequencing Organizing ```
80
Cortical layer
Outer gray matter | Location of cell bodies (neurons,glia)
81
Subcortical
White matter ( includes internal capsule) -Highways that connect cell bodies Deep nuclei: gray matter -BG, thalamus, hypothalamus
82
Meninges outside to in
``` Epidural -dura mater Subdural -arachnoid mater Subarachnoid - pia mater ```
83
Epidural space
Arterial blood | Torn meningeal artery- bleed out
84
Subdural space
Venous blood | Torn bridging vein
85
Subarachnoid space
Usually contains CSF | Arterial blood : aneurysm rupture
86
Path of CSF
``` Lateral ventricles Foramen of Monroe Third ventricle Cerebral aqueduct 4th ventricle Subarachnoid space Arachnoid villi project from SAS into sinuses ```
87
Anterior circulation of the brain
2 carotid arteries
88
Posterior circulation of the brain
2 vertebral arteries
89
Lateral corticospinal tract
Volitional movement | The UMN
90
DC/ML
``` Larger fiber Proprioception/ kinesthesia Discriminative touch Vibration Dull ```
91
Spinothalamic tract
``` Small fiber Pain Temp Crude touch Itch Tickle Sharp ``` Pain and temp are lateral Crude touch and pressure are anterior
92
Primary efferent track in spinal cord
Lateral corticospinal
93
Cells in CNS that give rise to efferent track
Pyramidal
94
Pain, touch, volitional movement is controlled be...
Contralateral side
95
Thalamus infarcts usually affect
Pain and touch
96
Impairments in right lateral cerebellum
Difficulty in verb generation | Learning & performing complex nonmotor tasks
97
warning signs of stroke
Face Arms Speech Time
98
modifiable stroke risk factors
``` blood pressure education smoking diabetes weight gain cholesterol inactivity sleep apnea ```
99
non modifiable stroke risk factors
``` TIA gender: females Age Race Family history ```
100
Types of stroke
``` Ischemic: 87% - embolic - thrombotic - lacunar Hemorrhagic: 13% TIA ```
101
Ischemic Stroke
Result of thrombus, embolus, or conditions that produce low systemic perfusion pressures Lack of cerebral blood flow deprives the brain of oxygen and leads to injury and death of tissues
102
Embolic stroke
most common type of ischemic stroke Blood clot that forms in another location and moves to the brain Cardiac origin most common; 80% of cardiac emboli occlude the MCA Vascular origin: starts as plaque formation and moves forward. Most commonly the aorta or vessels of the aorta May be paradoxical - congenital such as patent foramen oval, DVT
103
Thrombotic stroke
- forms in arteries directly feeding the brain - typically related to abnormalities w/in the vessel wall such as atherosclerosis, arteritis, dissections, and external compression of the vessels- Due to risk factors - Common precursor is htn - may also be caused by hematologic disorders and/or hypercholersterolemia - large vessel thrombosis that occurs in extra cranial vessels such as the carotid and vertebral arteries can lead to severe strokes.
104
Lacunar strokr
small vessel strokes. ischemia in one distal or small artery typically assoc with chronic HTN and diabetic microvascular disease size of infarct from 2mm- 3cm in size about 25% of all ischemic strokes.
105
different types of lacunar strokes
``` pure motor pure sensory sensorimotor ataxic hemiparesis clumsy hand syndrome dysarthria-just speech issues ```
106
hemorrhagic stroke
approx. 13% cellular destruction caused by ischemia secondary to pressure/bursting - mechanical injury caused by edema and the pressure of blood collection 75% of hemorrhagic strokes caused by a bleeding blood vessel occur in people who have htn
107
Common causes of hemorrhagic stroke
hypertensive bleed | ICH in the presence of an AVM or tumor, ruptured aneurysm- SAH, TBI
108
stroke from an aneurysm is called...
