Sensorimotor Approaches (Stroke) Flashcards Preview

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Producer of All Movement

Firing of motor neurons located in the anterior horn of the spinal cord. Directly innervate skeletal muscles.

** Basal Ganglia and Cerebellum in brain are also involved with motor control, and lesions here are associated with movement disorders.


4 Processes related to flow of information to control movement:

1) Motivation
2) Ideation
3) Programming
4) Execution


Motivation/Emotive Component of Movement

• Function of limbic system
• Motivational urge from limbic system to ideation by cortical association areas (lobes)



Connection of knowledge and affective behavior (ie: ideation of movement in cortical areas transferring to movement)
• Represents intentional, deliberate, and goal-directed aspect of behavior
• Relates to individual’s reason for motor performance.


Programming Component of Movement

• Cortical areas program movement strategy (plan) to meet movement goals
• Also involves premotor areas, basal ganglia, cerebellum


Motor Program

Procedure or spatiotemporal order of muscle activation needed for smooth/accurate motor performance.


Execution Component of Movement

• Motor cortex, cerebellum and spinal cord
• Concerned with activation of spinal motor neurons and interneurons that generate goal-directed movement and necessary postural adjustments


Order of Movement Creation in Brain

1) Limbic System (detects need) >
2) Cortical Association Areas (receive sensory input needed) >
3) Association Cortex + Basal Ganglia + Lateral Cerebellum + Premotor Cortex (motor program) >
4) Motor Cortex (conveys to brain/spinal cord) >
5) Cervical Spinal Neurons (activate precise movement/PNS) + Brainstem/Cerebellum (adjust posture)


Sensorimotor System

Structures of the brain that control movement, relying heavily on sensory feedback from exteroceptors/proprioceptors.


Voluntary Movement Depends On:

• Knowing where body is in space
• Knowing where body intends to go in external space
• Knowing internal/external loads to overcome
• Formulating a plan to perform the movement
• Holding the plan in memory until execution


Sensorimotor Cortex

• Integrating center of sensory/motor input
• Cortical areas immediately anterior and posterior to central sulcus

3 Principal MOTOR Regions (FRONTAL Lobe):
1) Primary Motor Area
2) Supplementary Motor Area
3) Premotor Area

2 Principal SENSORY Regions (PARIETAL Lobe):
1) Primary Somatosensory Cortex
2) Posterior Parietal Cortex


Lesion in Posterior Parietal Cortex Leads to:

• Impairment of body image and it’s relation to extrapersonal space (inappropriate movement strategy results)
• Neglect of contralateral body segments (extreme case)


Supplementary Motor Area

Planning of movement. Lesions here can result in apraxia, or also an inability to produce complex motor activities such as speaking, writing, buttoning, typing, etc.


Primary Motor Area

Integrates info received from other areas of brain and generates descending command for execution of movement. Lesions here result in motor execution deficits (contralateral muscle weakness, spasticity, and poor isolation of movement).


Lesions of Primary Somatosensory Cortex

Result in contralateral sensory loss, and uncoordinated movement (inability to register feedback).


Sensorimotor Intervention Approaches

• Viewed as targeting motor planning and lower-level execution process with aim of reintegrating complete motor control hierarchy
• Client is taught motor strategies or compensatory mechanisms to adapt to deficits using SENSORY STIMULATION to elicit specific movement patterns
• Stimuli start as external and eventually become intrinsic to encourage voluntary motor control.
• Limitations because it does not actively engage client’s volitional intent to perform motor act.
• Includes Rood Approach, Brunnstrom Approach, Proprioceptive Neuromuscular Approach (PNF), and Bobath/Neurodevelopmental Treatment Approach.


Reflex and Hierarchical Models of Motor Control (Sensorimotor Intervention)

View movement strategies along developmental continuum. Reflexes are normal responses from infancy in response to specific stimuli; form the basis of volitional (purposeful) movement.
• Motor control hierarchically arranged (higher centers of brain responsible for regulation/control of volitional movement, while lower levels regulate/control reflexive/automatic movement).
• Therefore, when CNS is damaged, lower levels take over (hence return to reflexive/unmoderated movement)
• These intervention approaches rely on sensory stimulation of muscles/joints to evoke motor responses, handling/positioning to effect muscle tone, and use of developmental postures to enhance ability to carry out movements.


Rood Approach

Sensorimotor intervention approach:
• Use of sensory stimulation to evoke motor response
• Use of developmental postures to promote changes in muscle tone

Sensory stimulation has potential to either inhibit or facilitate muscle tone. Can use slow rolling, neutral warmth, deep pressure, tapping, and prolonged stretch as stimuli. Also move client through developmental sequences.

Limited success due to short-lasting nature of stimuli.


