Motor Control Approaches

Motor Control Approaches
Neurodevelopmental Theorists/Theories: Catherine Trombly, Task-Focused, Motor Learning, Margaret Rood, The Bobaths (NDT), Signe Brunnstrom, PNF, Carr & Sheppard Reference: Cole & Tufano, Chapter 19
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
FOCUS
Neuroanatomy & Neurophysiology Principles of Neuroscience Treatment of paralysis, flaccidity & spasticity
of muscles resulting from damage or disease to the central nervous system Treatment of Movement disorders Framework focus: body structures, body functions, process skills, contexts, and activity demands.
Basic Assumptions
Each theorist has a somewhat different
approach, assessment technique, and intervention strategies. Most neurodevelopmental approaches require specialized training. These theorists use a behavioral learning approach to motor control based on the sequence normal developmental.
Assumptions: Traditional Theories

The remainder of the theories are currently
known as hierarchical or traditional theories of motor control, including

Rood The Bobaths NDT Brunnstrom Proprioceptive Neuromuscular Facilitation (PNF) Carr & Shepherd
Basic Assumptions, cont.

Margaret Rood, the earliest theorist, is both
an occupational and physical therapist. She stresses the importance of early reflexes in the relearning of motor control. Rood first used her techniques effectively with children with cerebral palsy. She believed that a baby uses reflexes to move initially but modifies them and eventually replaces the reflexes with voluntary movement.
Rood, 4 Basic Principles

Sensory input is required for normalization of
tone and evocation of desired muscular responses. Sensory motor control is developmentally based. Movement is purposeful, engagement in activities is required to produce a normal response. Repetition of movement is necessary for learning.
Rood, cont.
Facilitation techniques: light stroking,
brushing, icing, and joint compression are used to facilitate movement. Inhibition techniques: joint approximation (light compression), neutral warmth, pressure on tendon insertion, and slow rhythmical movement are used to inhibit unwanted movement (i.e., spasticity).
Rood identified 8 ontogenetic motor patterns in the following sequence

1. Supine withdrawal 2. Segmental rolling 3. Pivot prone (prone extension) 4. Neck co-contraction 5. Supporting self on elbows 6. All fours movement patterns 7. Standing 8. Walking
Rood, cont.
Positioning is a primary concern, especially
when little voluntary control exists. Extensive use of mats, bolsters, balls, and other specialized equipment is common in the Rood approach. Movement patterns can be incorporated into games, such as tug of war, to provide an occupational focus to regaining motor control.
The Bobaths, Drs. K. (physiologist) & B. (physiotherapist), British - 1948

AKA Neurodevelopment Treatment (NDT) Originally designed their therapy techniques
for persons with hemiplegia (caused by CVA, or stroke) Also worked with children with cerebral palsy NDT focuses on the sensation of movement; it is not movement itself, but the sensation of movement, that is learned and remembered
Bobaths, cont.
Reflex inhibiting postures are used to inhibit primitive
reflexes (RIPs). Sensory stimulation is regulated with great care. Weight bearing, placing and holding, tapping and joint compression are used to activate normal movement and posture. Compensation (such as one-handed feeding and dressing) using the noninvolved side is discouraged during recovery from stroke because it results in inactivity and poor recovery on the involved (paralyzed) side.
Brunnstrom, Signe - physical therapist, 1950-1970s

Focuses on reflexes which provide the components

of normal movement Proprioceptive (resistive) & exteroceptive (tactile) stimulation are used to elicit reflexes in the recovering adult hemiplegic Patients are encouraged to think about the movement and to gain control Brunnstrom also uses associated reactions and synergies A synergy is a total flexion or extension movement of a joint or limb
Brunnstroms 6 Stages of Recovery

1. Flaccidity, no voluntary movement 2. Synergies or minimal voluntary movement 3. Synergies performed voluntarily 4. Some deviation from synergy 5. Independent or isolated movement 6. Individual joint movement nearly normal with
minimal spasticity
Proprioceptive Neuromuscular Facilitation (PNF)

Developed by Herman Kabat, PhD, MD and
modified by many contributors since the 40s Uses diagonal & spiraling patterns of movement Guides thinking about the sequence of normal development Eleven basic principles (see Cole, p. 242) Uses two diagonal patterns crossing the midline for each major body part, often incorporating verbal commands.
Carr & Shepherds Motor Relearning Programme (for persons with stroke)
Contemporary approach (1990s) Uses dynamical systems model of motor
control Emphasize interaction between performer and environment Does not accept the hierarchical sequence of motor relearning proposed by other theorists Like other theorists, Carr & Shepherd discourage the early use of compensatory strategies
Carr & Shepherd, cont.

