10-01 Motor Control, Motor Learning, and Stages of Motor Control Flashcards
(93 cards)
1
Q
Three parts of Motor Function (3)
A
- Motor Control
- Motor Recovery
- Motor Learning
2
Q
Motor Control
A
- Area of study dealing with the understanding of the neural, physical and behavioral aspects of movement
- How brain communicates with rest of body on everything related to movement
3
Q
Motor Skill
A
- Purposeful and functionally-based motor skill
- Learned through interaction and exploration of the environment
4
Q
Motor Plan (Complex Motor Program)
A
- Idea or plan for purposeful movement
- Brain creates plan of action over time
- Concept –> brain, neuron, neurotransmitter –> movement
- Takes in sensory input and creates motor output
5
Q
Motor Program
A
- A set of commands that results in production of coordinated movement
- Possible contributions: synergistic component parts, force, direction, timing, duration, extent of movement
6
Q
Motor Memory (Procedural Memory)
A
- Recall “sub-routines” of the motor program
- Recall = Performing movement without thought (muscles remembering)
- Ex: Typing
7
Q
Components of Motor Memory (4)
A
- Initial movement conditions
- Sensory input: How movement felt, looked, sounded
- Specific movement parameters (Ex: force needed to guide movement)
- Outcome of the movement
8
Q
Neuroplasticity
A
- Ability of the CNS to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections
- Ability of brain to change or repair itself
- Ex: Learning new task, recovery from damage/injury
9
Q
Occurrences of neuroplasticity
A
- During development
- Response to environment
- Support learning
- Response to disease
- Relationship to therapy
- Ex: Re-routing of neuron synapses, chemical changes
10
Q
Adaptive neuroplasticity
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- Good, positive change
- What PTs/PTAs want to see
- Re-routing occurs (creates new routes in brain)
11
Q
Mal-Adaptive neuroplasticity
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- Does not generate new route
- Allows compensation/change to complete task vs. doing task properly
12
Q
Damages to CNS
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- Interferes with motor function processes
- Lesions produce specific, consistent, recognizable deficits
- Individual differences in CNS plasticity, recovery, functional outcomes (patients will prevent differently, although same affected area)
13
Q
Motor Learning
A
- CNS integrates vast amount of sensory and motor information to produce motor action
- “Perfect practice makes perfect” (Not perfect can lead to mal-adaptive neuroplasticity)
- Leads to permanent change for skilled behavior (retention)
- Ex: riding a bike
14
Q
PTA Requirements for motor learning
A
- Determine that skill is important to patient (desirable and realistic for pt to learn)
- Demonstrate task exactly as it should be done
- Relate skill to skill/situation that pt is familiar; pt uses past experiences as subroutines
- Clear and concise verbal instructions and VC
- Allow for trial and error
15
Q
Feedback
A
- Response-produced info received during or after a movement used to monitor output for corrective actions
- Intrinsic (inherent) - as natural part of movement (visual, proprioception)
- Extrinsic (augmented) - info received from outer influences (verbal/tactile cues, visual, biofeedback)
- Concurrent - occurs during movement
- Terminal - occurs after movement`
16
Q
Feedforward
A
- Sending of signals in advance of movement to ready sensorimotor system
17
Q
Dynamical Systems Control Theory
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- Organized around specific task demands
- Larger areas of CNS needed for complex tasks
- Higher CNS levels not used for simple (or discrete) tasks
18
Q
Hierarchical Control Theory
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- Organized top-down (High to low)
- High: organize sensory info, decision-making (association cortex, basal ganglia)
- Middle: Define specific motor programs, initiate commands (sensorimotor cortex, cerebellum, basal ganglia, brainstem)
- Lower: Execute movement (spinal cord)
- Inital skill acquisition: Higher levels needed
- As motor learning develops, only lower levels activated for motor programming
19
Q
Validity
A
- Test measures the parameter that it says it measures
20
Q
Reliability
A
- Consistency of results obtained by a tester
- Intra-rater: single examiner over repeated trials
- Inter-rater: several examiners over repeated trials
21
Q
Sensitivity
A
- True positive
- Proportion of times a method of analysis identifies present abnormality
22
Q
Specificity
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- True negative
- Proportion of times a method of analysis identifies absent abnormality
23
Q
Stages of Motor Control (4)
A
- Mobility
- Stability
- Controlled mobility
- Skill
- Can develop levels in order, but should work on simultaneously
24
Q
Mobility
A
- Transitional mobility
- Ability to move from one position to another (Ex: supine –> sidelying, supine –> prone)
- Ability to initiate movement through functional ROM (Ex: CVA pt ability to move arm)
25
Stability
- Static postural control
- Ability to maintain position/posture through co-contraction and tonic holding around a joint with COM over BOS with body not in motion
- Ex: unsupported sitting in midline, alternating isometric contractions
26
Controlled mobility
- Dynamic postural control
- Ability to move within WB position or rotate around long axis (move COM away from BOS and back)
- Ability to maintain postural stability and orientation with COM over BOS while parts are in motion
- Ex: POE activities, quadruped WS
27
Static-dynamic control
- Static-dynamic controlled mobility
| - Maintain posture while moving one or more limbs
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Skill
- Ability to consistently perform functional tasks and manipulate environment with normal postural reflex mechanisms/balance reactions
