Neuro data, motor control, pnf

Cerebral Hemisphere Functions

1. Right hemisphere – the non-dominate hemisphere.

· Sensory stimulus from LEFT side of the body

· Motor control of LEFT side of body

· Creativity

· Spatial ability

· Context/perception

· Recognition of faces, places and objects

· Non-verbal and artistic abilities

· Holistic processing of information

· Generalizations of concepts

· Determines spatial relationships.

Deficits of right hemisphere

· Poor judgement and safety awareness

· Unrealistic expectations

· Denial of disability or deficits

· Disturbances in body image

· Irritability

· Lethargy

2. Left hemisphere – the dominate hemisphere.

· Verbal and analytic

· Sequential, organized processing

· Plan movement sequences.

· Language is produced in the frontal, temporal and parietal lobes.

· Sensory stimulus from RIGHT side of body

· Motor control of RIGHT side of body

· Speech, language and comprehension

· Analysis and calculations

· Time and sequencing

· Recognition of words, letters and numbers

Deficits of left hemisphere

· Inability to motor plan (apraxia)

· Difficulty initiating, sequencing, processing a task

· Difficulty producing or comprehending speech

· Perseveration of speech or motor behaviors

3. Brachial Plexus

§ Musculocutaneous

· Innervates anterior compartment of arm: flexes shoulder and elbow, supinate forearm

· Dysfunction: motion is weakened but compensated with other mm, loss of sensation

§ Axillary

· Innervates shoulder, externally rotate and abduct

· Gives sensation over lower deltoid region

· Dysfunction: unable to abduct beyond 15 degrees, loss of sensation

§ Median

· Innervates majority of anterior forearm and some intrinsic hand; pronation of forearm, flexion of wrist and digits

· Gives sensation to palmar surface and fingers/tips of lateral 3.5 digits

· Dysfunction: forearm will be supinated and wrist and digit flexion weak/paralyzed; loss of sensation

§ Radial

· Innervates posterior arm and forearm; elbow extension, wrist and finger extension, forearm supination

· Gives sensation to posterior arm and dorsum of hand (lateral 3.5 digits, not tips)

· Dysfunction: unable to extend forearm, wrist and fingers, loss of sensation

§ Ulnar

· Innervates anterior compartment of forearm and hand and hand intrinsics: wrist flexion and adduction, 4^th and 5^th finger flexion at distal joint

· Gives sensation to palmar and dorsal surface of medial 1.5 digits

· Dysfunction: weak wrist flexion, abduction/adduction of finger absent, thumb adduction impaired, loss of sensation

4. Feedback – defined as sensory or perceptual information received because of movement.

a. Intrinsic – from intrinsic sensory channels (auditory, visual, vestibular, proprioceptive, somatic)

b. Extrinsic – information provided from an external source

i. Knowledge of results (KR) – how successful skill was performed, usually associated with outcome)

ii. Knowledge of performance (KP) – info about how movement was performed, analysis of movement

iii. Usefulness of KR and KP vary according to the skill being learned and availability of feedback from intrinsic sources

c. Types of feedback

i. Concurrent – feedback given during movement, KP info provided, best when highlighting info not available from intrinsic feedback

ii. Terminal – feedback given after movement

iii. Blocked – feedback on singular component of task provided in consecutive trials

iv. Variable (random) – feedback on multiple components of task provided on successive trials

d. Feedback Schedule

i. Immediate – feedback given immediately after movement

ii. Delayed – feedback given after brief time delay to allow learner time for self-assessment, contraindicated to give after long delays

iii. Summary- feedback given after a set number of trials

iv. Faded – feedback given first after every trial, then less frequently on subsequent block of trials

v. Bandwidth-KR – feedback only when performance deviates outside boundaries of correct performance

e. Specificity of feedback

i. Provide info about the task performance and not just motivational comments

ii. Include critical aspects of movement, task analysis, or key environmental conditions relevant to task success to facilitate learning

iii. Mode of feedback; decide which is optimal for individual given abilities and limitations (verbal, visual, kinesthetic)

5. Practice

a. Types of practice

i. Massed: sequence of practice and rest; rest time is much less than practice

ii. Distributed: spaced intervals in which practice time is = or less than rest time

b. Practice sequence

i. Blocked – one task performed repeatedly, uninterrupted by practice of any other task

ii. Random – variety of tasks are ordered randomly across trials, including variability of tasks

c. Practice order

i. Blocked – repeated practice of task or group of tasks in order. Eg 111222333 (three trials of each task in order)

ii. Serial – predictable and repeating order of multiple tasks, sequential eg 123123123

iii. Random – nonrepeating and unpredictable ordere of multiple tasks eg 123321312

d. Practice strategies

i. Mental – imagining or visualizing motor task without overt physical practice

ii. Part/whole – component parts of a task are practiced before practice of the whole task

iii. Transfer – gain (or loss) in capability of task performance as a result of practice on some other task

iv. Practice of lead-up activities – simpler task versions of complex task are practiced

6. Neural plasticity – nervous system’s ability to adapt and modify, changes occur in response to internal and external demands

7. Facilitation Techniques – goal is to promote functional movement through facilitation, inhibition, strengthening, or relaxation of mm groups (some focus on isometric contractions for stability and others promote mobility with isotonic contractions)

a. Rhythmic stabilization

i. Promotes stability and balance, can decrease pain and increase ROM, strength

ii. Co-contraction of muscles surrounding the target area to maintain a specific position

iii. Manual contacts emphasize rotary component of motion

b. Slow reversal/Dynamic reversals

i. Promoting mobility, controlled mobility, and skill stages of motor control

ii. Used to increase muscle power and endurance, improve coordination, and ROM

iii. No pause or relaxation between direction changes

iv. Concentric contraction of mm in one direction then in the opposite direction

v. Fatigue is minimized by rhythmically alternating between contracting mm groups

c. Hold Relax

i. Promoting mobility

ii. To increase ROM and achieve relaxation when pain is a factor in limiting ROM

iii. Body segment placed to limit of pain free motion

1. Isometric hold, verbal cue “match me” holding for at least 5 seconds

2. Resistance is applied and removed slowly and gently

3. Pt then asked to relax, and joint or body segment is moved (active or passive) through greater ROM

d. Rhythmic rotation

i. Promoting mobility

ii. To promote tone reduction

iii. Application of SLOW, PASSIVE, ROTARY movement along the long axis of body part to be addressed

e. Alternating isometrics

i. Promoting stability

ii. Isometric contractions in A/P or M/L direction

iii. Alternating, smooth changes

f. Contract Relax

i. to promote mobility

ii. to promote stretching of mm and increase ROM

iii. body segment moved (passive or active) to end of available range

1. activate shortened (tight) muscle dynamically “push into me”

2. block movement with resistance for 5-8 seconds

3. have pt relax then move into new range

g. Agonistic reversals (combination of isotonics)

i. Promoting controlled mobility, to increase power and muscular endurance over time

ii. Sequence of concentric contraction, hold, eccentric contraction, hold, and repeat

iii. manual contacts do not change position

iv. no relaxation between types of mm contractions