subarachnoid hemorrhage
109
ACA
medial aspect of frontal and parietal lobes | sub cortical structures such as the BG
110
MCA
entire lateral aspect of the cerebral hemisphere (frontal, temporal, parietal)
111
PCA
``` occipital lobe medial/ inferior temporal lobe upper brain stem midbrain thalamus ```
112
Differentiation of stroke types
- hemorrhagic strokes do not follow an artery distribution, sx may not follow typical pattern - vomiting, severe headache, and/or impaired consciousness are sx that may differentiate hemorrhagic from ischemic - important to determine hemorrhagic from ischemic for medical management
113
TIA
symptoms include focal deficits of an ischemic stroke and typically follow a vascular distribution - resolve in 24 hours. may not be completely normal, but resolve Reversible; no infarction of cerebral tissue 35% of people with TIAs have a stroke w/in 5 years work up essential to determine the cause and prevent future stroke
114
hemorrhagic conversion
- ischemic infarct may convert into hemorrhagic lesion - thrombi can migrate, lyse, and reperfuse into an ischemic area leading to small hemorrhages - damaged capillaries and small blood vessels no longer maintain their integrity - more common in large infarcts such as occluded MCA
115
Tissue plasminogen activator
Assists with bleeding for ischemic stroke Thrombolysis; powerful clot buster clinical diagnosis of ischemic stroke no recent trauma, surgery, or bleeding (may cause bleeding elsewhere) No rapidly improving symptoms (TIA) BP <185/110 treatable w/in 3 hrs of onset CT w/out ICH or major early infarct signs (will not reverse it) normal blu and platelets (PT/PTT)
116
Homunculus
discovered in 3rd century AD map of the primary sensory cortex shows areas of the cortex that respond to somatosensory stimulation shows area of the brain that controls motor and sensory input from different portions of the body
117
left sided stroke presentation
``` right sided weakness right sided sensory deficits speech and language deficits - non fluent (brocas) -fluent (wernickes) -global aphasia slow, cautious behavioral style difficulty planning and sequencing movements - apraxia more common (ideomotor, ideational) disorganized problem solving very aware of impairments anxious about poor performance difficulty with processing delays difficulty expressing positive emotion difficulty processing verbal cues and commands memory deficits: typically related to language ```
118
right sided stroke presentation
left sided weakness left sided sensory deficits spatial perceptual deficits - left sided unilateral neglect - agnosia Difficulty sustaining movement quick, impulsive behavioral style difficulty grasping overall pattern, problem solving, synthesizing info unaware of impairments; poor judgement rigidity of thought; no abstract reasoning difficulty processing visual cues difficulty with perception of emotion and expressing negative emotion memory deficits: typically related to spatial- perceptual information
119
clinical signs of brain stem stroke
``` changes in: breathing movement sensation eye movement heart rate blood pressure ```
120
clinical signs of cerebellar stroke
``` abnormal reflexes of the head and torso impaired coordination ataxic movement/ gait balance issues dizziness vomiting ```
121
ACA syndrome
occlusion of the ACA | - cognition, personality, reasoning, decision making, talking
122
ACA syndrome clinical signs
contralateral hemiparesis involving mainly LE contralateral hemisensory loss involving mainly LE urinary incontinence slowness, delay, motor inaction
123
MCA syndrome clinical signs
contralateral hemisensory loss/ hemiparesis (mainly UE and face) motor speech impairment (Brocas or non fluent aphasia with slow speech) Receptive speech impairment (wernicke's or fluent aphasia) global aphasia perceptual deficits and limb kinetic apraxia ataxia of contralateral limbs
124
PCA syndrome clinical signs
occlusion of the PCA, peripheral territory contralateral homonymous hemianopsia visual agnosia memory deficits To test: come in from side and find where they see you
125
thalamic pain syndrome
occlusion of the central territory of PCA
126
thalamic pain syndrome clinical signs
involuntary movements: stroke doesn't cause pain, the result of it does contralateral hemiplegia paresis of vertical eye movement
127
Medial medullary syndrome
Dejerine syndrome | occlusion of the vertebral artery, medullary branch
128
medial medullary syndrome signs
ipsilateral: - paralysis with atrophy of 1/2 of tongue with deviation to paralyzed side Contralateral: - paralysis of UE and LE - impaired tactile and proprioceptive sense
