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585-7
Motor Control Rehab
| Term | Definition |
|---|---|
| Motor control rehab theories is based on the way that CNS | Develops Functions Responds to injury Responds to experiences |
| models of motor control | Behavioral maturation Reflex hierarchical model Dynamic systems theory Neutral group selection theory |
| behavioral maturation theory | Old way of thinking Brain develops and becomes more complex as a result of genetic expression, we start to move more normally |
| reflex hierarchical model | Brainstem has a lot of reflexes that are controlled by higher centers of NS After an injury, you revert back to primitive reflexes |
| 1940s & 1950s | WW2 made TBIs Stroke & rehab more likely disabilities Polio vaccines decreased disability, but therapy was orthopedic |
| guiding principles of 1950s | CNS arranged in hierarchical fashion (high motor controls lower centers) Brain damage regresses CNS so rehab has to progress through milestones Want to reintegrate lower lvl reflexes Sensory input guides motor output |
| Rood | Behavioral maturation Normalization of tone by applied sensory stimulation Developmentally based sequence of regression & tx stages Use of purposeful activities |
| Brunnstrom | Proximal to distal recovery 6 stage recovery progression of synergistic mvmnt Forms basis of Chedoke McMaster scores & tx protocols |
| Brunnstrom stages | 1. Development of synergies 2. Voluntary movement within synergies 3. Some deviation from synergy 4. Independence from synergies in gross movement 5. Isolated joint movement |
| proprioceptive neuromuscular facilitation (PNF) | Developed by Kabat, Knott, Voss Method of hastening/ promoting response of NM mechanism through stimulation of proprioceptors Stimulation via manual contacts, visual cues, verbal commands |
| normal movement patterns for PNF | Flexion, abd, rotation of joints Diagonal patterns are used in therapy (D1/2 flex/ ext patterns of UE & LE) |
| Bobath | Karel & Bobath Proximal to distal recovery Normalization of tone & retrain postural responses Uses immature reflexes to retrain normal movements |
| neurodevelopmental treatment- 1950s (NDT) | Avoid and disallow abnormal movement and use of limbs Use reflex inhibiting patterns and handling techniques through various key points of control Reflex inhibiting has become response inhibiting patterns |
| 1950s contributions to current treatment approaches | Use sensory input techniques for facilitation Inhibition of abnormal tone Description of mvmnt synergies Use of research to develop treatment protocols Practice & repetition Analysis & description of normal mvmnt Analysis & use of activity |
| contemporary views of motor control rehab | Neuro-developmental treatment Motor relearning program Constraint induced movement therapy |
| dynamic systems theory | Made by Bernstein Behavior & movement emerges from interaction of multiple systems that are hetero-archical |
| 3 key principles of dynamic systems theory | Self organization Rate limiting factors Transitions |
| Self organization | Interacting systems can organize through repetition & practice & create patterns Patterns are contingent on prior events as well as experiments Ex. growth spurts |
| Rate- limiting factors | Any component of system can prevent success at functional task The way the system balances itself May not always be the best |
| Transitions | Motor behavior is made up of states of stability, instability, phase shifts During transition phase, new forms of movement are likely to occur Acute phases |
| neuronal group selection | Developed by Edelman May be perfect balance of Neuromaturation & dynamic systems Cortical & subcortical systems organized into variable networks based on successful & unsuccessful experiences |
| primary vs. neuronal repertoires | Variability amongst individuals Genetically influenced Sensory elicited reactions & responses vs. Emerge w/ successful experiences. Increased neuronal mapping w/ multiple systems |
| what is neuroplasticity | Increased excitability Single unit activity Dendritic arborization Spine density Synapse number Gross organization of motor & sensory Regional brain activity |
| neuroplasticity principles | 1. Use it or lose it 2. Use it and improve it 3. Specificity 4. Repetition matters 5. Intensity matters 6. Time matters 7. Salience matters 8. Age matters 9. Transference 10. Interference |
| salience matters | There must be a system in place to weigh importance of any given experience Purposeful and motivating activities may cause neurochemical changes that are required |
| positive symptoms | Spasticity- Increased tone, exaggerated tendon jerks, clonus, phasic stretch reflexes Babinski response Mass synergy patterns |
| negative symptoms | Loss of finger dexterity Weakness- inadequate recruitment, slow movement Loss of selective control of muscles & limb segments |
| neuro-developmental treatment (NDT) | Based on Bobath Focus on positive symptoms of upper motor neuron W/ successful experiences of mvmnt, we develop stroner repertoires of mvmnt w/ neuroplasticity |
| RIP | Response inhibiting patterns |
| NDT using language of neuronal group selection | Therapy focused on handling to deviate from repertoires w/ variations & repetition to develop adaptive movement Always in the context of posture |
| therapeutic handling allows therapist to | Feel client's response to changes in posture & movement Facilitate postural control & movement synergies Provide boundaries for movements Inhibit or constrain negative movement |
| motor relearning program | By Carr & Shepherd Uses language of dynamic systems theory Focus on negative signs of upper motor neuron syndrome CNS self reorganizes Biomechanical Strength is developed into motor plan, transference included |
| commonalities of NDT & MRP | Both side negative adaptation of soft tissue to contribute to dysfunction Both caution regarding interference of neuroplasticity so abnormal movement should be avoided |
| CIMT | Originate in 1960 by Taub 1980s adopted without the full protocol Forcing as much mvmnt as possible while shaping mvmnt toward most functional and real world use |
| CIMT as therapeutic package | Training under supervision Shaping- small steps by successive approximations Explicit feedback provided Functional task practice |
| limitations of MRP, NDT, CIMT | An assumption that there is at least some recruitment |
| light touch vs. quick stretch | Stimulates low threshold sensory fibers to activate reflex action of muscle vs. Light stretch in form of tapping or quick movement of muscle activates agonist & antagonist |
| vibration vs. heavy joint compression | High freq over belly or tendon of stretched muscle is form of stretch vs. Greater than body weight joint compression about joint promotes co-contraction |
| resistance vs. vestibular stimuli | Provided to moving muscle is form of stretch vs. Positional changes of head & body |
| facilitation techniques | Light touch Quick stretch Vibration Heavy joint compression Resistance Vestibular Stimuli |
| inhibition techniques | Neutral warmth Prolonged stretch Light joint approximation Tendon pressure Vestibular input |
| neutral warmth vs. light joint approximation | General or local vs. Less than body weight |
| prolonged stretch | Produces change that are both neural (decreased sensitivity of muscle spindle) and mechanical (increased sarcomere length and reduces cross bridging) |
| tendon pressure vs. vestibular input | Constant pressure over the tendon or muscle belly vs. Low rhythmical movement |
| proprioceptive NM facilitation | Facilitation- rhythmic initiation, quick stretch, resistance, rhythmic stabilization vs. Slow reversal hold relax, contract relax, hold relax Manual contacts |
| NMES | Artificial electrical stim of peripheral nerves Specific reasons why it may assist motor recovery unknown Provides additional influence to peripheral motor nerve to bring threshold to CST to successfully recruit Reinforces neuronal map, more sensory |
| treadmill suspended walking or mobile arm support | Support subthreshold motor recruitment Stronger neuronal map or reinforce it |
| virtual rehab | Immersive environment Intent of movement Motivating Encourages higher reps |
| what virtual rehab is not | Means of eliminating skilled input & monitoring movement Not fully utilize principle of neuroplasticity |
| treating pt with upper motor neuron syndrome | Use knowledge of biomech to understand problem Understand principles of neuroplasticity and chose paradigm Use old or new school techniques to support development |
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craftycats_
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