Motor Control and Coordination

Question 1

Motor Deficits include

Answer 1

• Motor control/coordination (“Motor Contol”)
• Balance/Proprioception (“Motor Control”)
• Muscle Strength (“Force”)
• Muscle Endurance (“Energy”)

Question 2

abarrent movement

Answer 2

abnormal movement

Question 3

Phase 1 we don’t gain motion but improve ____. We maintain muscle atrophy by providing ____.

Answer 3

quality of movement
isometric exercises.

These will all help in maintaining proximal and distal function.

Question 4

Phase 1 Presentation

Answer 4

Poor motor coordination/activation

Use functional movement screens

Question 5

Phase 1 Goal

Answer 5

• Improve movement coordination and muscle activation
• Prevent muscle atrophy
• Movement strategies to decrease pain

Question 6

Exercises for Phase 1

Answer 6

Submax isometrics

Question 7

Phase 2 Presentation

Answer 7

Strength and endurance deficits (Impaired muscle force production)

MMT, Set weight and do as many reps as possible, VO2max

Question 8

Phase 2 Goals

Answer 8

• Restore/improve motion, strength, balance and function
• Enhance ideal movement patterns by enhancing force production of muscle
• Progress to performing more advanced ADL’s

Question 9

Phase 3 Presentation

Answer 9

Strength and Endurance deficits of mm and limited ability to perform specific FUNCTIONS

Question 10

Phase 3 Goals

Answer 10

• Enhance neuromuscular control during “high level activities” (based on pt’s goals)
• Enhance endurance, dynamic stability, power, speed, etc.

Question 11

Phase 3 Strengthening Exercises

Answer 11

• Functional strengthening
• Higher level isotonics
• Exercise to enhance endurance
• OKC and CKC Rhythmic Stabilization
• Continued core stabilization
• Endurance

Question 12

Usual Examination findings associated with Early Poor Motor Control/Coordination

Answer 12

Subjective:
* History of either acute or chronic pain or any other condition that affects quality of motion (ex: surgery)
* Or: neurological condition affecting motor control (Ex: Stroke, Peripheral Nerve injury, Concussion)

AROM:(CASSS: Control, Amount, Symmetry, Speed, Symptom reproduction)
* QUANITY of motion is variable
* QUALITY of motion especially with functional motions is altered. “ABERRANT MOTION”

Motor:
* Compensations noted during any motor assessment.

Question 13

Dissociated (“Fractioned”) Movement

Answer 13

Break down motor patterns by facilitating body segments moving independently.

Question 14

Loss of dissociated movement examples

Answer 14

Examples of abnormality:
* Upper quarter: Dissociated scapular movement; scapular and humeral move in conjunction together such as when they can’t properly do a lateral raise
* Lower quarter: Dissociated pelvic movement

Question 15

Why do changes occur in acute pain with motor control?

Answer 15

• Protective mechanism; preventing joints to prevent further injury or pain
• Short term benefits by minimizing movement but can lead to long term consequences if it becomes habitual which leads to abberant movement

Examples:
* Antalgic gait; sprained ankle or knee injury
* observe someone turning head with acute neck pain (rotate through their trunk vs. their neck)

Question 16

Why do changes occur in CHRONIC pain with motor control?

Answer 16

• Pain leads to redistribution of activity within and between muscles
  – Increase activation of large superficial, biarticular muscles (leads to muscle tone “tightness”)
  – Decrease activation of deep stabilizing muscles (multifidus, gluteus medius, piriformis, deep hip flexors, lower trapezius, transverse abdominis)
• Pain and redistribution muscle activity leads to biomechanical changes. In other words…People move differently (more subtle than acute)
• Occurs centrally in the cortical levels in the brain

Question 17

Basic movement and posture is controlled by

Answer 17

• Basal ganglia
• Vestibular nuclei
• Reticular Formation

Question 18

New theory of motor adaptation to pain

Answer 18

variability: amount of segments moving

Question 19

Is this a Sensory Input Processing Error or Motor Output Processing Error?

Answer 19

Input from periphery and output of the brain (both motor and sensory). As a result of chronic pain, results in smuding of the homonculus.

