DEVELOPMENT OF FUNCTIONAL ABILITIES AND SKILLED PERFORMANCE

 After stroke → arm and hand coordination mildly to severely impaired → disability and high
cost to individuals and society
 The upper extremity important basic functions → perform functional tasks
 Struktur neural yang mendasari perkembangan motor abilities :
o The neonate brain contains a set number of neurons and a few standard connection
between them.
o The neonate respons to its environment with simple limb movements.
o Over time and with repetitions of these movements, preferred connections are
strengthened and unwanted ones dismantled.
o These connections are extremely plastic or adaptable as they have to adapt to change
in bodily growth and still produce the same accuracy of output.
 Human develop two level of sensorimotor response:
o Innate motor abilities
 Arise as we experience and explore the external environment and adressing
internal needs e.g. Feeding ourselves in response to hunger.
 These actions may automatically or intentionally learned as our normally
developing system respons to its environment from babyhood and they
become our repertoire of daily response.
o Skill performance
 Need to be deliberately learned and usually involved large amount of training.
 Some skills such as writing, are necessary for daily living, and others we may
choose to learn such as golf playing an instrument.
 Evidence indicates that children learn abilities and skills in the same way as adults.
 Abilities such as walking, stepping over objects in our path, picking up and transporting objects
emerge as concequence of interaction between our sensory, cognitive perceptual and motor
systems the objects at hand and relevant environmental forces.
 Based on research:
o An apreciation of object properties in relation to ourselves can emerge at a very early
age when given the appropriate environmental experiences to accumulate perceptual
traces to store for comparison in the future.
o Stored perceptual traces are necessary for anticipatory, and adaptive behaviors so that
the patient can modify movements during performance to suit the requirements of
the task or change environmental conditions.
o (Experience from early age is important for adaptive behavios)
 What development of upper abilities requires?
o Postural control of neck and trunk 
 Neck to be able to fix the eyes on an object before reach to the object can
occur
 Trunk to enabled a fixed base for the upper limb to transport, fix and enable
the hand to make manipulative adjustment.
o Postural control and ambulation to occur, the human system must be challenged by
gravitational forces. Postural and ambulation will not occur until gravitational effects
are mastered.
 o Evidence:
 Neonates have the ability to reach to a target with reasonable accuracy if the
head is externally controled
 But reaching does not emerge developmentally until the child is
biomechanically ready
 Important:
o The development of internal body representation or scheme to provide a postural
frame of reference for interpretating senses and coordinating actions for postural
control.
o Coordinate system for reach to grasp actions to provide a computed absolute position
of a target in relation to the head and body (eye hand coordination).
o Good eye hand coordination provide an absoulte position to coordinate reach and
grasp actions
o Good postural control can be based on the development from internal body which can
interpretating senses and coordinated actions
 Parameter of this system are (a) target, (b) combined binocular outflow from each eye. a + b +
information about state of the neck muscles = provide a stored estimate of target location in
relation to the body
 Skill learning is achieved by motor learning principles:
o Gain the ‘idea’ of action
o Cognitive stage  patient must determine what the objective of the skill is and begin
to process environmental factors that will affect their ability to produce the skill.
o Perceptual or associate stage  the learner begins to demonstrate a more refined
movement through practice.
o Automatic stage
o Massed vs variable practice
o Importance of generalization – contextual interference