Theories ofTheories ofMotor ControlMotor Control

ComplexSystemsTheory

Definition and levels of analysis

Task-BasedApproaches

Neurofacilitation Approaches

Motor Hierarchy

ReflexTheory

Map of EssentialMap of EssentialConceptsConcepts

Fall 2006DM McKeough

Theories of Motor controlTheories of Motor control

Definition and levels of analysis Reflex theory Hierarchical theory Complex systems theory Neurofacilitation Approaches Motor Re-learning, Task-Based Rehabilitation Motor Hierarch

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DescriptionDescription

The discipline of The discipline of Motor Control Motor Control is the study is the study of human movement and the systems that of human movement and the systems that control it under normal and pathological control it under normal and pathological conditions.conditions.

Levels of analysis (study)Levels of analysis (study) Environmental result of the movement Environmental result of the movement

(Outcome)(Outcome) Movement patternMovement pattern Neuromotor processes underlying movementNeuromotor processes underlying movement

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Reflex TheoryReflex Theory

Reflex TheoryReflex Theory (Charles Sherrington, early 1900s) (Charles Sherrington, early 1900s) Complex behavior (movement) is controlled by a Complex behavior (movement) is controlled by a

series of chained reflexes (e.g. Frog)series of chained reflexes (e.g. Frog)

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Hierarchical TheoryHierarchical Theory

Hierarchical Theory Hierarchical Theory (Hughlings Jackson 1930s)(Hughlings Jackson 1930s) Movement is controlled Movement is controlled

by a system consisting by a system consisting of 3 levels with a of 3 levels with a rigidrigid top down organizationtop down organization

Higher centers control Higher centers control lower centers via lower centers via inhibitioninhibition

““Disinhibition”Disinhibition” ““Release Release

phenomenon”phenomenon”

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Complex Systems Theory Complex Systems Theory 1/31/3

Individual

Task Environment

Movement

Movement emerges Movement emerges spontaneously from the spontaneously from the interaction of the interaction of the individual, the task, and individual, the task, and the performance the performance environmentenvironment

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Factors within the Factors within the Individual, Task, and Environment Individual, Task, and Environment 2/32/3

Individual

Task Environment

• Sensorimotor• Psychosocial• Cognitive• Stage of Motor Learning

• Taxonomy of tasks• Discrete/ continuous• Attentional demands

• Physical• Socioeconomic• Cultural

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Factors within the Factors within the Individual, Task, and Environment Individual, Task, and Environment 3/33/3

Cognition

Perception Action

Mobility

Stability Manipulation

Regulatory

Nonregulatory

I

T E

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Neurofacilitation Neurofacilitation Approaches Approaches 1/7 1/7

Developed during the 1950-1960s in parallel with Developed during the 1950-1960s in parallel with increasing knowledge of anatomy and physiology of the increasing knowledge of anatomy and physiology of the nervous systemnervous system

Bobath (NDT); Brunnstrom; Kabat, Knott & Voss (PNF); Bobath (NDT); Brunnstrom; Kabat, Knott & Voss (PNF); Ayers (Sensory Integration Therapy) developed the Ayers (Sensory Integration Therapy) developed the “Neurofacilitation Approaches” that replaced the muscle re-“Neurofacilitation Approaches” that replaced the muscle re-education approach used to treat the effects of Polio during education approach used to treat the effects of Polio during the 1940-1950sthe 1940-1950s

Neurofacilitation approaches were designed to treat the Neurofacilitation approaches were designed to treat the movement effects of stroke (UMN lesion) by attempting to movement effects of stroke (UMN lesion) by attempting to affect the CNS directly through the manipulation of sensory affect the CNS directly through the manipulation of sensory input input

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Neurofacilitation Neurofacilitation Approaches Approaches 2/7 2/7

AssumptionsAssumptions Normal movementNormal movement

Results from a chain of reflexes organized Results from a chain of reflexes organized hierarchically within the CNS (Control of movement is hierarchically within the CNS (Control of movement is top down – cortex controls brainstem and spinal cord)top down – cortex controls brainstem and spinal cord)

Normal developmentNormal development Characterized by the emergence of behavior Characterized by the emergence of behavior

organized at sequentially higher levels of the nervous organized at sequentially higher levels of the nervous systemsystem

Driven by sensory inputDriven by sensory input

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AssumptionsAssumptions Abnormal movementAbnormal movement

Caused by disruption of normal reflex mechanismsCaused by disruption of normal reflex mechanisms Cortical lesions cause the release of abnormal Cortical lesions cause the release of abnormal

reflexes organized at lower levels of the central reflexes organized at lower levels of the central nervous systemnervous system

Release of abnormal reflexes constrains the patient’s Release of abnormal reflexes constrains the patient’s ability to move normallyability to move normally

