motor control approaches

8/4/2019 Motor Control Approaches

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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Motor Control

Approaches

Neurodevelopmental Theorists/Theories:Catherine Trombly, Task-Focused,

Motor Learning, Margaret Rood,The Bobaths (NDT), Signe Brunnstrom, PNF,

Carr & SheppardReference: Cole & Tufano


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FOCUS

Neuroanatomy & Neurophysiology

Principles of Neuroscience

Treatment of paralysis, flaccidity & spasticity

of muscles resulting from damage or diseaseto the central nervous system

Treatment of Movement disorders

Framework focus: body structures, bodyfunctions, process skills, contexts, and activitydemands.


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Basic Assumptions

Each theorist has a somewhat differentapproach, assessment technique, andintervention strategies.

Most neurodevelopmental approachesrequire specialized training.

These theorists use a behavioral learningapproach to motor control based on thesequence normal developmental.


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Assumptions: Traditional Theories

The remainder of the theories are currentlyknown as hierarchical or traditional theories

of motor control, including

Rood The Bobaths NDT

Brunnstrom

Proprioceptive Neuromuscular Facilitation (PNF) Carr & Shepherd


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Basic Assumptions, cont.

Margaret Rood, the earliest theorist, is bothan occupational and physical therapist. Shestresses the importance of early reflexes inthe relearning of motor control.

Rood first used her techniques effectively withchildren with cerebral palsy.

She believed that a baby uses reflexes to

move initially but modifies them andeventually replaces the reflexes withvoluntary movement.


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Rood, 4 Basic Principles

Sensory input is required for normalization oftone and evocation of desired muscularresponses.

Sensory motor control is developmentallybased.

Movement is purposeful, engagement inactivities is required to produce a normal

response. Repetition of movement is necessary for

learning.


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Rood, cont.

Facilitation techniques: light stroking,brushing, icing, and joint compression areused to facilitate movement.

Inhibition techniques: joint approximation(light compression), neutral warmth, pressureon tendon insertion, and slow rhythmicalmovement are used to inhibit unwanted

movement (i.e., spasticity).


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Rood identified 8 ontogenetic motor

patterns in the following sequence

1. Supine withdrawal

2. Segmental rolling

3. Pivot prone (prone extension)

4. Neck co-contraction

5. Supporting self on elbows

6. All fours movement patterns

7. Standing

8. Walking


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Rood, cont.

Positioning is a primary concern, especiallywhen little voluntary control exists.

Extensive use of mats, bolsters, balls, and

other specialized equipment is common in theRood approach.

Movement patterns can be incorporated intogames, such as tug of war, to provide anoccupational focus to regaining motor control.


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The Bobaths, Drs. K. (physiologist) &

B. (physiotherapist), British - 1948

AKA Neurodevelopment Treatment (NDT)

Originally designed their therapy techniquesfor persons with hemiplegia (caused by CVA,

or stroke) Also worked with children with cerebral palsy

NDT focuses on the sensation of movement;

it is not movement itself, but the sensation ofmovement, that is learned and remembered


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Bobaths, cont.

Reflex inhibiting postures are used to inhibit primitivereflexes (RIPs).

Sensory stimulation is regulated with great care.

Weight bearing, placing and holding, tapping andjoint compression are used to activate normalmovement and posture.

Compensation (such as one-handed feeding anddressing) using the noninvolved side is discouragedduring recovery from stroke because it results ininactivity and poor recovery on the involved(paralyzed) side.


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Brunnstrom, Signe - physical therapist,

1950-1970s

Focuses on reflexes which provide the componentsof normal movement

Proprioceptive (resistive) & exteroceptive (tactile)stimulation are used to elicit reflexes in therecovering adult hemiplegic

Patients are encouraged to think about themovement and to gain control

Brunnstrom also uses associated reactions andsynergies

A synergy is a total flexion or extension movement ofa joint or limb


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Brunnstroms 6 Stages of Recovery

1. Flaccidity, no voluntary movement

2. Synergies or minimal voluntary movement

3. Synergies performed voluntarily

4. Some deviation from synergy

5. Independent or isolated movement

6. Individual joint movement nearly normal with

minimal spasticity


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Proprioceptive Neuromuscular

Facilitation (PNF)

Developed by Herman Kabat, PhD, MD andmodified by many contributors since the 40s

Uses diagonal & spiraling patterns of

movement Guides thinking about the sequence of

normal development

Eleven basic principles (see Cole, p. 242)

Uses two diagonal patterns crossing the mid-line for each major body part, oftenincorporating verbal commands.


