Lecture 1a/1b: Introduction and Motor Control

What factors influence function?

environmental factors and personal factors

According to the ICF, environmental factors are

extrinsic to the person (objects, tools, physical and social environments, etc.)

Why is it important to know all the parts and movements of the trunk?

for alignment, mobility, stability and control of all these parts o the trunk are important for balance and postural control

According to the ICF, problems with body functions and structures is an

impairment

Motor execution involves:

muscle contraction

How is motor learning measured?

retention test, reduction in errors, increased automaticity, decreased effort, increased speed, demonstration of skill after no practice, generalizability

Why do you assess postural control and balance first?

safety, can be fairly independent if they can maintain balance, proximal stability necessary for distal mobility/function

What is the normal resting position for the scapula?

slight upward rotation, inferior angle slightly farther from spine than root and glenoid fossa is angled slightly upward so that the head of the humerus is caught on lip of GF

Abnormal movement does what?

takes more energy, takes more time, can lead to injuries, can lead to a lack of enjoyment in a wide range of activities, looks bad (has social implications), doesn't tap into patient's learned habits and implicit movement patterns

What is the cognitive (acquisition) stage of motor learning?

task is new, conscious attention is required, performance is inconsistent, improvements are rapid and feedback is important

The nature of movement is the relationship of:

task, person, and environment

What is motor control?

the ability to regulate or direct the mechanisms essential to movement

What are the middle three levels of the ICF?

the levels of functioning: -body functions & structures -activities -participation

What two models does the ICF combine?

the medical model (disability is created by a problem within a person) and the social model (disability is created by society and is not an attribute)

What step is key to making us occupational therapists?

the third step of improving posture and balance, engaging in functional tasks (need knowledge of alignment, need to work with patients in all positions of function, don't need to be perfect to move on to stages)

What are primary motor impairments?

these are directly attributable to the brain lesion -positive and negative motor signs

What are secondary motor impairments?

these are preventable and develop due to inactivity asymmetries, immobility -decrease PROM, diminished flexibility between body segments, pain, edema, etc.

What are maladaptive movement strategies?

these develop as a response to attempts to move within the constraints of the primary and secondary motor impairments; typically awkward and inefficient -synergies and other movement patterns

What is the autonomous (generalization) stage of motor learning?

this stage is automatic, feedback is not important and improvements are slow but can continue for years

What is the associative (retention) stage of motor learning?

this stage is longer (weeks to months), feedback is monitored internally and performance becomes consistent

What is inhibition?

to decrease, prevent any undesired response, movement or otherwise

What is facilitation?

to enable, increase, encourage, promote, make possibly any desired response, movement or otherwise

What is mobilization/stretching?

to increase the length of soft tissue when it is impeding ROM and/or function

What is handling?

using our hands/body on the patient's body during therapy - consist of a dynamic reciprocal interaction

What are the three sensory components of balance?

vision, somatosensory and vestibular

How do you determine the direction of pressure?

"go along for the ride" - feeling the direction of pressure within a movement

What is important when facilitating in functional activities?

-make your feedback match client's feedforward -motor learning research tells us we MUST incorporate movement into function

Why is handling important?

-pts may lack intrinsic feedback to guide mvmt -many interventions use it -may be PROM, assisting with alignment (should be done within context of task and should be graded and faded)

Why is the motor system needed for balance?

-strength and timing of muscle contractions -sustained force production -sufficient joint mobility and muscle length

What is motor learning?

a set of processes associated with practice.... leading to relatively permanent changes in the capability for responding (practice makes permanent)

What are the two general approaches for rehab?

remedial/restorative/recovery and compensatory/functional

How can patient's monitor their quality of movement?

-using mirrors to provide feedback -use the unaffected side to remind of what typical movement looks like -videotaping specific movements during session for a log and can display progressions

What is problem solving sequence #1?

1. ask pt for the mvmt (directly or indirectly) 2. facilitate the mvmt (hands off cue or hands on) 3. take them through the movement passively (do PROM, relax and let me move you) 4. stretch or mobilize to achieve the movement 5. make it functional (repeat, challenge, add complexity, change context, apply motor learning principles, etc.)