Abnormal movement is the Abnormal movement is the directdirect result of lesion not result of lesion not secondary or compensatory actions**secondary or compensatory actions**

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Neurofacilitation Neurofacilitation Approaches Approaches 4/74/7

AssumptionsAssumptions Abnormal movementAbnormal movement

In both children and adults, movement is dominated In both children and adults, movement is dominated by primitive reflexes by primitive reflexes

In children, cortical lesions interrupt normal In children, cortical lesions interrupt normal corticalization thus motor control is dominated by corticalization thus motor control is dominated by primitive reflexes organized at lower levels of the primitive reflexes organized at lower levels of the CNS (primitive reflexes are never constrained)CNS (primitive reflexes are never constrained)

In adults, with acquired motor cortical lesions, In adults, with acquired motor cortical lesions, damage to the higher levels of the CNS release lower damage to the higher levels of the CNS release lower levels and movement is dominated by primitive levels and movement is dominated by primitive reflexes (primitive reflexes are constrained then reflexes (primitive reflexes are constrained then released)released)

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Neurofacilitation Neurofacilitation Approaches Approaches 5/7 5/7

AssumptionsAssumptions Recovery of functionRecovery of function

Requires that higher centers once again control lower Requires that higher centers once again control lower centerscenters

Recapitulates normal development, therefore, Recapitulates normal development, therefore, intervention should proceed along a developmental intervention should proceed along a developmental sequencesequence

Functional skills will automatically return once Functional skills will automatically return once abnormal movement is inhibited**abnormal movement is inhibited**

Repetition of normal movement patterns will Repetition of normal movement patterns will automatically transfer to functional tasks**automatically transfer to functional tasks**

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Neurofacilitation Neurofacilitation Approaches Approaches 6/7 6/7

Clinical ImplicationsClinical Implications Examination should identify abnormal reflexes Examination should identify abnormal reflexes

controlling movementcontrolling movement Intervention should modify abnormal reflexesIntervention should modify abnormal reflexes Intervention modifies the CNS through sensory Intervention modifies the CNS through sensory

inputinput

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Neurofacilitation Neurofacilitation Approaches Approaches 7/7 7/7

Current changes to Neurofacilitation Current changes to Neurofacilitation Approaches Approaches Increased emphasis on directly training Increased emphasis on directly training

functional tasks as opposed to “normal functional tasks as opposed to “normal movement”movement”

Decreased emphasis on inhibiting abnormal Decreased emphasis on inhibiting abnormal reflexesreflexes

Increased consideration of motor learning Increased consideration of motor learning principles (stages of motor learning, feedback, principles (stages of motor learning, feedback, practice schedules, etc…)practice schedules, etc…)

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Motor Re-learningMotor Re-learningTask-Based Rehabilitation Task-Based Rehabilitation 1/21/2

AssumptionsAssumptions Normal movementNormal movement

Performer + Task + EnvironmentPerformer + Task + Environment Abnormal movement results from impairment Abnormal movement results from impairment

in one or more of the systems controlling in one or more of the systems controlling movementmovement

Abnormal movement pattern is the Abnormal movement pattern is the performer’s best solution to the task given performer’s best solution to the task given the systems remaining after damage not the systems remaining after damage not just the result of the lesion itself**just the result of the lesion itself**

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Motor Re-learningMotor Re-learningTask-Based Rehabilitation Task-Based Rehabilitation 2/22/2 AssumptionsAssumptions

Recovery of functionRecovery of function Recovery is produced by plastic reorganization of Recovery is produced by plastic reorganization of

undamaged control centers (neural plasticity)undamaged control centers (neural plasticity) Clinical Implications Clinical Implications

Recovery is best produced by practice of purposeful, Recovery is best produced by practice of purposeful, goal-oriented tasks that are meaningful to pt’s goals goal-oriented tasks that are meaningful to pt’s goals (task specificity)(task specificity)

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Motor HierarchyMotor Hierarchy MC system consists of 3 levelsMC system consists of 3 levels

Highest levelHighest level: association cortex, : association cortex, sensory, and motor areassensory, and motor areas

Concern: select movement goal Concern: select movement goal and strategyand strategy

Middle levelMiddle level: BG, Cb, and : BG, Cb, and brainstem motor centersbrainstem motor centers

Concern: specifying spatial, Concern: specifying spatial, temporal, and force parameters temporal, and force parameters of the motor planof the motor plan

Lowest levelLowest level: LMNs, motor plant, : LMNs, motor plant, FB about sensory consequences FB about sensory consequences of the movementof the movement

Concern: producing the Concern: producing the movement pattern and supplying movement pattern and supplying sensory FBsensory FB

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© DM McKeough 2009© DM McKeough 2009

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