Stages & Techniques of Motor Learning

musculoskeletal

cardiopulmonary

nervous

autonomic

immune

5 systems involved with motor control

capacity for movement

CVP & MS =

control of movement

N & MS =

neural perfusion

CVP & N =

Overlapping all

ANS and Immune System =

Physical​

Mental​

Social​

Emotional​

4 categories of function

Functional Capability

Environmental demands + Individual's abilities =

Intervention ​

Promote wellness + improve/maintain function + prevent limitations =

Functional Outcomes

Improved movement control + capacity =​

What must be considered when developing intervention strategy?

All

Activities

includes the postures and movements that will be used

Stages of control

increase in complexity as we go from mobility-stability-controlled mobility-skill

Parameters of capacity

include frequency, duration and intensity and adjust tissue, physiological and learn stresses

transitional mobility

Presence of a functional range of motion through which to move AND the ability to initiate and sustain active movement through the range.

Increase Range of motion​

Increase ability to initiate AROM

2 goals for mobility

passive techniques

Joint Mobilization

Prolonged stretching​

Joint distraction​

Rhythmical rotation​

Maintained pressure

Others--vibration, manual tapping, ice

active techniques

Hold Relax

Contract Relax

Rhythmic Stabilization

hold relax

Isometric technique ​

hold relax

- uses principles of autogenic inhibition​

hold relax

- prevents extreme tension w/in ms​

hold relax

- ms relaxes w/stretch or increased tension​

hold relax

Use when ROM is decreased on one side of a joint​

hold relax

Use when pain is cause of limitation or pain accompanies the limitation

contract relax

Used when contractile tissue is limiting motion needed​

contract relax

- uses principles of reciprocal inhibition​

contract relax

- relax ms on one side of joint to accommodate contraction on other side​

contract relax

- protects ms from injury​

contract relax

Works best with tight antagonistic muscles​

contract relax

Yields greater increases than HR

rhythmic stabilization

- Promotes mobility by decreasing muscle splinting around a joint​

rhythmic stabilization

- Simultaneous isometric contractions of agonist and antagonist with no relaxation​

rhythmic stabilization

- Gradually increase resistance​

rhythmic stabilization

- Ask for gradual relaxation

active exercises for movement

•Replication (Hold Relax Active Movement HRAM)

•Repeated Stretch (Repeated Contractions RC)

•Rhythmic Initiation

replication

- Most appropriate when not accompanied by pain, decreased ROM or increased tone​​

replication

- Goal: to improve ability to initiate movement from lengthened range and sustain it throughout the range

replication

- muscle starts short

replication

Passively place muscle in shortened range​

Facilitate isometric contraction​

Use sensory input to enhance muscle response​

Hold for 10 seconds--optimal coactivation occurs​

Patient relaxes​

Return to lengthened range, quick stretch and then assists response if needed​

repeated stretch

Isotonic contractions​

repeated stretch

Unidirectional​

repeated stretch

- Facilitate with quick stretch and resistance through the range and at the weakest part of the range​

repeated stretch

- Can use isometric hold at point of weakness

repeated stretch

- muscle starts lengthened

Incoordination​

Muscle imbalances​

Diminished muscular endurance

3 Indications for Repeated Stretch

repeated stretch

Take to lengthened range​

Stretch​

Verbal encouragement​

Ask for active contraction​

Apply appropriate resistance​

Ask for isometric hold​

rhythmic initiation

Have patient totally relax​

Do passive ROM through increments of range​

Progress to active assistive, active and then resisted movements​

Can be unidirectional or in both directions

stability

Inherent component of movement control​

​Proximal muscle

_____needed to provide a foundation for movement of distal segments​ postural control necessary before you can ​have dynamic stability

dynamic stability

​Proximal muscle needed to provide a foundation for movement of distal segments​ postural control necessary before you can ​have ____

Sustained muscle contractions​

Shortened range for increasing duration​

2 goals of muscle stability

Coordinated isometric contractions​

In midline or weight-bearing postures

2 goals of Postural stability

•Shortened Held Resisted Contraction (SHRC)