What are the intervention steps to improve postural control and balance?

1.) Achieve optimal alignment - stay there 2.) Develop kinesthetic awareness - get there 3.) Engage in functional tasks - live there

How much practice to patients need in rehab?

300-800 reps per session (used COPM to find motivating activities)

What is important for achieving optimal alignment?

OTs must know what this optimal alignment is, and interventions to achieve alignment: -handling -feedback -environment -devices -tasks

What does each level of functioning in the ICF model represent?

a full continuum, from full functioning to full disability

To promote neuroplasticity, motor learning should include:

active use of body parts, enhanced environments with goal-driven tasks, complex problem solving (mistakes acceptable), feedback used judiciously, redundancy is necessary, variation in practice and conditions is best

When ribs are expanded they are

actively apart

When ribs are compressed they are

actively together

According to the ICF, problems doing an activity is an

activity limitation

What is a good starting point for anyone with a movement disorder?

addressing postural control and balance in sitting and standing

What are general intervention techniques to enhance trunk control?

appropriate starting posture, appropriate trunk PROM, various postures, reaching tasks, use varying environments, ADL/mobility tasks, therapeutic exercise

What is an acquired brain injury (ABI)?

brain impairments that occur after birth (stroke, TBI)

When would you allow abnormal, synergistic movement?

in the beginning of practice or when that is all that is available to the client - you don't want to complete discourage all movement because sometimes that is all they are capable of in the moment

How do you determine how much pressure to use?

initial contact = first touch, can be powerful (do not push) additional pressure = the least amount to get desired response, hand should be like a dimmer switch

What are negative motor signs?

insufficiency that may include paralysis (hemiplegia or hemiparesis), sensory loss, fatigue, decreased movement speed, difficulty organizing movement, etc.

What is important for developing kinesthetic awareness?

interventions: -decrease scaffolding provided in step 1 -empower pt. to become more autonomous

According to the ICF, personal factors are

intrinsic to the person, unrelated to health condition (age, values, health beliefs, world view, etc.)

What are positive motor signs?

involuntary increase that may include spasticity, hypertonicity, hyperreflexia, ataxia, intention tremor, etc.

Why is the SC joint less mobile?

it provides stability because it is the only bony attachment from the scapula to the rest of the thorax

What is the first rule for facilitation when using hands or physical cues?

knowing what the desired movement or movements comprising an activity are

How is learning different from performance?

learning persists from session to session, month to month and year to year with long-term potentiation or depression and relatively permanent changes in the capability for responding

What is balance?

maintaining center of mass over base of support CoM over BoS

According to the ICF, problems with participation is a

participation restriction

When ribs are flared they are

passively apart

When ribs are collapsed they are

passively together

What is optimal alignment for sitting?

pelvis: neutral to slight anterior tilt, no lat. tilt or pelvic rotation spine: midline, neutral to slight spinal extension co-contraction of: spinal flexors and extensors shoulders: symmetrical, slightly ant. to hips hips and knees: hips and knees flexed to around 90, no rot or abd/add ankles and feet: ankles to 90 degrees, no inversion or eversion, feet flat on floor

What is optimal alignment for standing?

pelvis: neutral to slight anterior tilt, no lat. tilt or pelvic rotation spine: midline, neutral to slight spinal extension co-contraction of: spinal flexors and extensors shoulders: symmetrical, slightly ant. to hips hips and knees: hips at 0, no rot or abd/add, knees actively extended not locked ankles and feet: ankles to 90 degrees, no inversion or eversion, weight distributed evenly through feet

How is performance different from learning?

performance involves within session observations, temporary changes in response during practice and short-term capabilities as a result of instruction

Motor control involves:

planning, initiating, organizing, coordinating and learning movement

What are your points of contact with handling?

proximal - on muscle moving the part of the moving part itself (responses may be faster, may have more control over outcome) distal - not on the muscle moving the part or on the moving part itself (responses may be slower, less control, use when proximal point isn't available or trying to upgrade challenge)