Brunnstrom (Movement Therapy) Approach

Sensorimotor intervention approach:
• For individuals who had sustained a CVA
• Draws from reflex and hierarchical models
• Views spastic/flaccid muscle tone and reflexive movements as part of recovery toward volitional movement
• Stages of motor recovery (1-6) from flaccidity to individual joint movements.
• Emphasis placed on promotion of movement from reflexive to volitional
• Example: resistance applied to one side of body to increase muscle tone on opposite, affected side in order to facilitate reflexive movement until client demonstrates volitional control over the movement pattern.


Proprioceptive Neuromuscular Facilitation Approach (PNF)

Sensorimotor intervention approach grounded on reflex/hierarchical model of motor control.
• Major emphasis on developmental sequencing of movement and balanced interplay betw agonist/antagonist in producing volitional movement
• MASS MOVEMENT PATTERNS and postures for limbs and trunk (DIAGONAL in nature) used to promote movement
• Tactile, auditory, visual stimulation actively incorporated to promote motor response
• Example: client asked to reach into bag on left side to retrieve objects to be placed into cabinet on right side.
• Successful in increasing ROM and stretching tight muscles
• May reduce falls in older adults.
• May be used as preparatory activity or applied within performance of a task.
• Used for conditions such as Parkinson’s, SCI, arthritis, stroke, TBI and hand injuries.
• Can reduce sensory deficits in CVA pts


Neurodevelopmental Treatment (NDT) Approach

Sensorimotor intervention approach based on normal development and movement.
• Drawn from hierarchical model of motor control
• To normalize muscle tone, inhibit primitive reflexes, and facilitate normal postural reactions
• Goal to improve quality of movement and relearn normal movement patterns
• Employ numerous techniques: handling; use of inhibitory techniques (diminish impact of spasticity); weight bearing over affected limb; using positions that encourage bilateral use; and avoidance of sensory input affecting muscle tone.
• Many of the techniques are used within context of purposeful activities.


Client Factors Addressed by PNF

• Posture
• Mobility
• Strength
• Effort
• Coordination


How PNF is Administered by Therapist

Facilitation techniques are superimposed on movement patterns and postures through therapist’s

Uses CERVICOCAUDAL and PROXIMODISTAL direction in tx. Head, neck, trunk come before extremities. (Postural control is key!)

Address movement in BOTH directions to avoid any neglected abilities (ie: getting up but also sitting down; dressing and undressing).

May be preparatory method, or applied within the performance of a task.

Used for: Parkinson’s, SCI, Arthritis, CVA, TBI, and Hand Injuries.


Reciprocal Inhibition

Theoretical model used to explain benefits of PNF. Neuromuscular reflex that inhibits opposing muscles during movement. Example: contract elbow flexors, then elbow extensors are inhibited. This is the idea behind active stretching and a component of PNF stretching.


Synergy Patterns

Primitive movements that dominate reflex and voluntary effort when spasticity is present after CVA. Interferes with coordinated voluntary movement such as eating, dressing and walking.

FLEXION Synergy Pattern: Scapular retraction, shoulder abd and ext rotation, elbow flexion, forearm supination, wrist/finger flexion. Hip flex, abd, ext rotation, knee flex, ankle dorsiflexion.

EXTENSION Synergy Pattern: Scapular protraction, shoulder add and int rotation, elbow ext, forearm pronation, wrist/finger flexion. Hip ext, add, and int rotation, knee ext, ankle plantar flex/inversion, toe flexion.


PNF Balance betw Antagonist Muscles

Observe where imbalance exists, and then facilitate the weaker component. If client shows flexor synergy, extension should be facilitated. (Think of bed positioning, keeping affected limbs in opposite position of synergy pattern.) In the presence of spasticity, first inhibit spasticity, then facilitate antagonistic muscles, reflexes and postures.


How sensory input from therapist leads to motor learning (PNF):

Example: Therapist cues verbally (input 1), “Reach for the cup,” which causes client to look up (input 2) toward the movement, to touch (input 3) the cup. Motor learning occurs when these external cues no longer needed.

External input may also be in the form of joint approximation (contact) from the therapist (ie: through shoulders and pelvis of client with apraxia while standing for a task), or stretch (stretching finger extensors to facilitate object release); so client learns how normal movement feels.


Verbal Mediation in PNF

Auditory feedback to facilitate motor performance. Clients say aloud the steps required for a movement and to help learn to perform it. Studies show it helps client retain sequence of steps.


Visual Stimuli in PNF

Visual stimuli assist in initation/coordination of movement. Ensure client tracks in direction of movement. Can position activities (or therapist!) to facilitate movement in a certain direction. ie: Therapist may stand diagonally in front of client to facilitate forward direction.


Tactile System in PNF

Most efficient stimuli to build cognitive and emotional experiences. Feel movement patterns that are coordinated and balanced.