Neurological Physical Therapy

COURSE CODE: SHS 422

SHS.422.Lec-03

RABIA MAJEED
SEMESTER:FALL 2021
 REFERENCE FOR TODAY’S
LECTURE

Physical Rehabilitation by Susan B.

O’Sullivan, PT, EdD, Thomas J. Schmitz,
PT, PhDGeorge D. Fulk, PT, PhD
5th edition
 MOTOR FUNCTION

• Motor control evolve from complex set of neural,

physical and behavioral processes
• Some movements have genetic basis – reflex
pattern
• Other movements – motor skills – learned through
interaction and exploration of environment
 MOTOR FUNCTION

• Motor program – an abstract representation that, when

initiated, results in the production of a coordinated

movement sequence

• Motor plan – an idea or plan for purposeful movement

that is made up of several component motor programs

 MOTOR FUNCTION

• Motor Memory – involves the recall of motor

programs or subroutines and includes information on
– Initial movement condition
– Sensory consequences
– Specific movement parameters
– Outcome of movement
 MOTOR FUNCTION

• Neuroplasticity – capacity of brain to adapt to

injury through mechanisms of repair and change
• Short term changes in efficiency or strength of
synaptic connections to long term structural
changes in the organization and number of
connections among neuron
 MOTOR FUNCTION

• Memory allows for continued access of this information for

repeat performance or modification of existing pattern of

movement

• Motor learning – a set of internal processes associated with

practice or experience leading to relatively permanent changes

in the capability of skilled behaviour

 MOTOR FUNCTION

• Feedback – response produced information received

during or after the movement and is used to monitor

output for corrective actions

• Feedforward – sending of signals in advance of

movement to ready the sensorimotor system

 MOTOR FUNCTION

• Coordination – ability to execute smooth, accurate

and controlled motor responses

• Coordinative structures – functionally specific units

of muscles and joints that are constrained by nervous

system to act cooperatively to produce an action

INTRODUCTION TO THEORIES
OF NEUROLOGICAL
REHABILITATION
Neurological rehabilitation is a doctor-
supervised program designed for people with
diseases, trauma, or disorders of the nervous
system. Neurological rehabilitation can often
improve function, reduce symptoms, and
improve the well-being of the patient
 .
• In recent decades there has been a special
interest in theories that could explain the
regulation of motor control, and their
applications

• These theories are often based on models of

brain function, philosophically reflecting
different criteria on how movement is controlled
by the brain, each being emphasized in different
neural components of the movement
 THEORIES

Motor Control

Motor Learning
 Motor Control

• Ability to regulate or direct the mechanism

essential for movement

• “An area of study dealing with the

understanding of the neural, physical and
behavioral aspects of biological (e.g., human)
movement”
IMPORTANCE OF MOTOR CONTROL

 Understanding motor control specifically the nature and

control of movement is critical to clinical practice.
 We deal with patients who have motor control problems
producing functional movement disorders, which can
be managed by;

– changing movement,
– increasing the capacity of movement,
– improving the quality of posture and movement
essential for function.
• Information processing of human motor
behavior occurs in stages

Stimulus identification
Response selection stage
Response programming
 Motor control

• In the initial stage, stimulus identification, relevant stimuli

about current body state, movement, and environment, are

selected

• and identified

• This includes somatosensory, visual, and vestibular inputs

 MOTOR CONTROL

• In the response selection stage the plan for

movement is developed.

• A motor plan is defined as an idea or plan for

purposeful movement and is made up of component

motor programs
 MOTOR CONTROL

• The final stage is termed response programming.

• Neural control centers translate and change the idea for movement

into muscular actions defined by a motor program.

• A motor program is defined as “an abstract representation that,

when initiated, results in the production of a coordinated

movement sequence.”
 .
• During response execution (movement output), muscles are selected against an

appropriate background of postural control.

• Feedforward control is the sending of signals in advance of movement to ready a

part of the system for incoming sensory feedback or for a future motor command.

• It allows for anticipatory adjustments in postural activity.

