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What Does Movement Emerge From
Task, Individual, Environment
Discrete Movement
Kicking a ball or moving from sit to stand. Has a recognizable beginning and end
Continuous Movement
Walking or running. The end point is decided by the performer
Open Movements
Playing soccer or tennis. Requires performer to adapt to constantly changing and unpredictable environment
Closed Movement
Tasks performed in fixed or predictable environments
Stability Tasks
Sitting or standing. Performed with non-moving BOS
Mobility Tasks
Walking and running. Requires moving BOS
Reflex Theory
Actions and behaviors are explained through a chain of reflexes.
Reflexes have a receptor, conductor, and effector
Doesn’t explain how 1 stimulus can produce different responses, the production of novel movements, and movements without sensory info
Hierarchical Theory
Control is top down (we know this isn’t true now)
Currently: Each level of nervous system acts on other levels, and things also happen in parallel
Central Motor Pattern and CPGs
Rules for how you move, retraining movements must be done functionally
CPGs
Hardwired support
Principle of Abundance
Muscles not used to eliminate redundant degrees of freedom are used to ensure flexible and stable performance of tasks
Ensures covariation
Covariation
Variability allows adaptation
High vs low chair, soft vs hard surface
System Theory: 1st Level
Tonus
Resides in spinal cord, prepares motor functions to respond appropriately
System Theory: 2nd Level
Synergies
In brain stem, responsible for subconscious and restricts degrees of freedom
System Theory: 3rd Level
Space
Large sensory inflow processes the environment to help dictate how you move
System Theory: 4th Level
Action
In the Frontal Cortex, flexibility to find several potential motor solutions for the same movement program
Leading Level
Controls goal directed movement
Background Level
Provides support so movement can be executed
Dynamic Systems Theory
When individual parts come together, its elements behave in an ordered way
Nonlinear System
Output not proportional to input
Control Parameter
Variable that regulates change in behavior of entire system
Neurofacilitation
Retraining motor control by facilitating or inhibiting different movement patterns
Limiting Factor on Emergence of Behavior
Immature systems
Birth-3 months
ATNR & STNR
Optical Righting
Labyrinthine Righting
Body on Head Righting
4 months
Prone balance
5-6 months
Neck on body righting
Body on neck righting
6-7 months
Forward catch (parachuting)
7-8 months
Sitting balance
8-9 months
Sideways catch
9-10 months
Backwards catch
10-12 months
Stance balance
Independent Sitting: Stage 1
No control
4 months
Independent Sitting: Stage 2
Attempts to initiate upright sitting
5 months
Independent Sitting: Stage 3
Partial control, large body sway
6 months
Independent Sitting: Stage 4
Functional control, minimal sway
8 months
Motor development/Designs of movement
Sensory stimulation techniques (sensitization and desensitization)
Rood
Weight Bearing and Stabilization Tasks
Heavy Work/Tonic Muscles
Muscles work in the background, normalise tone
Mobility Tasks
Light Work/Phasic Muscles
Acomplished in non-weight bearing
Rood’s Motor Development Level 1
Mobility
Free, flexible motion
Rood’s Motor Development Level 2
Stability
Co-contraction of agonists and antagonists to allow for weight bearing and later dynamic holding
Rood’s Motor Development Level 3
Controlled Mobility
Closed chain movement
Rood’s Motor Development Level 4
Skill
Open chain, coordinated movement
Light Touch
Facilitates contraction of underlying muscles
Tapping
Facilitates phasic contraction of the muscles
Quick Stretch
Facilitates contraction, muscle spindles
Quick Ice
Facilitates contraction of underlying muscles
Traction
Causes muscle relaxation and promotes movement
Approximation
Promotes stability
Resistance
Muscle activation, but requires patient to be strong
Prolonged Stretch
Inhibits muscle contraction
Deep Pressure
Relaxation of muscle
Pacinian Corpuscles
Neutral Warmth
General Relaxation
Slow Stroking
Calms Patient
Prolonged Cold
Relaxation and reduction of pain
Fugl-Meyer Assessment
Signe Brunnstrom
Gold standard for stroke patients, used in researh because of long admin time
Associated Reactions
Synergistic patterns move involuntarily when another part of body is performing strong or forceful movement
Flexor Synergy: Scapula
Retraction and Elevation
Flexor Synergy: Shoulder
Abduction and External Rotation
Flexor Synergy: Elbow
Flexion
Flexor Synergy: Forearm
Supination
Flexor Synergy: Wrist
Flexion
Flexor Synergy: Fingers/Thumb
Flexion/Adduction
Flexor Synergy: Pelvis
Elevation and Retraction
Flexor Synergy: Hip
Flexion, Abduction, External Rotation
Flexor Synergy: Knee
Flexion
Flexor Synergy: Ankle
Dorsiflexion and Inversion
Flexor Synergy: Toes
Dorsiflexion
Extensor Synergy: Scapula
Protraction and Depression
Extensor Synergy: Shoulder
Adduction, Internal Rotation
Extensor Synergy: Elbow
Extension
Extensor Synergy: Forearm
Pronation
Extensor Synergy: Wrist
Flexion or Extension
Extensor Synergy: Fingers/Thumb
Flexion and Adduction
Extensor Synergy: Hip
Extension, Adduction, Internal Rotation
Extensor Synergy: Knee
Extension
Extensor Synergy: Ankle
Plantarflexion and inversion
Extensor Synergy: Toes
Plantarflexion
Motor Recovery Stage 1
Extremities are flaccid. Typically occurs immediately after the lesion and persists for a few hours to a few days
Motor Recovery Stage 2
Minimal volitional motions are possible and associated reactions are in synergistic patterns. Spasticity begins to develop
Motor Recovery Stage 3
Voluntary control of the synergies is possible through partial range. Spasticity peaks
Motor Recovery Stage 4
Limited motions combining synergistic movements are possible. Spasticity begins to decline
Motor Recovery Stage 5
More advanced movement combinations are possible as spasticity continues to diminish
Motor Recovery Stage 6
Isolated movements are possible with near normal coordination. Spasticity has declined and may only be evident with increased speed of movement
Rhythmic Initiation
Initiate movement
Hold Relax
For full ROM and if they are stronger than you
Contract relax
For full ROM
Agonist Reversal
Eccentric Strength
Repeated Contractions
Concentric movements
Repeated Quick Stretch
Concentric movements
Sister Kenny
Developed muscle re-ed for children with polio
Kabel, Knott, and Voss
Developed PNF
Stepping Pattern 1
High Guard
Stepping Pattern 2
High step frequency (lots of little steps)
Stepping Pattern 3
Absence of reciprocal swinging movements between bilateral UE and LE
Stepping Pattern 4
Stance phase: increased knee flexion
Stepping Pattern 5
Swing phase: increased hip flexion, pelvic tilt, and hip abduction, decreased ankle flexion
Stepping Pattern 6
Heel Strike: ankle plantarflexion/foot flat
Side-lying to Supine
1-2 months
Supine to Side-lying
4-5 months