Question 20

Phases 1-3 Triangle Progress

Answer 20

Start in the red and build into strength and endurance

Question 21

Scapular and Humeral Dissociation

Answer 21

• Scapular dissociation: Ability for scapula to move independently of fixed humerus or spine (teach “Scapular clocks”)
• Humeral dissociation: Ability of humerus to move independent of fixed scapula (teach isolated humeral motion). Ex: Lateral Raise; can’t move humerus without scapula)

Question 22

Femoral and Pelvic dissociation

Answer 22

• Pelvic dissociation: Ability to isolate pelvic motion with stable femur (teach “Pelvic tilts” and “pelvic clocks”)
• Femoral dissociation: Femur motion on stable pelvis (teach isolated hip motion)

Question 23

Scapula Dissociation Exercise

Answer 23

Moving the Scapula in isolation
(ex: Scapular clocks)

Question 24

Humeral Dissociation Exercise

Answer 24

Moving the humerus in isolation of a fixed scapula
(Ex: Prone Horizontal Extension “T”)

Question 25

Examples of Patient Populations (“Indications”) - Upper

Answer 25

* Chronic Neck pain * Neck injury following motor vehicle accident * Chronic Shoulder pain * Frozen shoulder * Shoulder surgery esp. with prolonged immobilization * Shoulder immobilization following trauma * History of stroke * Other neurological conditions that affect motor function ## Footnote 50% of outpatient are the top 4 conditions

Question 26

Pelvic Dissociation Ex

Answer 26

“Pelvic Dissociation”: Moving the pelvis on a fixed femur Supine: * Pelvic tilts * Pelvic clocks Sit * Pelvic tilts/clocks * Hip hinging Stand: * “Hip hinging” (Cue: Use of stick – THREE POINTS OF CONTACT on head, thoracic and sacrum)

Question 27

Implication of Inadequate Pelvic Dissociation

Answer 27

Rounded: Leads to over loading erector spinae Hyperextended: Puts too much pressure on facets joints

Question 28

Femoral Dissociation Ex

Answer 28

“Femoral Dissociation”: Moving the Femur on a fixed pelvis Supine: * Supine unilateral bent knee fall out * Supine bilateral KTC with hip abduction/rotation Side lying: * Hip abduction/rotation: “clamshells” * Hip IR/ER at 0 & 90 deg WB: * Hip flexion/Abduction/IR

Question 29

Examples of Patient Populations Lower (“Indications”)

Answer 29

Chronic back and/or hip and/or knee pain Back injury or pain Back and/or hip and/or knee surgery Knee injury Pelvic floor dysfunction Neurological conditions of the lower extremity especially with gait deviations

Question 30

People with chronic pain with struggle with ____ cues. The use of ____ cues is needed.

Answer 30

1. internal 2. external

Question 31

Which is best? Verbal, tactile or visual? Internal vs external?

Answer 31

Whichever leads to the desired outcome you are working toward.

Question 32

internal cue def

Answer 32

Cues directed to the action itself AND/OR Cues directed to the mm activation that contriubute to the action ## Footnote Integrate verbal, tacticle, and visual

Question 33

external cue def

Answer 33

Cue/direction directed to the effect of the action ## Footnote Integrate verbal, tacticle, and visual

Question 34

Dosage for Motor Control

Answer 34

Must take into account ideal and realistic. More practice is better but the patient doing the exercise is more important. Ideal: 1 Pelvic Clock Morning and Night, 1x every 1 hour 10-15-20 pelvic tilts

Question 35

Addressing motor control deficits with strength will result in..

Answer 35

No changes. We must address motor coordination deficit specific interventions not strength. Motor control needs to be integrated early and then later when returning them back to their high levels of activity.

Question 36

Patients that have fear of movement, hypervigalence of movement or other referral patterns will...

Answer 36

Result in alternate movement patterns and require a psychosocial education intervention to desensitise them and teach them that movement is good!

Question 37

Intervention: Enhance Isolated Muscle Activation

Answer 37

Link between pain/injury and ability for muscle to contract in response to that injury/pain EX: Lumbo-pelvic, Pelvic-LE comples, Cervico-thoracic complex

Question 38

Mucles prone to motor control/coordination deficits

Answer 38

Cervico-thoracic syndrome: “Upper Cross Syndrome” * Deep neck flexors * Serratus anterior * Mid and lower trapezius * Shoulder external rotators Lumbo-pelvic-hip syndrome: “Lower Cross Syndrome” * Transversus abdominus * Internal oblique * Multifidus of lumbar * Pelvic floor muscles * Gluteus Maximus and hip medius and other hip ER * Vastus Lateralis, medialis and intermedialis

Question 39

Dysfunction typically is seen by activation of...

Answer 39

postural muscles first then phasic. Proper mechanics are phasic muscles followed by postural.

Question 40

Examples evidence of Patient Populations (“Indications”) - Poor activation patterns

Answer 40

* **Chronic back and/or hip pain** – Poor deep abdominal and multifidus activation * **Pelvic floor dysfunction** – poor pelvic floor activation * **Knee surgery** – poor quadricep and gluteal activation * **Neck pain following motor vehicle accident**– poor deep neck flexor activation * **Shoulder pain** – poor lower trapezius activation