OCTH 5101 week 9 2024_ Sensory-Motor Control FOR

Sensory and Motor Frameworks for Occupational Therapy (OCTH 5101)

Week 9 - 2024

• Instructor: Felicia Chew, MS, OTR/L, FAOTA

Page 2: Motor Control FOR

• Reference: Cole MB, Tufano R. Applied Theories in Occupational Therapy: A Practical Approach © 2020 SLACK Incorporated.

Page 3: Theorists

• Sensory Integration (Ayres, 1960’s)

• Neurodevelopmental Theory (NDT) (Bobath, 1990)

• Sensorimotor Approach (Rood, 1954)

• Proprioceptive Neuromuscular Facilitation (PNF) (Knott and Voss, 1968)

• Movement Therapy (Brunnstrom, 1970)

Page 4: Sensory Integration

• Sensation impacts lived experiences.

• Dysfunctions include:

  • Hypersensitivity

  • Tactile defensiveness

  • Vestibular issues

  • Postural control challenges

Page 5: Theoretical Base for Sensory Integration

• CNS Neuroplasticity: The brain's ability to reorganize itself.

• Staged Development: Development occurs in stages, with critical milestones.

• Integrated Brain Function: The brain works as an integrated whole.

• Adaptive Interactions: Engage with environment for sensory integration.

• Inner Drive: Motivation to develop skills and behaviors.

Page 6: Sensory Integration Development Stages

• Phase 1: Integration of tactile, vestibular, proprioceptive senses (1st year).

• Phase 2: Establishing foundations for emotional stability and body perception (2nd year).

• Phase 3: Incorporate auditory and visual inputs, purposeful activity (3rd year).

• Phase 4: Dominance development through cooperation of brain and body (4-5 years).

Page 7: Function vs. Dysfunction

• Function: Participation in self-directed activities.

• Dysfunction: Responses to sensory stimuli—overreaction or underreaction.

Page 8: Evaluation - SIPT (Sensory Integration and Praxis Test)

• Administration Time: ~2 hours for all tests; ~10 min for each test.

• Methods: Norm-referenced, clinician-administered.

• Subscales Include: Space Visualization, Figure Ground Perception, etc.

• Requires specialist training in sensory integration.

Page 9: Intervention

• Focus Areas:

  • Play

  • Equipment group dynamics

  • Sensory environments.

Page 10: Brunnstrom Approach

• Emphasizes reflex modification in normal development.

• Addresses dysfunction from CVA or brain damage.

• Developmental Recovery Sequence: Progress from flaccidity to voluntary movements.

Page 11: Proprioceptive Neuromuscular Facilitation (PNF)

• Balanced movement between antagonistic muscles.

• Movement Progressions: Cephalocaudal, proximodistal.

• Incorporation of natural movement patterns and goal-directed activities.

Page 12: Rood Approach

• Initially for motor control issues (CP, etc.).

• Movement emerges from subcortical reflex patterns.

• Sensory stimulation impacts motor responses—either facilitory or inhibitory.

• Importance of repetition in learning.

Page 13: Neurodevelopmental Therapy (NDT)

• Objective: Restore skilled voluntary movements in individuals.

• Focus on normal growth, motor milestones, and reflex hierarchies.

• Recognizes various reflex types: primitive, righting, protective.

Page 14: Basic Assumptions of NDT

• Motor control development is hierarchical:

  • Cephalocaudal,

  • Proximal to distal,

  • Gross to fine.

• Children internalize movement sensations.

• Stability must precede mobility.

Page 15: Philosophical Tenets of NDT

• Treatment should be functionally oriented and integrative.

• Evaluation and treatment are dynamic, collaborative processes.

• Acknowledges the holistic nature of therapy and interdisciplinary cooperation.

Page 16: Function & Dysfunction in NDT

• Functional motor control: Ability to perform voluntary skilled movements.

