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Theory

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general explanation of how something works - cannot be tested per say

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Hypotheses

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specific statements about the relationships between 2+ variables, deduced from a more general theory - can be tested thru collection of data

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Hypothesis orientated algorithm for clinicians (HOAC)

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- PTs examination strategy is based on hypotheses regarding the nature of the problem - PT tests and refines his/her hypotheses based on the outcome of the examination - PT plans intervention strategy based on the refined hypotheses

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Theory of human motor control

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- human motor control is complex and multidimensional - not a unified theory of motor control

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6 Motor Control Theories that have most influenced PT management of patients with CNS dysfunction

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- reflex theory - hierarchical theory - motor programming theory - bernstein's systems theory - ecological theory - dynamic systems theory

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Reflex theory

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movements are reflex responses to stimuli

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Clinical application of reflex theory

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- some patients reflexes seem to have a substantial impact on functional movement

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Evaluation based on reflex theory

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- eval consists of identifying what sensory inputs result in what motor outputs, and how each stim- response relationship impacts on function

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Interventions based on reflex theory

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- using sensory input to achieve desired outputs - eliminating sensory inputs resulting in undesired outputs

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Manipulating sensory inputs to improve function example

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- tonic labyrinthine reflex (stim -> response) - head in relative supine -> increases extensor tone across neck, trunk, and extremities - head in relative prone -> increases flexor tone across neck trunk and extremities

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If there is a strong primitive reflex usually means

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not good motor control

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Limitations of Reflex Theory

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doesnt explain: how people can produce movements spontaneously, wihtout any change in sensory input, how diff responses can result from the same stim

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Hierarchical Theory

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- control of movement occurs from the top down - in a healthy org, motor control system is a bureaucracy in which each level must take orders from the level just above it, and ultimately the highest level of the CNS controls what movement occurs

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Damage to CNS...

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releases control over lower levels and thats why we see primitive reflexes in patients with CNS dysfunction

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Neuromaturational Theory (hierarchical developmental theory)

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- normal sequence of motor development occurs as a consequence of progressively higher levels of the CNS maturing and gaining control over the lower reflex levels

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Cortex controls?

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- equilibrium reactions - bipedal function

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Midbrain controls?

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- righting reactions - quadrupedal function

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Brainstem spinal cord

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- primitive reflex - apedal function

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Tx of pts with developmental delay or adults with brain damage

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Should follow developmental sequence, highest level of motor control is dependent on the function of the intermediate level which suppresses the primitive reflex level

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Early versions of NDT...

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tried to suppress primitive reflexes and stim postural control following the developmental sequence

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In traditional NDT, if your patient didnt have adequate righting and equilibrium rx to have good sitting balance...

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you would not work on standing activity, you would spend your tx time working on equilibrium and righting rx with the pt sitting or quadruped

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Limitation of Hierarchical theory

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- doesnt explain why sometimes health individuals control of motor output is dominated by lower levels - examples: hot pain, some kids learn to walk before they can crawl

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Motor Programming Theory

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movement patterns or rules of action are stored in the CNS as motor programs and can either be triggered by sensory input or initiated centrally - addresses some of the limitations of the reflex theory - explains how movements can occur in the absence of sensory input and allows for spontaneous and voluntary movements

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Stereotyped movement patterns suggested...

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there are central pattern generators in the CNS

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Variety of Types of Motor Programs - motor programs can: - motor programs can be:

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- exist in the organism at birth, such as CPGs or can be learned, such as postural strategies or handwriting - specific to particular muscles or more abstract relationships between antagonistic movements

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Evaluation should include a determination of what programs are...

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intact and what motor programs need to be taught, re-taught or compensated for

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Motor Program Theory: Intervention invovles

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teaching the pt new motor programs or teaching the pt to apply surviving motor programs to perform desired activities

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Examples for using motor program theory: - if patient does not use an ankle strategy - if a patient who had a stroke can only move the arm in a flexor synergy

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- teach the pt to perform this motor program - teach him a variety of other motor programs

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Limitations of Motor Programming Theory

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motor programs stored in the CNS cannot take into account variations in the amount of muscle activation needed when the muscle is positioned against gravity vs gravity eliminated and when a muscle is weak due to fatigue

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Bernstein's Systems Theory. He recognized...

