OCTH 5101 week 9 2024_ Motor Control FOR

Week 9 - Motor Control FOR

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

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• Motor Control FOR details provided.

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

Page 3: Theorists

• Neurodevelopmental Theory (NDT) - Bobath, 1990

• Sensorimotor Approach - Rood, 1954

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

• Movement Therapy - Brunnstrom, 1970

Page 4: Brunnstrom

• Normal development involves a progression of reflex modification.

• Dysfunction occurs due to conditions like CVA leading to lower levels of motor control.

• Recovery sequence: from flaccid to voluntary isolated joint movements.

Page 5: Proprioceptive Neuromuscular Facilitation (PNF)

• Focuses on alternating balanced movements of antagonistic muscles.

• Development follows an orderly sequence and proceeds:

  • Cephalocaudally (head to tail)

  • Proximodistally (from center to extremities)

• Engages natural movement patterns combined with facilitation techniques.

Page 6: Rood

• Developed for individuals with CP and motor control problems.

• Normal movement arises from subcortical reflex patterns, supporting voluntary control.

• Sensory stimulation has both inhibitory and facilitatory effects.

• Importance of repetition in reinforcing learning.

Page 7: Neurodevelopmental Therapy (NDT)

• Aims to restore skilled voluntary movement in individuals with

  • Cerebral Palsy

  • Hemiplegia from CVA

• Theory emphasizes reductionism and normal growth/milestones.

• Focus on reflex hierarchies, attitudinal reflexes, and protective reflexes.

Page 8: Basic Assumptions of NDT

• Movement control progresses:

  • Cephalocaudal

  • Proximal to Distal

  • Gross to Fine

• Children develop control over primitive reflexes.

• Recovery requires internalizing movement sensations, prioritizing stability over mobility.

• Normalizing tone must precede recovery.

Page 9: Philosophical Tenets of NDT

• Functional treatment integrated into ADLs.

• Continuous evaluation and problem-solving incorporation.

• Respect for client and family needs is crucial.

• Knowledge of normal movement and biomechanics is essential for treatment strategies.

• NDT is holistic and individualized, requiring interdisciplinary approaches.

Page 10: Function & Dysfunction

• Functional motor control: Ability to perform voluntary skilled movements necessary for daily life.

• Dysfunction characteristics:

  • Lack of postural control

  • Abnormal muscle tone

  • Generalized spasticity

  • Difficulties inhibiting nonfunctional movements and sensory disturbances.

Page 11: Change & Motivation

• Change facilitated through specific techniques:

  • Handling

  • Inhibition techniques

  • Facilitatory methods

  • Placement strategies

  • Reflex-inhibiting patterns.

• Motivation factors are not distinctly addressed.

Page 12: Evaluation & Intervention

• Evaluation

  • Assess functional movement abilities through observation and handling.

  • Collaborative goal setting with clients and families.

• Intervention strategies

  • Focus on occupations for both practice of movement and achievement of goals.

  • For developmental disabilities, handling and facilitation methods are used.

Page 13: Motor Learning and Task-Oriented Frames

• Reference: Cole Chapter 21

Page 14: Motor Learning Theories

• Combines psychological, behavioral, and neurological theories.

• Focuses on the direct relationship between learning and task performance.

• Client-centered and task-oriented approaches.

Page 15: Focus of Motor Learning

• Objective: Restore functional movement across various health conditions.

• Engagement in meaningful tasks enhances motivation for recovery.

Page 16: Theoretical Base

• Incorporates:

  • Nonlinear science

  • Neuroplasticity and brain self-organization

  • Social Cognitive Theory for motivation.

Page 17: Learning Theory (Timmerman)

• Types of learning:

  • Associative learning: Procedural and declarative.

  • Nonassociative learning: Habituation and sensitization.

• Importance of task-oriented training in recovery.

Page 18: Function & Dysfunction Dynamics

• Continuum of function from:

  • Cognitive stage to autonomous stage.

