MOTOR APPROACHES AND DIA

Muscle Tone

Degree of muscle tension.

Facilitatory

Treatment that increases tone or increases muscle activation.

Inhibitory

Treatment that reduces tone of decreases muscle activation.

Proprioception

The ability to sense the position, location, orientation, and movement of the body and its parts.

Attractor state

Preferred pattern of organization within a system.

Control parameter

Variable that, when changed, will influence changes in a system’s pattern of organization.

Theoretical base of motor control approaches.

Restoration of voluntary movement and basic hierarchical structure is that movement is controlled by central nervous system.

Rood Approach

One of the earliest approaches to understand and organize rehabilitation efforts and interventions with children and adults with neurological impairments.

Key concepts within Rood FOR.

• Normalized muscle tone is required in order to develop motor control and mastery of a desired movment.

• Flexion and extension patterns of movement are evident in our daily occupations.

• Repetition of muscular responses is crucial to learning movement patterns.

• The ability for clients to engage in occupations or meaningful functional activity is required for development of normal movement.

Facilitatory techniques within Rood FOR.

• Heavy joint compression

• Manual resistance to a body part

• Quick stretch

• Tapping

• Vibration

• Fast brushing

• Vestibular stimulation (fast movement)

Inhibitory techniques within Rood FOR.

• Neutral warmth

• Slow stroking

• Light joint compression

• Vestibular stimulation (slow movement)

• Tendon pressure

• Prolonged stretch

Four components of motor control within Rood FOR.

• Reciprocal innervation

• Co-contraction

• Heavy work

• Skill

Developmental sequence within Rood Approach.

1. Supine withdrawal/flexion (total flexion in supine)

2. Rollover

3. Prone extension (prone with upper trunk/head extension)

4. Neck co-contraction (prone with isolated head extension)

5. Prone on elbows

6. All fours (quadruped)

7. Static standing

8. Walking

Movement theory

Effective and meaningful evaluation and treatment is based on understanding a “normal” motor response to a cerebral vascular event.

Primitive reflexive movement patterns

Movement patterns wherein stroke patients revert back to.

Brunnstrom Assumptions

1. Motor return is always proximal to distal.

2. Progress can be slow or rapid through stages, and progress can cease at any stage.

3. Clients gain flexion of primitive movement patterns first, then extension.

4. Clients first recover reflexive movement and then progress to isolated movement.

5. Clients achieve gross motor movement and then progress to isolated, selective movement.

6. Use of cutaneous (skin) and proprioceptive stimulus as well as reflexes will help facilitate a client as he or she progresses through the stages of recovery.

7. Stages of recovery are not necessarily discrete—a client may show movement patterns of two different stages at once.

8. Practice of movement patterns within the context of daily activities promotes motor recovery.

Assessments within Brunnstrom FOR should include.

• Sensory testing

• Associated reactions and reflexes

• Presence of limb synergies

• Amount of voluntary movement a client can generate

• Tests of motor speed

• Prehension ability in the hand

Standardized assessment tools

Brunnstrom stages of recovered was influenced by the development of these tools.