•Stabilizing Reversals

•Rhythmic Stabilization (RS)

3 techniques to develop stability

Shortened Held Resisted Contractions (SHRC)

Uses resistance​​ to promote stability

Shortened Held Resisted Contractions (SHRC)

Applied to isometric contraction of ms in shortened range​​

Shortened Held Resisted Contractions (SHRC)

Used on extensor muscles (postural antigravity ms​)

Instability in weight bearing and holding​

Poor static postural control​

Weakness

3 indications for SHRC

SHRC

- Move muscle into shortened range where they commonly function​

- Start in non weight bearing postures and progress to weight bearing​

- Hold against resistance​

stabilizing reversals

are a Progression of SHRC​

stabilizing reversals

- Use when segment can be maintained in midline or weight bearing position​

stabilizing reversals

- Manual contacts are on same side of segment at the same time

stabilizing reversals

- Alternate contacts from one side to the other​

stabilizing reversals

- No relaxation allowed between contractions​

stabilizing reversals

- Give commands before moving hands​

stabilizing reversals

- Can be used in any direction​

​

Instability in weight bearing, holding​​

Poor Static Postural Control​​

Weakness

3 indications for stabilizing reversals

rhythmic stabilization (stability)

- Progression of SR ​

rhythmic stabilization (stability)

- Isometric contraction of agonist followed by antagonistic isometric contraction​

rhythmic stabilization (stability)

- No relaxation between contractions​

rhythmic stabilization (stability)

- Very careful grading of resistance​

rhythmic stabilization (stability)

- Contacts on opposite side of joint surfaces simultaneously​

rhythmic stabilization (stability)

- Involves rotation​

rhythmic stabilization (stability)

- Hold and don’t let me move you​

rhythmic stabilization (stability)

- Can be used on trunk or extremities​

rhythmic stabilization (stability)

- Good to use when one is weak and the other strong, promotes overflow

controlled mobility (dynamic postural control)

- Ability to alter a position or move in a weight-bearing position while maintaining postural stability​

controlled mobility (dynamic postural control)

- Represent mobility superimposed on stability​

controlled mobility (dynamic postural control)

- Allows patient to move between postures independently

controlled mobility (dynamic postural control)

- Hands before commands

- Weight shifting in weight-bearing postures​

- Movement A/P, medial/lateral and/or rotation​

- Reversal of antagonists or concentric-eccentric contractions​

- Trunk rotation

4 goals of controlled mobility

Dynamic Reversal​

Dynamic Reversal Hold​

Combination of Isotonics

3 techniques of controlled mobility

dynamic reversal

- Concentric contractions​

dynamic reversal

- No relaxation​

dynamic reversal

- Are isotonic, shortening contractions

dynamic reversal hold

- Add isometric contraction at end of range​

dynamic reversal hold

- Usually at point of weakness​

dynamic reversal hold

- Helps increase weight bearing​

dynamic reversal hold

- Can do through increments of range

combination of isotonics

- Used to promote eccentric contractions​

combination of isotonics

- Emphasizes muscle groups on one side of a joint at a time​

combination of isotonics

- Ask for concentric contraction--then at the end of range ask patient to lower the part​

combination of isotonics

- Lowering must be against gravity and/or resistance

static-dynamic level of control

- Transition between controlled mobility and skill​

static-dynamic level of control

- Performed in weight bearing postures when trunk & proximal segments are controlled as one or two limbs are lifted from the supporting surface

skill

- Involves highly coordinated movements that allow for adaptability to meet demands of individual and the environment​

skill

- Used to describe quality of performance​

skill

- Implies consistency in performing functional tasks with economy of effort​

skill

- Must be able to do other stages before they get here

Proper timing​

Sequencing​

Speed​

Coordination of body, limb segments

skill focuses on: (4

Normal Timing (NT)​

Resisted Progression (RP)​

- Dynamic reversal​

- Dynamic reversal hold​

- Combination of isotonics

5 techniques for skill

normal timing

- Promotes proximal to distal timing (in limbs) integral to normal function​ (Reversed in trunk​)