Clients taught to avoid abnormal
compensation for weak muscles Treatment techniques based on extensive study of how normal movement occurs during functional tasks Acknowledge critical role of cognition in motor learning Movement patterns practiced in context of tasks, rather than exercises
Carr & Shepherd, 7 Categories of Functional Daily Activities

1. Upper limb function 2. Orofacial function 3. Sitting up over the side of the bed 4. Balanced sitting 5. Standing up & sitting down 6. Balanced standing 7. Walking
Function and Dysfunction

Function assumes the ability to plan and
execute normal voluntary movement Dysfunction is viewed as neurophysiologically based; CNS deficits result in abnormal muscle tone and lack of voluntary purposeful movement Each theorist has a separate way to measure the extent of dysfunction
Change
Changes in motor control are physiologically induced. Engagement in activity can produce physiological
change leading to motor control Individuals relearn movement patterns in a predictable developmental sequence Theorists differ in the use of early reflexes to produce movement Handling, sensory stimulation, and manipulation of affected muscles can facilitate motor relearning
Assessment and Treatment

Specific to each theorist These traditional models have also been
called reflex-hierarchical or neuromaturational because they are based on relearning movement in a normal developmental sequence. New evidence tends to disprove the effectiveness of these approaches.
Transition from Motor Control to Motor Learning

Began in 1990s with classic article by
Mathiowetz & Bass Haugen, and Tromblys Slagle Lecture. The following introduces Tromblys model as changing OTs thinking about establishing or restoring voluntary movement.
Task Focused Approach: Trombly

Occupational Functioning Model introduced
in 1995 Descending hierarchy of tasks & roles Goal is to develop competency & self-esteem Context & environment surround and permeate all levels of the hierarchy When clients have mastered the foundation capacities, they move on to task-focused interventions (individual or group) Trombly calls this occupation as end
Task Focused Approach, cont.

Five general principles: 1. Client centered focus 2. Occupation based focus 3. Person & Environment enablers/barriers 4. Practice & Feedback - encoding 5. General treatment goals role fulfillment, problem-solving skills re: best way to accomplish valued tasks
Dynamical Systems Theory & Trombly

Applied to physical disabilities, this theory
combines reflexive and voluntary motor control CNS receives/interprets multiple cues from the environment and involves multiple subsystems when planning to reach desired goals (preferred tasks & roles) Occupational performance is a product of the interaction between the person, the task, and multiple environmental factors.
Assumptions: Task Focused Approach

Tromblys task focused approach is based on
theories of motor learning and dynamical systems theory. Meaningful tasks are graded and sequenced according to each clients needs & abilities. Each task requires experimentation using different strategies & contexts in order for motor skills to be learned. Currently the preferred approach in OT for intervention after stroke/CNS damage
The End
Next time: Motor Learning Frame of
Reference in OT

Motor Control Approaches

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Motor Control Approaches

Assumptions: Traditional Theories

known as hierarchical or traditional theories of motor control, including

Basic Assumptions, cont.

Rood, 4 Basic Principles

Rood identified 8 ontogenetic motor patterns in the following sequence

The Bobaths, Drs. K. (physiologist) & B. (physiotherapist), British - 1948

Brunnstrom, Signe - physical therapist, 1950-1970s

Brunnstroms 6 Stages of Recovery

Proprioceptive Neuromuscular Facilitation (PNF)

Carr & Shepherd, cont.

Carr & Shepherd, 7 Categories of Functional Daily Activities

Function and Dysfunction

Assessment and Treatment

Transition from Motor Control to Motor Learning

Task Focused Approach: Trombly

Task Focused Approach, cont.

Dynamical Systems Theory & Trombly

Assumptions: Task Focused Approach

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