Interventions to Improve Motor Control and Motor Learning Flashcards Preview

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Flashcards in Interventions to Improve Motor Control and Motor Learning Deck (34):
1

Objectives

Compare and contrast theories of motor control, motor learning and common principles of therapeutic interventions.
Identify the purposes and components of a motor control assessment
Define: spasticity, clonus, decerebrate rigidity, decorticate rigidity and flaccidity
Identify common causes of motor control impairments (discussed last lecture & throughout course)

fyi

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  • Components discussed previously (various components of a PT examination)
  • An assessment of impairments, activity limitations and functional restrictions
  • Plan of care is formulated
  • is often the basis of the POC
  • breaking a task into subtasks; an activity down into components

Activity-based, task-oriented intervention

3

  • Deals with “the understanding of neural, physical and behavioral aspects of movement.”  And….
  • Processing of human motor behavior:
  • Stimulus identification
  • Response selection stage: develop a plan for movement

Motor Control

4

  • Plan for purposeful movement- MOTOR PLAN
  • Made up of components
  • A prototype is chosen
  • Choose what fits the situation best

ex: log rolling -using the strategy of something you've done before and your body remembers.  

Response Selection Stage

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neural control centers translate the idea for movement into actionmotor program

All steps occur very quickly

Response programming

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  • “Abstract representation that, when initiated, results in production of a coordinated movement sequence.”
    • Considers synergistic component parts
    • Force
    • Direction
    • Timing
    • Duration
    • Extent of movement
    • Feedforward and Feedback

Motor Program

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  • “Internal processes associated with practice or experience leading to relatively permanent changes in the capability for skilled behavior.”
  • Don’t observe change in CNS directly, but will see change in motor behavior
  • Practice: determines improvements in performance
  • Learning: does not always occur when increase in performance is observed.

Motor Learning

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Motor Learning
Retention

apply a learned skill to learning of a similar skill (i.e. transfer to multiple surfaces)

Generalizability

9

Demonstrate the skill that has been learned over time, after no recent practice (retention interval) - no recent practice and can still do it.

Motor Learning
Retention

10

Motor Learning
Retention

ability to perform a measured task in altered environmental situations (i.e. walking with a cane inside/ walking outside) -really just change the environment.

Resistance to contextual change

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Stages of Motor Learning

develop understanding of the skill-  what stage?

Cognitive

12

Stages of Motor Learning

  • What do I need to do?
  • How do I do it well?
  • Uses sensory motor skills, discard strategies that you don’t find useful
  • When learning, rely heavily on vision

cognitive map

13

Stages of Motor Learning

  • Middle state of learning
  • Refine motor practice through continued learning
  • Proprioception is very important

what stage ?

Associative

14

Stages of Motor Learning

  • largely autonomic response from repeating the skill many times
  • Minimal cognitive monitoring

what stage?

Autonomous

15

Not Ready for Task-Oriented Training???

  • P14- box 2.2

 

  • Identifying threshold abilities is important to ensure that interventions will be successful and beneficial

built from the basics-  

if no trunk controll you can't work on standing.  start with trunk contol first and work from there

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  • Occurs when postures progress to more challenging circumstances for the body
    • Higher COM
    • More narrow BOS
    • More coordination between body segments

Where does the problem lie?

 

Box 2.3- treatment benefits of various postures and activities

Degrees of Freedom Problem

 

17

Identify lead up activities that each posture assists with (review together with your peers)- 5 minutes

  • Prone on elbows
  • Quadruped
  • Bridging
  • Sitting
  • Kneeling and half-kneeling
  • Modified plantigrade
  • Standing

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As therapists, how do we enhance motor learning???

Significant amount of practice
Feedback
Large amount of information processing

19

As therapists, how do we enhance motor learning???

  • Facilitate task understanding and practice
  • Determine level of skill
  • Make sure that skill is functionally relevant
  • Show pt how it is similar to something else they have done

Strategic development

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Strategy Development

  • Demonstrate the task for the patient
  • _________________________ p18
  • Point out similarities to other motor tasks
  • Have patients who have graduated demonstrate what they can do
  • Have a patient with C-6 quad. demonstrate for other patients with quad.
  • Instructions need to be clear and concise
  • Therapist should NOT correct all errors
  • Allow for some trial and error

 

In cognitive stage of learning

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Guidance- treatment intervention

What is it?

  • Helps when learning an unfamiliar skill
  • Use touch to guide patient toward correct movements
  • Have pt practice actively with appropriate guided movements
  • Increase verbal guidance as tactile assistance is decreased
  • Best used for slow, postural responses

22

  • Pt becomes more involved in analyzing and self correcting
  • Clinician can ask questions guiding the patient in correcting the activity
  • When ask questions, confirm that patient is answering and trouble shooting correctly
  • Use of augmented cues
    • Tapping, light resistance, etc.

Active Decision Making

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Strategies

Verbal Instructions and Cueing

Box 2.4- anticipating patient needs

 

Examples….????

24

Strategies

  • Task breakdown to assist with learning
  • More effective with transfers versus walking; the task should have independent parts that can be practiced
  • DO NOT DELAY practice 

Parts-to-Whole Practice

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Strategy Refinement

In the associated and autonomous stages of learning……

 

 

 

 

  • Focus on refinement of skills
  • Should have very consistent movement
  • Focus on proprioceptive feedback
    • Patient should “feel the movement”
  • Movement patterns should become more adaptable and be able to change with the change in environment
  • Dual-task training- two tasks at once
  • Use distracters at this stage to identify how much autonomous control is present 

26

There will be times that patients do not reach this level of learning: they may be able to perform well within a structure environment (the back yard), but are not capable of consistently performing in an open environment (the front yard)

example of front yard : more stimulus in front yard

back yard: more closed environment so pt can focus.

Late Stage Learning

27

  • Helps promote motor learning
  • Can be intrinsic (due to the natural result of moving), or extrinsic
    • Intrinsic:
    • Extrinsic:

use of Feedback

28

 feedback that occurs while task is performed

Concurrent feedback

29

feedback that is given at end of task

Terminal feedback

30

  • Do you recall this??  Initially covered in PTA 105
    • Knowledge of Results
    • Knowledge of Performance
    • p20

Knowledge of Results:  

 


Knowledge of Performance:

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  • Always consider what type of _________, how much and when it should be given
    • Frequent- has shown to help performance, but slow retention
    • Varied- “slows initial acquisition while improving performance on a retention test”
    • Do not give too much 
  • What sensory deficits does the patient have? Use a form of sensory input that the patient can use effectively
  • Easier to harder (visual to proprioceptive)

feedback

32

Varied Feedback- Box 2.6

  1. Summed feedback
  2. Faded feedback
  3. Bandwidth feedback:
  4. Delayed feedback:
     

  1. every 2nd or 3rd attempt
  2. give first at beginning of each trial and then spread out
  3. give only when outside certain parameters for error
  4. give after a brief time delay

33

What is important About Practice?

  • Make sure that patient practices desired activity
  • Helps to increase the learning
  • Watch for faulty postures and habits

34

 

Group 1: Massed versus Distributed Practice
Group 2: Blocked versus Random Practice
Group 3: Mental Practice
Group 4: Closed versus Open Environments

Group 1: Massed versus Distributed Practice

Group 2: Blocked versus Random Practice

Group 3: Mental Practice

Group 4: Closed versus Open Environments