- Consistently doing activity in uncontrolled environment
- Ex: community locomotion
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Elements of Motor Function (10)
- Consciousness and arousal
- Cognition
- Sensory integrity and integration
- Joint integrity, postural alignment and mobility
- Tone
- Reflex integrity
- Cranial nerve integrity
- Muscle performance
- Voluntary movement patterns
- Postural control and balance
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Consciousness
- Ascending reticular activating system: brainstem
- Arouse, awaken, sleep-wake cycles
- 5 levels: consciousness, lethargy, obtundation, stupor, coma
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Consciousness (Level)
- State of alertness and awareness of surroundings
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Lethargy
- Slow motor processing
- Drowsy, but opens eyes and responds briefly
- Easily falls asleep, impaired focus
- Requires constant stimulation
- Speak loudly, ask simple questions
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Obtundation
- Dull or blunted sensitivity
- Difficult to arouse, slow responses
- When aroused, appears confused and demonstrates little interest or awareness
- Longer period of time than lethargy
- Little awareness of environment
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Stupor
- Semi-consciousness
- Lacks responsiveness
- Requires strong stimulus (often painful) to arouse
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Coma
- Unconscious patient, unable to arouse
- Eyes open
- No sleep-wake cycle
- No response to painful stimuli
- Generally time-limited
36
Minimally conscious (vegetative) state
- Return of irregular sleep-wake cycles
- Normalization of vegetative functions: respiration, digestion, BP
- Aroused, unaware of environment
- No purposeful or cog responsiveness
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Persistent vegetative state
- Vegetative state for 1 year or more
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Cognition (4)
- Orientation
- Attention
- Memory
- Executive or higher cog functions
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Focal deficits
- Only one or a few cog deficits
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Diffuse (profuse) or multifocal or global deficits
- Deficits across many areas of cog function
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Orientation
- Time, place, person, circumstance
- A + O x3: time, place, person
- A + O x4: time, place, person, circumstance
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Attention
- Capacity of the brain to process info from environment or from long-term memory
- 4 types: selective, sustained, alternating, divided
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Selective attention
- Screen and process relevant info while screening out irrelevant info
- Can function in busy environment; focus on specific conversation and block others
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Sustained attention
- Length of time pt maintains attention
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Alternating attention
- Switching attention between two different tasks (adding 2 numbers, then subtracting 2 numbers)
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Divided attention (dual task)
- Perform 2 tasks simultaneously
| - Ex: Walk and talk or walk and text
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Elements of Memory (3)
- Acquisition/Learning (Registration)
- Storage/Retention
- Retrieval/Recall
- Memory is like card catalog, store info till you need to recall
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Short-term memory
- Capability to remember day to day events, learn new material and retrieve after minutes, hours or days
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Long-term memory
- Recall facts or events such as birthdates or anniversaries
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Amnesia
- Memory deficits
| - Usually no long-term memory
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Anterograde (Post-traumatic) amnesia
- Inability to learn new info
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Retrograde amnesia
- Inability to remember previously learned info prior to insult to brain
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Higher cognitive functions (4)
- Info and vocabulary
- Calculations (time, measurements)
- Abstract thinking (problem solving)
- Constructional ability (ability to copy figures)
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Dysarthria
- Speech articulation deficits
| - Speech errors, timing, vocal quality, pitch, volume, breath frequency
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Receptive aphasia
- Wernicke's aphasia = fluent aphasia
- Pt can talk, but does not understand
- Left-sided damage (CVA, TBI)
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Expressive aphasia
- Broca's aphasia = non-fluent aphasia
- Pt has difficulty talking, but understands
- Left-sided damage (usually not TBI)
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Global aphasia
- Worst of both worlds
| - Receptive + Expressive aphasia
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Sensory integrity and integration
- Sensory info is necessary for motor function
- Provides feedback for initial movement
- Detects errors during movement
- Provides outcome info that can assist in learning for future movement
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Tone (4)
- Resistance of muscle to passive elongation or stretch
- Hypertonia (Spasticity, Rigidity)
- Hypotonia (Flaccidity)
- Dystonia (Disordered, impaired)
- Decorticate and Decerebrate Rigidity
- Document type of tone present, affected body segments, activity that caused tone to change
60
Spasticity
- Velocity-dependent
- Upper Motor Neuron (UMN) sign: lesion on corticospinal segment of brain