• Feedback is response-produced sensory information received during or after the

movement and is used to monitor movement output for corrective actions.

 Theories of motor control
• Theories of Motor Control describe the viewpoints regarding how movement is controlled.

• Reflex theory

• Hierarchical theory

• Motor programming theory

• Systems theory

• Dynamic action theory

• Theory of parallel distributed processing

• Activity-oriented theory

• Ecological theory
 REFLEX THEORY

• Sir Charles Sherrington (1906) neurophysiologist wrote

a book “integrative action of Nervous System”

According to this theory reflexes were the building

blocks of complex behavior intended to achieve a
common objective.
He described this behavior in terms of compound
reflexes and their combined or chained action
A stimulus provokes a response, which is transformed
into the stimulus of the next response
– 3 parts: receptor, pathway, effector
– Reflexes were the building blocks of complex
behavior
– Reflexes worked together or in sequence to
achieve a goal
 Clinical implications

• Reflex theory Recovering Motor Control is

based on increasing or decreasing the effect of

different reflexes during motor tasks

 Limitations

–There are number of limitations of a reflex theory of

Motor Control (Rosenbaum, 1991):
1. Reflexes can not be considered as the Basic unit of behavior. Because:
a. Reflex must be activated by an outside agent.
b. Unable to explain spontaneous and voluntary movements
2. It does not explain and predict movement that occurs in the Absence
of sensory stimulus as animal move in a relatively coordinated fashion
in the absence of sensory input.
3. It does not explain Fast movements
4. The concept that a chain of reflexes can creating complex behavior
fails to explain the fact that a single stimulus can result in varying
responses depends upon context and descending commands.
 HEIRARCHICAL THEORY
• Hughling Jackson
• There are Higher, Middle, and Lower levels of
motor control, equated with higher association
areas: the motor cortex and spinal level of
motor function (forester 1977) CORTEX
• Top down organizational control, strictly
vertical
• Never bottom up control MIDBRAIN

BRAINSTEM &
SPINAL CORD
 HIERARCHICAL THEORY
• The hierarchical theory states that the central
nervous sys-tem (CNS) is organized in hierarchical
levels such that the higher association areas are
followed by the motor cortex, followed by the
spinal levels of motor function.
• Each higher level controls the level below it
according to strict vertical hierarchy; the lines of
control do not cross, and lower levels cannot
exert control
 Hierarchical theory

Hierarchical theory, in which control was

viewed as proceeding only in a descending
top-down direction from higher to lower
centers, with the cortex always in control.
Multiple descending systems are engaged for
control movement and posture.
• The concept of motor learning, regarded as the
set of internal processes associated with
practice and experience that produce relatively
permanent changes in the ability to produce
motor activities through a specific skill, is also
relevant in the context of neuroscience.
• Thus, both motor control and learning are seen
as key fields of study for health professionals in
the field of neuro-rehabilitation.
Reflex /Hierarchical Theory
• The hierarchical theory does not explain how
a reflex on the lowest hierarchical level would
dominate motor function (withdrawal reflex).
 Motor Programming Theory

• Instead of the CNS being just and always

“reactive”, this theory states that CNS can act on
its own as a result of prepared motor programs
• There is an abstract motor program stored on
the higher levels and sent down to be
interpreted and carried out depending on the
situation and context.
 Motor Programming Theory

• It suggests that movement is possible in absence

of a reflex action such that the spinal neural

network would be able to produce a movement

rhythm without any sensory stimuli

 Motor Programming Theory
• It also introduces the concept of central pattern
generators (CPGs), or specific neural circuits able to
generate movements such as walking or running.
• Incoming sensory stimuli exert an important
modulatory effect on CPGs
• The term motor program may be used to identify a
central pattern generator (CPG) that is a specific
neural circuit represents neural connections that
are stereotyped.
• Clinical implication
.
– Clinicians move beyond reflex explanation for motor control disorders.