• Dysfunctions include:

  • Lack of postural control,

  • Abnormal tone,

  • Sensory disturbances.

Page 17: Change & Motivation in Motor Learning

• Change facilitated through techniques:

  • Handling,

  • Inhibition and facilitation.

  • Reflex-inhibiting patterns (RIPs).

Page 18: Evaluation and Intervention

• Evaluation methods:

  • Observational assessment,

  • Collaborative goal setting.

• Interventions focus on:

  • Functional movement practice,

  • Utilization of occupations as means and ends.

Page 19: Motor Learning and Task-Oriented Frames

• Reference: Cole chapter 21.

Page 20: Motor Learning Theories

• Integrated from various disciplines:

  • Psychology, neurology, behavioral sciences.

• Focus on task performance as central to learning.

Page 21: Focus on Functional Movement

• Aimed at a wide range of health conditions.

• Emphasizes client-chosen meaningful tasks.

Page 22: Theoretical Base for Motor Learning

• Grounded in:

  • Nonlinear science,

  • Neuroplasticity,

  • Social cognitive theory.

Page 23: Learning Theory Insights

• Associative Learning: Procedural and declarative forms.

• Nonassociative Learning: Habituation and sensitization principles.

Page 24: Function & Dysfunction Analysis

• Continuum from function to dysfunction includes:

  • Cognitive, fixation, and autonomous stages.

Page 25: Change & Motivation Strategies

• Learning through trial and error.

• Importance of social and occupational motivators.

Page 26: Evaluation & Intervention Strategies

• Holistic approach in evaluation and intervention:

  • Remediation,

  • Adaptation,

  • Compensation.

Page 27: Example Interventions

Weight Bearing Strategies

• Aimed at normalizing muscle tone.

• Use of dynamic reaching and forearm patterns.

Constraint-Induced Movement Therapy (CIMT)

• Effective for stroke survivors.

• Involves forced use of the affected limb with intense practice.

Page 28: Continued Example Interventions

Cognitive Orientation to Occupational Performance (CO-OP)

• Targets children with motor-based learning challenges.

• Focuses on skill acquisition, strategy use, and generalization.

Page 29: Cognitive Behavioral FOR Overview

Theoretical Foundations

• Based on cognitive and behavioral theories; examines cognitive development levels.

Page 30: Behaviorism and Learning

• Includes:

  • Operant and classical conditioning,

  • Learning as a process of behavior change focused on observable behaviors.

Page 31: Cognitive Behavioral FOR Constructs

• Focus on:

  • Thinking influences behavior,

  • Behavior change via structured learning,

  • Populations served: Developmental disorders, neuro diseases, mental illnesses.

Page 32: Cognitive Behavioral FOR Function vs. Dysfunction

• Evaluates cognitive abilities, social interaction skills, motivation, and stress management capabilities.

Page 33: Evaluation Techniques for Cognitive Dysfunction

• Use of records, interviews, stress tests, and scales for analysis of cognition and behavior.

Page 34: Postulates on Change

• Ongoing change linked to beliefs; useful with self-aware clients.

Page 35: Postulates on Intervention Techniques

• Focused on psychoeducational and life skills groups, addressing self-regulation and critical thinking.

Page 36: Social Cognitive FOR Overview

Focus

• Involves wellness, prevention, and social participation.

Page 37: Social Cognitive Concepts

• Human agency, intentionality, and self-efficacy are central.

Page 38: Function & Dysfunction in Social Cognitive Theory

• Emphasizes self-awareness and ability to manage health and achieve goals.

Page 39: Change & Motivation Principles

• Explores the Transtheoretical Stages of Change (Precontemplation through Maintenance).

Page 40: Evaluation Techniques for Social Cognitive Framework

• Informal behavioral analysis and creative media assessments.

Page 41: Intervention Strategies

• Enhances self-identity and life goals through various therapeutic approaches, including Acceptance and Commitment Therapy.