• Functionality increases with degrees of freedom.

• Recognizing need for compensatory strategies.

Page 19: Change & Motivation Understood

• Change involves:

  • Learning motor strategies through trial and error.

  • Practice and refinement are vital for skill enhancement.

• Motivation is linked to social roles and meaningful tasks.

Page 20: Evaluation & Intervention

• Dynamic evaluation during occupational tasks.

• Holistic intervention strategies:

  • Remediation for motor and cognitive skills.

  • Adaptation for task demands and environment.

  • Compensation for task modification.

Page 21: Example Interventions

• Weight Bearing Strategies for OP

  • Goals:

    • Normalize muscle tone.

    • Dynamic and weight-bearing patterns for upper and lower extremities.

• Constraint Induced Movement Therapy (CIMT)

  • Focuses on forced use of affected side post-CVA.

  • Repetitive and functional task practice.

Page 22: Additional Interventions

• Cognitive Orientation to Occupational Performance Approach (CO-OP)

  • Targets children with motor-based learning issues.

  • Objectives include skill acquisition, strategy use, generalization, and transfer of learning.

Page 23: Cognitive Behavioral FOR

• Introduction to Cognitive Behavioral Frame of Reference.

Page 24: Cognitive Behavioral FOR - Theoretical Base

• Grounded in cognitive development theory (Piaget) focusing on:

  • Hierarchical levels of cognition through stages.

  • Emphasis on qualitative changes in knowledge understanding.

Page 25: Continuation of Cognitive Behavioral FOR - Theoretical Base

• Emphasis on behavioral theories for change focusing on observable behaviors using:

  • Operant conditioning (Skinner) and classical conditioning (Pavlov).

  • Learning occurs through behavioral connections and social observation.

Page 26: Main Constructs of Cognitive Behavioral Theory

• Focus on:

  • Influence of thinking on behavior.

  • Self-regulation in thoughts and behavior.

  • Developing coping skills and altering thinking patterns.

• Applicable populations include those with:

  • Developmental disorders, neurological diseases, mental illness, and stressors.

Page 27: Function & Dysfunction in Cognitive Behavioral Theory

• Focus areas include:

  • Cognitive abilities, stress management, self-regulation, behaviors, and motivation.

Page 28: Evaluation in Cognitive Behavioral Theory

• Assessment methods:

  • Medical and social history analysis, clinical observations, and cognitive tests.

Page 29: Change in Cognitive Behavioral Theory

• Change principles emphasize the link between belief systems and behavior alteration.

• Useful for addressing anxiety, phobias, and motivation.

• Recommendations to use alongside occupation-focused models for improved understanding.

Page 30: Intervention in Cognitive Behavioral Therapy

• Common practices include:

  • Psychoeducational groups and self-regulation programs targeting coping, goal-setting, and relaxation strategies.

Page 31: Introduction to Social Cognitive FOR

• Establishes connections with occupational therapy.

Page 32: Focus of Social Cognitive Theory

• Encompasses all occupations with a strong emphasis on:

  • Thought processes, social participation, and prevention.

• Effective for groups facing mental health issues.

Page 33: Concepts from Social Cognitive Theory

• Key elements include human agency, intentionality, and self-efficacy.

• Underlines learning through observation and internal motivation.

Page 34: Function & Dysfunction in Social Cognitive Theory

• Emphasis on personal agency, health management, and goal setting in functional individuals.

Page 35: Change & Motivation in Social Cognitive Theory

• Transtheoretical stages of change emphasize:

  • Motivation supported by competence, autonomy, and relationships.

Page 36: Evaluation in Social Cognitive Theory

• Informal assessments and creative media are utilized to evaluate behavior.

Page 37: Intervention Strategies in Social Cognitive Theory

• Focuses on strengthening self-identity and life goals through therapeutic methodologies such as:

  • Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT).