neuro motor control

3 crucial elements for motor control

Neural circuit, motor plan, environment

Task goal

Movements are goal oriented

Map of motor command needed to complete task, generation of movement

Sensory forward model

Motor command mapped to a set of predicted sensory outcomes (what a person expects to feel on accomplishing task)

What sections of the brain are active during motor control?

Basal ganglia, cerebellum, frontal lobe

Stages of motor learning

Cognitive, associative, autonomous

What is motor learning?

The study of how individuals acquire, modify, and retain motor memories so they can be used, reused, and modified during functional activities

Cognitive stage

Learning new skill or relearning an old one under CONSCIOUS control

Need practice often and lots of external feedback as well as closed environment

Associative/refinement stage

Can execute movements within specific environmental constraints, decreased errors, less effort

Improve control and add variance, improves internal feedback so less external feedback

Autonomous stage/retention

Task becomes more automatic with less need for cognitive control

Open environment, mainly error free, internal feedback is dominant

Hallmark of learning

Ability to retain and transfer the skill into different settings under different conditions and environmental/cognitive challenges

What are essentials to motor learning?

Practice, task attention, feedback, environmental progression

Blocked practice

Repeating the same component of a task under the same conditions, used in cognitive stage

Random practice

Varying the activities being practiced, used as patients progress into associative/autonomous stage

whole learning

practicing a task in its entirety, best practiced as whole activity instead of breaking into parts

pure-part learning

used for complex activities where component parts are discrete motor programs by themselves

parts do not need to be practiced into specific order ie. tennis serve

progressive/sequential-part learning

used when teaching serial tasks that require many steps that have to be performed in a specific sequence to be successful

ie, standing from wc

whole-part-whole learning

1. completely whole task

2. clinician breaks down task into separate components (need help)

3. re-completes whole task

practice schedule

nature and frequency that someone practices the task

mass practice

repetitive practice with few interruptions

*practice time is greater than the amount of rest

variable/distributed practice

intervals between practice

random practice

varying practice among different task

*practice without scheduled frequency/duration

intrinsic feedback

sensory responses from patients own body information them about task

extrinsic feedback

outside source providing feedback (therapist, mirror, tactile cues/facilitation)

types of extrinsic feedback

knowledge of performance: about quality or movement

knowledge of results: about outcome of movement compared to goal

summary: give after task

faded: given after every trial then decreased

delayed: withhold for short time

neuroplasticity

cellular adaptations in the CNS that allow an individual to learn new skills or relearn function previously lost bc of cellular death by trauma or disease at any age

primitive reflexes

stereotypical movement patterns response to specific stimuli, most integrate by 4-6 months

neck righting on body

passively turn head to one side and body rotates as a whole (LOG ROLL) to align body with the head

body righting on body

passively rotate upper or lower trunk and body segment not rotated follows to align body segments (segmental rolling)

labyrinthine head righting

w/o vision, if body is tipped, the head will orient to vertical position to keep mouth horizontal

optical righting

if body tipped, body & head orient to vertical position with mouth horizontal using vision

what are righting reactions ?

help establish and maintain the alignment of the head, trunk & extremities

keeps vertical upright posture

what are equilibrium reactions?

patterns of movement that maintain balance as COG moves over BOS

what are protective reactions?

safeguard if equilibrium reactions fail

when does LE (step strategy) occur?

15-17 mos

how can the visual system be challenged ?

balance eyes open, then eyes closed

assess for potential visual field cuts, double vision, gaze control

how can you challenge somatosensory?

balance on unstable surfaces such as foam, uneven surfaces, slopes

how can you challenge the vestibular system?

examination of balance with movement of the head, eyes closed, on unstable surfaces

reactive postural responses

cannot anticipate changes in COG over BOS so not aware & cannot plan balance recovery

perturbations or eyes closed

anticipatory postural responses

can anticipate change in COG over BOS & pre-set postural muscles & strategies

ie. tandem walking, walking backwards, reaching

ankle strategy

elicited 1st by small disturbances in balance, head & hip move in same direction

hip strategy

activated by larger, faster disturbances in balance

head & hips move in opposite direction

stepping strategy

activated by fast, large perturbations that move COG beyond BOS, protective extension of LE to realign BOS under COG

suspensory strategy

attempt to lower COG over BOS

knee flexion, crouching or squatting

BERG balance test

assesses risk for falling, can be static or dynamic

functional reach test/multi-directional

measures balance/risk for falling, limits of stability

tinetti performance oriented mobility

screens for fall risk, reflects position changes & maneuvers used in daily functional activities

timed up & go

mobility, balance, walking ability, fall risk

motor assessment scale

everyday functional mobility & looks at recovery

mini best test

assesses balance impairments, deficits are more specific so interventions are more specific

functional gait assessment/dynamic gait index

assess fall risk, if equal or less than 19 is fall risk