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Definition and levels of analysis

Neurofacilitation Approaches

Motor Hierarchy Theories of Motor Control Task-Based Approaches

Map of Essential Concepts


Reflex Theory Complex Systems Theory

Theories of Motor control


Definition and levels of analysis Reflex theory Hierarchical theory

Complex systems theory


Neurofacilitation Approaches Motor Re-learning, Task-Based Rehabilitation

Motor Hierarch

Description
The discipline of Motor Control is the study of human movement and the systems that control it under normal and pathological conditions. Levels of analysis (study)

Environmental

(Outcome) Movement pattern Neuromotor processes underlying movement

result of the movement

Reflex Theory

Reflex Theory (Charles Sherrington, early 1900s)

Complex behavior (movement) is controlled by a series of chained reflexes (e.g. Frog)

Hierarchical Theory

Hierarchical Theory

(Hughlings Jackson 1930s)

Movement is controlled by a system consisting of 3 levels with a rigid top down organization Higher centers control lower centers via inhibition

Disinhibition Release phenomenon

Complex Systems Theory 1/3

Movement emerges spontaneously from the interaction of the individual, the task, and the performance environment

Individual

Movement

Task

Environment

Factors within the Individual, Task, and Environment 2/3


Individual

Sensorimotor Psychosocial Cognitive Stage of Motor Learning

Task Taxonomy of tasks Discrete/ continuous Attentional demands

Environment Physical Socioeconomic Cultural

Factors within the Individual, Task, and Environment 3/3


Cognition Perception Action

I T E

Mobility

Regulatory

Stability

Manipulation

Nonregulatory

Neurofacilitation Approaches 1/7

Developed during the 1950-1960s in parallel with increasing knowledge of anatomy and physiology of the nervous system Bobath (NDT); Brunnstrom; Kabat, Knott & Voss (PNF); Ayers (Sensory Integration Therapy) developed the Neurofacilitation Approaches that replaced the muscle reeducation approach used to treat the effects of Polio during the 1940-1950s Neurofacilitation approaches were designed to treat the movement effects of stroke (UMN lesion) by attempting to affect the CNS directly through the manipulation of sensory input

Neurofacilitation Approaches 2/7

Assumptions
Normal

movement

Results

from a chain of reflexes organized hierarchically within the CNS (Control of movement is top down cortex controls brainstem and spinal cord)

Normal

development

Characterized

by the emergence of behavior organized at sequentially higher levels of the nervous system by sensory input

Driven

Neurofacilitation Approaches 3/7

Assumptions
Abnormal
Caused Cortical Release

movement

by disruption of normal reflex mechanisms

lesions cause the release of abnormal reflexes organized at lower levels of the central nervous system of abnormal reflexes constrains the patients ability to move normally movement is the direct result of lesion not secondary or compensatory actions**

Abnormal

Neurofacilitation Approaches 4/7

Assumptions
Abnormal
In In

movement

both children and adults, movement is dominated by primitive reflexes children, cortical lesions interrupt normal corticalization thus motor control is dominated by primitive reflexes organized at lower levels of the CNS (primitive reflexes are never constrained) adults, with acquired motor cortical lesions, damage to the higher levels of the CNS release lower levels and movement is dominated by primitive reflexes (primitive reflexes are constrained then released)

In

Neurofacilitation Approaches 5/7

Assumptions
Recovery
Requires

of function
that higher centers once again control lower

centers

Recapitulates

normal development, therefore, intervention should proceed along a developmental sequence


skills will automatically return once abnormal movement is inhibited** of normal movement patterns will automatically transfer to functional tasks**

Functional Repetition

Neurofacilitation Approaches 6/7

Clinical Implications
Examination Intervention Intervention

should identify abnormal reflexes controlling movement should modify abnormal reflexes modifies the CNS through sensory

input

Neurofacilitation Approaches 7/7

Current changes to Neurofacilitation Approaches


Increased emphasis on directly training functional tasks as opposed to normal movement

Decreased emphasis on inhibiting abnormal reflexes


Increased consideration of motor learning principles (stages of motor learning, feedback, practice schedules, etc)

Motor Re-learning Task-Based Rehabilitation

1/2

Assumptions
Normal

movement

Performer + Task + Environment

Abnormal

movement results from impairment in one or more of the systems controlling movement

Abnormal movement pattern is the performers best solution to the task given the systems remaining after damage not just the result of the lesion itself**

Motor Re-learning Task-Based Rehabilitation 2/2

Assumptions
Recovery

of function

Recovery

is produced by plastic reorganization of undamaged control centers (neural plasticity)

Clinical

Implications

Recovery

is best produced by practice of purposeful, goal-oriented tasks that are meaningful to pts goals (task specificity)

Motor Hierarchy

MC system consists of 3 levels

Highest level: association cortex, sensory, and motor areas

S1

Concern: select movement goal and strategy

Middle level: BG, Cb, and brainstem motor centers

Concern: specifying spatial, temporal, and force parameters of the motor plan

Lowest level: LMNs, motor plant, FB about sensory consequences of the movement

Concern: producing the movement pattern and supplying sensory FB

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