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Recognized the CNS is not the only thing involved in determining the motor output of the organism. Recognized that the human body is a physical subject to physical laws such as gravity, inertia, and friction, and that motor output is a function of many factors, including biomechanical features of the body

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Bernstein's Systems Theory - what type of model? and description

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- distributed (as opposed to hierarchical) model of motor control: control of movement is distributed throughout many interacting systems working cooperatively to achieve movement

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Bernstein's Systems Theory - synergies...

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exist to simplify the problem of controlling the many degrees of freedom in the body -> not necessarily bad but it is all they can do

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Clinical application of Bernstein's Systems Theory- it reminded neurological therapists...

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- sometimes mechanical limitations, rather than primitive reflexes, were causing patients' problems with movements

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Bernstein's Systems Theory.. Evaluations must consider

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biomechanical aspects of human movement as well as neurological control issues, and identify which aspects are the limiting factor for each patient problem

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Interventions (using Bernstein's Systems Theory )

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- address biomechanical constraints: increase flexibility (stretching) and increase ability of muscles to generate force (strengthening) - address learning movement combos (synergies) that occur in functional activities

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Limitations of Bernstein's Systems Theory

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- more comprehensive than previous - fails to consider cognitive and perceptual aspects of how the organism interacts with the environment

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Ecological theory

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- motor control evolved to enable organisms to interact with their environments in order to perform goal-oriented behavior

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Affordance

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an opportunity for action that the environment offers to the organism (living thing) - the concept of affordances takes into account characteristics of the organsim as well as characteristics of the environment

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How we perceive affordances is

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learned through our own interaction with the environment or through the experience of others that is shared with us

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Characteristics of the environment are only meaningful in so far as they

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enable or prevent desired actions

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Perception is

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our interpretation of the meaning of our sensations

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Movement in the environment allows the

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individual to translate meaningless sensory input (eg color and light) into meaningful perception (objects and surfaces)

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Therapists must

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- eval pt's ability to perceive the relevant features of the environment - provide intervention to facilitate pts perception - eval the extent to which a pt is interpreting the environment in a way that enables the pt to be successful at goal-oriented behavior

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Limitations of ecological theory

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focuses on the person/environment interface, but doesnt address other aspects of neuromotor control

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Dynamic systems theory of motor control

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merging of dynamical action theory with bernstein's systems theory to address two critical features of motor control - it is a complex system in which there are many interactive subcomponents - it is a dynamic system which means it changes over time

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Dynamic systems theory

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- complex systems have many subcomponents that interact. interaction among these subcomponents takes the system to a new state that cannot be explained through reduction to the subcomponents - new states/new patterns emerge through the interaction of multiple subcomponents - no need for a higher center issuing commands to achieve coordinated action

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the change from one sate to another is referred to

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as a phase shift or transition;

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the phase shift/transition is a

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nonlinear change - movement pattern is not directly proportional to the change in velocity

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clinical example of this phase shift/transition

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the change from doing one step at a time to step over step

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Control parameter - is - examples

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- subcomponent of the complex system that if changed results in the emergence of a new state - ex: shift from walking to trotting to galloping, velocity = control parameter - may be linear but doesnt have to be

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Stability and instability in the system is measured

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in terms of variability in the state of the system (stability is not talking about balance)

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A pertubation to the system could cause

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a stable state to transition to an unstable state which = instability of the system (variability) which a patient needs to be in to have an effective change

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Clinical implications intervention for dynamic systems theory

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- intervene in a functional context. Motor behavior emerges within the context of the person actively engaging in performing a task unnecessary to follow developmental sequence - manipulate control parameters to enable patients to achieve desired movements

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Limitations of Dynamic SystemsTheory

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does not describe the details about how the nervous system and the body work that help us hypothesize likely control parameters -> details of interventions would be a matter of trial and error

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