Traditional Motor Control Theory Flashcards
Overview
Central problems with hemiplegia. loss of postural control and selected movement.
Abnormal tone and movement.
Lead to non-functional movement patterns and functional limitations.
Basic principles of NDT
- Normal movement sequences and balance are focus of intervention.
- Emphasis is normalization of sensory and perceptual experiences through tactile and kinesthetic stimulation
- Treatment is individualized,
- Abnormal tone, primitive reflex patterns and mass synergies interfere with normal movement patterns.
- treatment focuses on inhibiting or eliminating patterns, normalizing postural tone, promoting active control of movements.
NDT of persons with CVA
manual techniques,
Goal= prevent or eliminate abnormal tone and coordination, retrain normal movement responses, increase functional use of hemiplegic side.
Handling= provides specific tactile, proprioceptive and kinesthetic messages which help patient to organize quality of movement
-facilitation and inhibition
-key points of muscle control
Inhibition
Abnormal tone and coordination, Decrease spasticity, Block or eliminate abnormal patterns of movement, Reflex inhibiting patterns. Decrease spasticity***
Facilitation
Tone normalized,
Activate automatic postural responses, trunk control,
Re-educate weight bearing and non weight bearing movements in arm and leg. Person is low tone and you are trying to get them to the middle of the spectrum.
Occupational functioning
with NDT you are always incorporating the arm into activity.
Problems of CVA
Posture, Motor, Asymmetry, Non-weight bearing, Fear, Sensory loss, Neglect, Painful shoulder.
Assessment
Observation,
Handling- identify abnormal and normal movement patterns on involved side
Placing response- Pt. holds position if movement control present on hemiplegic side.
Occupation-as-means
Use activities to provide motor learning opportunities,
Cooking while weight bearing
Occupation-as-end
Patient directly engaged in learning task,
Self care tasks
Techniques
Encourage weightbearing over involved side, (most effective for regulating tone, increases client awareness of involved side),
Encourage trunk rotation (visual field opens up, most common for clients to move in “blocklike” pattern, by stimulating trunk rotation become more stable),
Encourage trunk elongation (common posture, gentle stretching),
Encourage scapular protraction.
Slow, controlled movements,
Proper positioning
Rood and PNF
Both use reflex arcs to elicit particular types of motor responses by supplying sensory stimulation in a controlled way,
Both address vital function (respiration, facial motions, tongue motions, swallowing, bowel and bladder control),
Facilitation and inhibition of muscle function along with concepts of stability and mobility are basic to application of controlled sensory stimulation used in both approaches.
Hypertonicity
Can lead to malalignment of trunk and limbs which will lead to contracture with subsequent deformity.
Hypotonicity
Important to counteract joint subluxation, overstretching of muscles, edema, pain and contracture
Proprioceptive Neuromuscular facilitation (PNF)
Mass movement patterns that are spiral and diagonal in nature and that resemble movement seen in functional activities,
Are unilateral, bilateral and total patterns.
PNF- impacts motor learning
Auditory - Verbal commands (brief and clear) - Verbal mediation (say steps aloud) Visual -positioning of self and objects Tactile - Manual contacts
Assessment (proximal to distal)
Vital and related functions, Head and neck region, Upper trunk, UEs, Lower trunk, LEs, ADL's
treatment
works towards the patient goals,
Therapist uses the patterns of movements and procedures to facilitate movement into function.
PNF uses total patterns rather than breaking down the movement. A PNF therapist would not have pt practice wrist extension without doing the entire pattern.
Diagonal patterns
are mass movement patterns observed on most functional activities.
Part of the challenge is recognizing the diagonal patterns in ADL’s
Knowledge of the diagonals is necessary to identify the areas of deficiency.
Each pattern has a flexion and extension component.
Eyes follow the hand of leading arm so the head and hand cross midline
UE D1 F&E
seatbelt (combing hear, opening door)
UE D2 F&E
picking a apple and putting it in basket
Symmetrical
Paired extremities perform similar movements at the same time.
Rood
Principles of treatment
- Humans function in a dynamic fashion
- Muscles have different duties,
- Heavy work muscles should be integrated before light work muscles
Rood- basic treatment assumptions
appropriate sensory stimulation can elicit specific motor responses,
- Thus, muscle action can be activated, facilitated, and inhibited through the sensory system,
- Motor control is regained through a predictable developmental sequence.