129
Lateral Medullary syndrome
wallenburg's syndrome | occlusion of PICA or vertebral artery
130
Lateral Medullary syndrome signs
ipsilateral: - decreased pain and temperature sensation to the face - cerebellar ataxia - vertigo/ nausea - nystagmus - dysphagia contralateral: - impaired pain and thermal sense over 50% of the body
131
Complete basilar artery syndrome
``` locked in syndrome signs: - hemiparesis to quadriplegia - bilateral cranial nerve palsy - consciousness and sensation are spared - patient cannot more or speak but remains alert and oriented ```
132
medial inferior pontine syndrome
foville's syndrome | occlusion of paramedic branch of basilar artery
133
medial inferior pontine syndrome signs
ipsilateral: - paralysis of conjugate gaze to side of lesion - nystagmus - ataxic gait - double vision with lateral gaze Contralateral: - paresis of face, UE, and LE - impaired tactile and proprioceptive sense over 50% of the body
134
lateral inferior pontine syndrome
occlusion of the AICA
135
lateral inferior pontine syndrome signs
ipsilateral: - horizontal and vertical nystagmus, vertigo, nausea, and vomiting - facial paralysis - deafness/ tinnitus - ataxia - impaired sensation over face Contralateral: - impaired pain and thermal sense over 1/2 the body
136
PT precautions with stroke
- acute pt usually on bed rest for first 24-48hrs. check activity order - may be taking anticoagulant and considered a fall risk - monitor vitals carefully; be aware of MAP ranges - ischemic: 130-140 - hemorrhagic <110 - MAP= (2DBP+SBP)/3 - If pt presenting with new stroke like symptoms, place flat and call an MD
137
Evaluation tips for stroke
- determine ability to communicate. consider expressive, receptive, and global aphasia; watch documentation - hemorrhagic strokes may present similar to TBI - if patient moving in synergistic pattern- pronation, flexion of the elbow - important to demonstrate standing and ambulation for rehab acceptance; may also attempt w/c mobility - watch for change in symptoms- evolving stroke
138
factors that determine motor recovery
- CNS damage promotes shift to intact neural subsystems rather than spared components within lesioned area - reorganization dependent upon learning styles, timeliness of tx, age and envt of brain, active engagement, unmasking latent pathways
139
treatment techniques for stroke
- want to decrease pain first - if neglect, orient them to body position, want to acclimate them and make them aware of their envt - stand on side of neglect to increase awareness - if decreased tone in shoulders, provide elbow support to prevent shoulder subluxation - to facilitate move outside of synergy patterns, position pt in positions to isolate targeted muscle group - reduce spasticity: PROM and stretching with slow gradual movements
140
circuit training and stroke
greater gains in gait velocity over the course of inpatient rehab compared to the standard care
141
ESTIM and stroke
found FES to perineal nerve had higher success avoiding obstacles than AFO lower muscle strength benefit the most
142
negative effects of constraint induced movement therapy and stroke
may alter CoG temporarily limiting postural control limits functional training: transitions in infants/ toddlers increased patient irritability secondary to restraint
143
positive effects of constraint induced movement therapy
allows for emphasis on postural control and stability long term improvement in functional mobility from using B UE for functional tasks opportunity to focus on other primary impairments (endurance, balance)
144
PT sessions and CIMT
with restraint on, focus on postural control perform functional mobility tasks with emphasis on affected UE use focus on other impairments: balance, endurance
145
Acute care PT implications
Do not break test pt to determine strength assess sensation and corresponding dermatomes pt family education essential decreased arousal may be due to medications pain management essential note what they are connected to
146
RBC
delivers oxygen to tissues, absorption of cellular metabolic byproducts, maintains acid base balance normal: 3.6to 5.0x10^6
147
anemia
``` decreased RBC increased fatigue watch for signs of hypoxia chest pain dizziness SOB muscle cramping ```
148
polycythemia
compensatory increase in RBC may occur due to reduction in plasma volume results in increased blood viscosity which may decrease peripheral flow
149
hematocrit
measurement of the percentage of whole blood occupied by cells women: 37-47% men: 41-53% no exercise <25%
150
hemoglobin