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Carr & Shepherds Motor Relearning

Programme (for persons with stroke)

Contemporary approach (1990s)

Uses dynamical systems model of motorcontrol

Emphasize interaction between performerand environment

Does not accept the hierarchical sequence ofmotor relearning proposed by other theorists

Like other theorists, Carr & Shepherddiscourage the early use of compensatorystrategies


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Carr & Shepherd, cont.

Clients taught to avoid abnormalcompensation for weak muscles

Treatment techniques based on extensive

study of how normal movement occurs duringfunctional tasks

Acknowledge critical role of cognition in motorlearning

Movement patterns practiced in context oftasks, rather than exercises


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Carr & Shepherd, 7 Categories of

Functional Daily Activities

1. Upper limb function

2. Orofacial function

3. Sitting up over the side of the bed

4. Balanced sitting

5. Standing up & sitting down

6. Balanced standing

7. Walking


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Function and Dysfunction

Function assumes the ability to plan andexecute normal voluntary movement

Dysfunction is viewed as neurophysiologically

based; CNS deficits result in abnormalmuscle tone and lack of voluntary purposefulmovement

Each theorist has a separate way to measurethe extent of dysfunction


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Change

Changes in motor control are physiologically induced.

Engagement in activity can produce physiologicalchange leading to motor control

Individuals relearn movement patterns in apredictable developmental sequence

Theorists differ in the use of early reflexes to producemovement

Handling, sensory stimulation, and manipulation ofaffected muscles can facilitate motor relearning


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Assessment and Treatment

Specific to each theorist

These traditional models have also been

called reflex-hierarchical or

neuromaturational because they are basedon relearning movement in a normal

developmental sequence.

New evidence tends to disprove theeffectiveness of these approaches.


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Transition from Motor Control to

Motor Learning

Began in 1990s with classic article byMathiowetz & Bass Haugen, and Tromblys

Slagle Lecture.

The following introduces Tromblys model aschanging OTs thinking about establishing or

restoring voluntary movement.


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Task Focused Approach: Trombly

Occupational Functioning Model introducedin 1995

Descending hierarchy of tasks & roles

Goal is to develop competency & self-esteem

Context & environment surround and -permeate all levels of the hierarchy

When clients have mastered the foundation

capacities, they move on to task-focusedinterventions (individual or group)

Trombly calls this occupation as end


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Task Focused Approach, cont.

Five general principles:

1. Client centered focus

2. Occupation based focus

3. Person & Environment enablers/barriers

4. Practice & Feedback - encoding

5. General treatment goals role fulfillment,

problem-solving skills re: best way toaccomplish valued tasks


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Dynamical Systems Theory &

Trombly

Applied to physical disabilities, this theorycombines reflexive and voluntary motorcontrol

CNS receives/interprets multiple cues fromthe environment and involves multiplesubsystems when planning to reach desiredgoals (preferred tasks & roles)

Occupational performance is a product of theinteraction between the person, the task, andmultiple environmental factors.


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Assumptions: Task Focused Approach

Tromblys task focused approach is based ontheories of motor learning and dynamicalsystems theory.

Meaningful tasks are graded and sequencedaccording to each clients needs & abilities.

Each task requires experimentation usingdifferent strategies & contexts in order for

motor skills to be learned. Currently the preferred approach in OT for

intervention after stroke/CNS damage


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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,b d C l M (2008) A li d h i i i l h i l h Th f NJ SLACK I d

The End

Next time: Biomechanical and RehabilitationFOR

motor control approaches

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