– It explain abnormal movements are the result of the problems or abnormalities in

central pattern generator (CPG)

Limitations

• It never replace the concept of importance of sensory input in controlling

movement

• Motor program or CPG is not considered as sole determinant of action

• It can also not explain how a single command produce different

movements
 System theory
• Nicolai Bernstein ( 1896-1966)
• It states that ‘‘movements are controlled
neither centrally nor peripherally, but rather
are effected by interactions among multiple
systems’’.
• Control of integrated movement was probably distributed
throughout many interacting systems working cooperatively to
achieve movement.
• The body is regarded as a mechanical system
subject to both internal forces and external
forces (gravity)

• The same central command may give rise to

very different movements due to interactions
between external forces and variations in the
initial conditions; also, the same movements
maybe elicited by different commands
• Systems theory predicts real behavior much
more accurately than the preceding theories
• Since it considers not only what the nervous
system contributes to motion, but also the
contributions of different systems together
with the forces of gravity and inertia.
 .
Clinical implication
Body as mechanical device

Movement are not only the result of nervous

system activation and control but both nervous
and other body systems
 Dynamical Action Theory
Principle of self-organization
Considering the self-organization principle, the theory
states that when a system made up of individual parts is
integrated, its parts will act collectively in an organized
manner. They will not require any instructions from a
higher centre on how to achieve coordinated action

1. Movement underlying action results from the interaction

of both physical and neural components
2. No need for higher center to issue instruction or give
command because coordinated movement will be
achieved no matter what
 Dynamical Action Theory
• Limitation :
• The theory proposes that movement is the result of
elements that interact, with no need for motor
programmers
• It altogether removes emphasis on the CNS
Clinical implication
• The dynamic action theory minimizes the importance of
the idea that the CNS sends commands to control
movement, and it searches for physical explanations
that may also contribute to the characteristics of
movement
THEORY OF PARALLEL DISTRIBUTED PROCESSING

• The theory of parallel distributed processing

(PDP) describes the way in which the
nervous system processes information in
order to act.
 According to this theory, the nervous system
operates both by
 Serial processes (by processing information
through a single channel)
 Parallel processes (by interpreting information
from multiple channels and analyzing it
simultaneously in different ways)
• As with neural synapses, each element may be
affected by others in a positive or negative
way, and to a greater or lesser extent
Efficiency in task performance depends on the
quantity of output connections and the
strength of those connections
 LIMITATION
• Models based on this theory do not imitate
information processing during the
performance and learning stages.
 ACTIVITY-ORIENTED THEORY
• The activity-oriented theory is based on the
premise that the objective of Motor Control is
to master the movement involved in
completing a specific action, and not just
move for the sake of moving
• Movement control is organized according to
goal-oriented functional behavior
• Greene pointed out the need for a theory
able to explain how neural circuits operate in
order to complete an action and therefore
able to provide the basis for a clearer picture
of the motor system.
 Clinical implementation
• Activity-oriented theory informs us about the
fundamental activities of the CNS and the
essential elements controlled during an
action.
• Limitations
• It states that MC recovery should focus on
essentially functional activities.
 ECOLOGICAL THEORY
• In the 1960s, Gibson explored the way in which our
motor systems allow us to interact more effectively
with our surroundings in order to develop goal-
oriented behavior
• He focused on how we detect information in our
setting that is relevant to our actions, and how we then
use this information to determine our movements
• The individual actively explores his or her environment,
and the environment promotes the performance of
activities that are environmentally appropriate
 Ecological Theory

• Motor control evolved so that animals could

cope with the environment around them.
• It is not sensation but perception that was
important to the individual
SIGNIFICANCE
Emphasis has shifted from the nervous system
to the organism- environment interface
INDUVID
UAL
 LIMITATION:

• Ecological theory places little emphasis on the

organization and function of the nervous
system.
 Some useful Links
• https://www.youtube.com/watch?v=4t2ww3g
fKrg

• http://slideplayer.com/slide/6930455/

• https://www.coursera.org/learn/neurobiology
/lecture/0bSof/motor-hierarchy