- Clasp-knife response
- Clonus
- Positive Babinski sign
61
Rigidity
- Increase tone through ROM regardless of velocity (fast or slow)
- Lead pipe rigidity - Not going to move
- Cogwheel rigidity (Ratchet-like) - Give-hold, give-hold
- Lesions of Basil Ganglia (i.e., Parkinson's)
62
Hypotonicity
- Lack of resistance to passive stretch
- Flaccidity (no tone) or very low tone
- Lower motor neuron (LMN): Anterior horn, peripheral nerves affected
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Dystonia
Hyperkinetic, disordered tone and involuntary movements
64
Decorticate posturing
- Abnormal flexor pattern; sustained contraction and posturing; pretty severe brain damage (globally)
- UE in flexion (elbows, wrist, fingers, flexed with shoulder adduction)
- LE in extension (extension, IT, plantarflexion)
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Decerberate posturing
- Abnormal extensor pattern; sustained contraction of trunk and extermities (except wrist flexion)
66
Reflex integrity (3)
- Deep tendon reflexes (DTRs)
- Superficial cutaneous reflexes
- Primitive reflexes
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Deep Tendon Reflexes (DTRs)
- Tapping over tendon
68
Superficial cutaneous reflexes
- Light touch to skin elicits muscle activation
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Primitive Reflexes
- Appears at infancy
| - Integrate into CNS early on
70
Cranial Nerve Integrity
- 1, 2, 8 = Sensory
- 3, 4, 6, 11, 12 = Motor
- 5, 7, 9, 10 = Mixed
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Muscle Performance
- Capacity of m to generate force
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Muscle Power
- Amount of work produced per unit of time
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Muscle Endurance
- Ability of muscle to contract over a period of time
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Atrophy
- Lack of LMN innervation
| - Disuse "Use it or lose it"
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Synergy
- Movement patterns
- Voluntary, used functionally
- Abnormal mass synergies: Obligatory, stereotypical
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Synergies
- Based on Hierarchial Control Theory
- Damage to brain --> higher centers damaged
- Higher centers control complex motor patterns, Inhibition of massive gross motor patterns; higher centers lose control, middle and lower centers emerge
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Postural Control
- Ability to maintain body in equilibrium or to control body's position in space for stability and orientation
- COM over BOS
78
Postural Orientation
- Ability to maintain normal alignment relationships between various body segments, and between body and environment
- Aligns to environment
79
Postural Stability Control
- Static equilibrium, static balance or stability
| - Ability to maintain stability and orientation with the COM over the BOS with body at rest
80
Dynamic Postural Control
- Dynamic equilibrium, dynamic balance or controlled mobility
- Ability to maintain stability and orientation with the COM over the BOS while parts of the body are in motion
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Goals of Postural Control
- Improve static balance
- Improve dynamic balance
- Improve adaptation of balance skills for varying task and environmental conditions
- Improve sensory function
- Improve safety awareness and compensatory strategies to effect fall prevention
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Causes of Static (stationary) Balance Deficits (6)
- Decreased strength
- Tonal imbalances (Spasticity in one area can affect balance)
- Impaired voluntary control
- Hypermobility (ataxia, athetosis)
- Sensory hypersensitivity (tactile defensive)
- Increased anxiety or arousal
83
Signs of Postural Instability (5)
- Excessive postural sway
- Wide BOS
- High guard hand position
- Requires hand hold assistance
- LOB
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Strategies for Intervention (3)
- Guidance
- Feedback
- Practice
85
Recovery of Function (3)
- Spontaneous recovery
- Function-induced recovery
- Compensation
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Spontaneous Recovery
- Occurs immediately after insult to CNS
- Neuronal changes due to repair processes of brain
- Can result in function being restored in neural tissue initially lost
87
Function-induced Recovery (9)
- Challenge pt to get benefit of exercise
- Use it or lose it
- Repetition is important - need significant amount of repetition
- Intensity is important
- Use and shape to pt ability (modify with progress)
- Enhance selection of behaviorally important stimuli
- Enhance attention and feedback
- Target goal-directed skills (As pt or family what goals are for PT)
- Timing is important
- Age
88
Compensation
- Using alternate strategies to complete a task
- New motor patterns appear from adaptation of remaining motor elements or substitution or alternate motor strategies and body segments
- Mal-adaptative neuroplasticity may kick in
89
Guidance
- Physically assist only as much as is needed
- PTA provides missing "piece"
- Tactile and kinesthestic input (guide movement, where you touch pt matters)
- Decrease guidance as proficiency increases
90
Practice
- Must correctly perform
- Plan breaks strategically
- Blocked practice vs. random practice
- Practice order
- Mental practice
- Transferring to other situations or environments
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Blocked practice
- One task performed repeatedly, uninterrupted by repeated task
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Random practice
- Tasks practiced, order of test is random
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Neurodevelopmental postures and potential treatment benefits (7)
- POE
- Quadruped
- Bridging
- Sitting
- Kneeling and half kneeling
- Modified plantargrade
- Standing