iron containing protein with strong affinity for oxygen single RBC carries 4 Hb molecules men: 13-18 women: 12-16 therapy contraindicated when < 5 leads to heart failure
151
platelets
essential in clotting blood normal: 150,000-300,000 no exercise when <120,000
152
thrombocytopenia
platelets <140,000 increased risk of bleeding avoid activities that may cause bruising or loss of balance
153
prothrombin time
time required for clot to form | normal is 11-13.5 seconds (oral meds, coumadin may effect)
154
Partial thromboplastin time
blood separated into plasma and cells looks at intrinsic cascade normal is 30-45 sec (IV meds/ heparin)
155
international normalized ratio
unitless measure used to correct for differences in prothrombin time by various institutions 2-3 may be therapeutic
156
alert
state of being aware, attentive, and mentally functional
157
agitated
pt is excessively restless | demonstrates increased physical and/or mental activity
158
delirium
state of disorientation accompanied by irritability, agitation, suspicious, and/or fear pt may also misperceive stimuli
159
dementia
state of altered mental processes that usually does not change arousability
160
somnolent
prolonged drowsiness | resembles a sleepy trance
161
obtundant
dulled response to stimuli | patient typically confused and requires constant stimulation for all activities
162
stupor
patient aroused only by intense stimuli | motor response and reflex reaction typically preserved
163
coma
unconsciousness without spontaneous eye opening and with minimal or no response to external stimuli
164
modified ashworth scale
0-no increase 1- slight catch, release at end of motion 1+ resistance after catch 2 increase tone throughout 3 difficult to move throughout but can get through 4 rigid
165
3 sensory inputs to balance
visual vestibular somatosensory/ proprioception
166
reflex theory
reflexes are building blocks of motor control | work in sequence to create movement
167
reflex theory limitations
they require an external stimulus to be generated | does not explain spontaneous or volitional movement
168
hierarchical theory
top down approach to control of movement higher, middle, lower levels of control higher control middle, middle control lower without variation
169
hierarchical theory limitations
cannot explain withdrawal reflex in a top down, the motor could only be initiated by the higher cortical center not by a reflexive lower level pain response
170
motor programming theory
motor programs (CPGs) drive movement without the need for sensory input
171
motor programming limitations
same motor program can produce different results depending on the external forces at work
172
systems theory
look at whole body as a mechanical system and integrate all the forces acting on the body to control or influence movement DF all of the varied DF in any given movement need to be coordinated in order for a smooth motion use synergistic patterns to control
173
systems theory limitations
does not account for the environmental influences on movement
174
dynamic action theory
movement emerges as a result of the elements in the environment as needed - not a result of specific commands from the CNS or premeditated motor programs Control parameters can change and create a change in the system and a new motor behavior increasing velocity of gait will transition one into a jog and then a run
175
dynamic action theory limitations
relegates the CNS to a relatively unimportant role
176
ecological theory
we detect information from our environment relevant to action and use that information to control movement perception more important than basic sensation nervous system is perception action system not a sensory motor - person chooses higher chair in room
177
ecological limitations
less emphasis on organization and function of the nervous system
178
closed loop theory
sensory feedback aids in learning the skill to perform it better on the subsequent trials - perceptual trace: knowledge of the correct movement, detects error in movement and corrects - Memory trace: selection and initiation of movement
179
schema theory
novel movement is completed ML enhanced by practicing specific motor tasks under different conditions - Recall schema: same movement with difference force using memory to choose correct response - recognition schema: evaluates the response
180
fitts and posner 3 stage
cognitive: what to do and determines what to do to complete it Associative: how to do, determines strategy Autonomous: how to succeed
181
systems 3 stage model
novice: simplify movement to decreases DF advanced: release some DF, allowing more joints to be involved Expert: releases all DF needed for task