What is the goal of motor control for the novice?
The goal is to find a NEW movement STRATEGY
What can be expected during skill acquisition?
- A high degree of attention to task
- Variable performance
- Heavy reliance on FEEDBACK/sensory info to adjust motor response
What is the goal of motor control for an expert?
The goal is skill RETENTION -- want a permanent change in behavior
What is the focus of developing motor control for an expert?
- Increase movement efficiency/consistency (automatic/fast)
- Decreased attention demand
- Decrease reliance on external feedback
- Use feedback only to adjust to unexpected changes
How does damage to the nervous system alter the motor control game?
Motor system = weakness, incoordination, hypertone
Sensory = loss of tactile, proprio, visual, vestibular
Altered perception/safety awareness
What is Task-Oriented Training
Manipulation of a task and practice of variables that is focused on pt. centered functional goals that allows the pt. to problem solve motor tasks
What are the skill acquisition strategies for task-oriented treatment?
- Immediate feedback
- Blocked practice with less variation
What are the skill retention strategies for task-oriented treatment?
- Summary feedback (allows for pt. to develop internal feedback)
- Random practice
- High variation and challenge
T/F: Movement can only be classified as developmental or learned; there is not cross over between classifications.
False: classifications aren't exclusive
Typically developmental movement influences learned movement
T/F: In order to understand abnormal movements in our patients and to know how to address them, we must first understand normal movement and learning.
Side note: abnormal movement in the context of the pt.'s normal
What does the brain car about in regards to how movement is completed?
It depends... options include:
- Accuracy of movement/Movement Quality
- Funcitonality/Overall outcome of movement
- Energy Conservation
T/F: "What the brain cares about" changes over the lifespan.
T/F: Central Pattern Generators are a type of closed loop system.
False: open loop
T/F: In an open loop system sensory information is disregarded.
Before: need to know intial position
During/After: errors are monitored to modify future movement (cerebellum involved)
What have the concerns about motor programs led to?
The concept of generalized motor programs
T/F: Changes in performance can be temporary
True: for example, due to fatigue/drugs/etc
How is learning measured?
With a retention test or a transfer test
What measure of retention is most often relied on in clinic?
Absolute retention or relative difference score when documenting progress
What is the most important variable in motor learning?
T/F: Repetitive motor activity alone produces functional reorganization of cortical maps.
False: does NOT produce functional reorganization
What type of practice causes remapping of the brian?
When a fully learned skill incurs a new challenge
The LEARNING of a skill reorganize the brian
What type of rest periods are more beneficial to performance during practice?
longer rest (distributed practice)
What is a diagnostic indicator of an UMN problem?
stretch sensitive hypertonicity
How do you examine tone?
Passive movement of limbs at varying speeds
(min, mod, severe, modified ashworth, tardieu)
T/F: Static hand splints are beneficial in preventing contracture following stroke
tend to decrease function and increase pain
Side note: better alternative = dynamic hand orthosis
T/F: Serial casting is effective at improving ROM in ppl w/CP and TBI
Disadv: higher risk of skin lesion/infection; difficult technique; limited functioning while one
T/F: Ankle mobs increase PROM in those s/p stroke allowing for change in functional ankle use
False: increased PROM 7-10 degrees but not improvement in function
What is the goal of task specific training in a weak pt?
Maximize pt-initiated activity to promote motor recovery and plasticity
What are the strength training guidelines?
- Overload principle
- %1 RM
- Low rep w/rest
How do you make high rep exercise demands more engaging for the pt?
- add a speed demand
- decreased the number but demand perfection
T/F: You need to assess strength separate from coordination
True: coordination can't be assessed unless the pt. has sufficient strength
What side of the brain drives perception?
The non-dominant side of the brain
What is the test for motor control called?
What does NDT stand for>
Apart from task specific training, what needs to be addressed with mobility training?
ROM and Strength
T/F: Most functional goals are discrete tasks.
False: continuous tasks
If the ability to integrate feedback is limited [due to neuropathology] then the system will be acting in an _______ _______ manner to an extent
What drives the closed looop system?
Error -- cerebellum compares reality to plan and makes adjustments
**Error can be good; body is using error to solve motor problems
What is task transfer?
The ability to use a general motor plan and apply it to a similar situation -- transferring the task skill to a new context
What can increase stability with transfers in those SCI?
Hooking arms behind objects
What degree of tilt provides actual pressure relief?
65 degrees of tilt
What is the most important factor in W/C prescription
Patient's functional level (now and in the future)
What level SCI could benefit from Tbar/goal post control
Why is it important for those with SCI to be able to do WC wheelie
Important for uneven terrain/curbs/etc
What should you not do in those with autonomic dysreflexia?
DO NOT lay them flat (allows pressure to more easily effect the brain)
Term: initial period of post spinal injury where reflexes remain hyporeflexive progressing to hyperreflexia
T/F: Infertility is uncommon in SCI
False: common due to difficulty with temperature regulation
What does the stim bike promote in those with SCI?
Circulation, prevention of atrophy, osteoporosis prevention
**Osteoporosis is preventing by mm pulling on bone, not just WB alone
**Will not promote mm return
T/F: At slower speeds there is increased variability with gait.
When is steady velocity typically reached?
Within 1-3 steps
Which type of turn is more stable?
What accounts for the largest amount of public falls?
Particularly stair descent which accounts for 4/5 falls
What sit to stand strategy is seen more commonly in elderly individuals?
T/F: Older adults tend to over correct for erros with gait.
What type of KR delay is importance for integration of movement
Post KR Delay
T/F: Providing a distracting activity in the KR-Delay interval has not effect on learning.
Flase, can interfere with learning
T/F: Sometimes qualititative feedback can be erroneous feedback.
True: Ex. saying "good job" when the performance was not good
Which is better for skill retention, absolute or relative KR frequency
Relative (50% frequency)
What is the focus of orthotic perscription?
What is the typical degrees of DF used for orthotics?
0 to 5 degrees
T/F: There was significant improvement in those pt with FES compared to AFO training
False: no significant difference between groups