Vision , Auditory, Speech

Epilepsy, Mental Retardation Learning Disabilities

Children with Cerebral Palsy

Movement Posture Poor Sensorimotor Experiences Poor Perceptual motor Processing Vision, Auditory, Hand, Oromotor, Breathing, Speech

CENTRAL NERVOUS SYSTEM

HARMONY INTEGRATED CONTROL INHIBITORY CONTROL

TREATMENT = ARTIFICIAL INTERVENTION = RECOVERING INHIBTORY CONTROL OF C.N.S

MOVEMENT
AROUSAL ATTENTION AWAKENESS MOTIVATION SAFETY SENSORY =INFORMATION =VISION, AUDITORY TACTILE, CUTANEOUS PROPRIOCEPTIVE

PERCEPTUAL COGNITIVE PROCESS FEEDBACK FEEDFORWARD BIOMECHANIC ALIGNMENT/MIDLINE BODY SCHEME MUSCLE PROPERTIES

PERCEPTUAL - MOTOR INTEGRATION MODEL

INPUT
PROCESSING
ORGANISATION MEMORY EXPERIENCES (past / present) INTERPRETATION Taking in information from senses : - internal - external Cognitive Planning & executing a response : - motor - behaviour

OUTPUT

processing

FEEDBACK / FEEDFORWARD
critical to learning & adaption of new experiences reinforces observable behaviour provides new input internal / external

MEMORIES OF MOVEMENT

PERCEPTUAL COGNITIVE PROCESS SENSORIMOTOR EXPERIENCES FEEDBACK-FEEDFORWARD CHANNEL

PERCEPTUAL PROCESS
BODY AWARENESS IMAGE, CONCEPT,SCHEME ALIGNMENT, MIDLINE, LATERALITY WEIGHT BEARING, SHIFTING MOBILE WEIGHT BEARING, GRADING BASE OF SUPPORT PERCEIVE OURSELVES AS THREE DIMENSIONAL INDIVIDUALS ALLOWS US TO DEVELOP SENSE OF MIDDLE/MIDLINE AND AWARENESS OF TOPBOTTOM-FRONT-BACK-SIDES

Fig. 2. 4 Cartoon summary highlighting the motivational function of the limbic system in motor control. Direct and indirect connections indicated as heavy and light arrows. Feedforward connections (A) and feedback between equivalent system in (B).
EMOTIVE
HIGHEST LEVEL LIMBIC SYSTEM DEMANDS (FILL MY NEEDS!) ASSOCIATION SYSTEM SELECTS (TAKE THIS RECUTE!)

COGNITIVE
MIDDLE LEVEL PROJECTION SYSTEM GUIDES (DO IT THIS WAY. NOW!) LOWEST LEVEL SPINAL SYSTEM SKELETAL MUSCULAR SYSTEM

EXECUTES (DO IT!)

MOVES (DOING IT!)

* The Materialization of genetic information = Feedforward * Changing (learning) = Feedback Functional property of Brain Adaptation to the Environment Functional Plasticity of the Brain ex) # Movement of Neonates Adaptation to environmental changes antigravity Righting, Equilibrium learning of Body image

* Developmental process of the Brain Hereditary factor Environmental factor Reciprocal exchange

TONE INFLENCE PATTERN

NEURAL FACTOR AROUSAL , PROPRIOCEPTIVE REFLEX, CUTANEOUS REFLEX, FEEDBACK, FEEDFORWARD PERCEPTION, COGNITION

TONE INFLUENCE PATTERN

NONE NEURAL FACTORS BIOMECHANICS MUSCLE PROPERTIES

Level of Arousal
Feedforward Proprioceptive reflex & cutaneous reflex Cognition & Perception

Normal Tone Stability & Mobility

Feedbackward
Biomechanics

Muscle Properties

Abnormal tone Abnormal pattern of movement/posture TIPs Tone(neural) Proprioceptive reflexes Tone(non neural) Biomechanical alignment More efficient Force production

Cutaneous reflexes

Feedback/feedforward mechanism

More normal postural tone

More efficient and effective control of posture and movement for function

NONE NEURAL FACTORS

1.

VISCO-ELASTIC PROPERTIES 1)Elasticity: the length How extensible are the muscle fibers ? 2) Viscosity: the Velosity How quickly can the length of the muscle be extended ? 3) Plasticity : the Time How long does it take to return ? 4) Contracture: shrtenning, reduced number of sarcomeres in reduced for force output

NONE NEURAL FACTORS

2. Muscle fiber properties Type I slow Type II fast Most of muscles have a mixture of flber types ; slow, fast, intermediate

MORPHOMETRIC ANALYSIS OF NORMAL SKELETAL MUSCLE

INFANCY, CHILDHOOD,ADLOLSCENE AUTOPSY STUDY DELTOID AND LATERAL VASTUS 113 BABY AFTER BIRTH 40% TYPE 1 FIBER 2 POSTNATAL YEARS 60% MEAN DIAMETER OF MUSCLE FIBER BIRTH : 10-12 MICRON 15-20 YRS : 40-60 MICRON TYPE 2 FIBER /MALE : 15-20YRS; THICKER THAN TYPE 1 FIBER TYPE 2 FIBER /FEMALE: SMALLER THAN TYPE 1 FIBER BEFORE 15YRS: NO DIFFERENCES : MALE AND FEMALE TYPE 1 FIBER WERE USUALLY THICKER THAN TYPE 2 FIBER

JOURNAL NEUROLOGY SCI 1988 DEC.

GROWTH AND DEVELOPMENT OF HUMAN MUSCLES

VASTUS LATERALIS PROPORTION OF TYPE 2 FIBERS INCREASES SIGNIFICANTLY 5 T0 20 YEARS OLD 5 YRS( 35%), 20YRS(50%) TOTAL NUMBER OF FIBER MOST LIKELY CAUSED BY TRANSFORMATION OF TYPE 1 TO TYPE 2 FIBERS

MUSCLE NERVE 1992 MAR.

NONE NEURAL FACTORS

Classic length- tension curve Maximum tension around its mid-length - shortened, lengthened muscle - Hypertonia, Hypotonia - cant produce adequate tension and force to produce an efficient movement

BASED ON CLINICAL PRACTICE AND EMERGING THEORIES

Normal postural control mechanism 1. Normal postural tone 2. All degree of reciprocal innervation 3. All patterns of movement

P R E P A R A T I O N

Sensation Perception Cognition

Aims of management 1. Increase skill repertoire 2. Maintain functional level 3. General management

FOR FUNCTION
THEORY 1. Tone = neural and nonneural 2. Dynamic interacting systems 3. Motor control theories : feedback and feedforward 4. Central and peripheral mechanism 5. Changed clinical picture

T.I.P.S Tone reduction : neural and non-neural factors Inhibition-Facilitation-stimulation Balance reaction as part of task goal Essential elements for function : problem solving

TEAMWORK

* Artificial intervention = We should realize system of the Brain (Inhibitory Mechanism)

* Change

Intentional signal of CNS Environment / Adaptation Biological property of neuron network Activated by specific input Preparation of building up the new neuron synapsis as a human being