Reflex Theory:

What is it's basis?

Who came up with it?

Sensory inputs control motor outputs

Movement is driven by sensory inputs

I.e. muscle taping creates muscle activation

Author: Sherrington

Hierarchical Theory:

What is the basis?

Who came up with it?

Hierarchical Theory:

Top down approach; central control mechanisms

SC= reflex motor pattern

Brain stme= static reflex control

Cerebral cortex= voluntary movement

Dynamic systems theory is made up of what?

DST pulls from the system theory model and has the key component of variability

This is the the theory that puts forth the different attractor states

Compensatory

Functional

Neuromotor

Motor Learning

Substitution

Adaptation

Assistive/supportive devices

task-specific training

Behavioral shaping

environmental enrichment

Neuromotor training

Developmental Activities

Balance, coordination, postural training

Gait/Locomotor training

Strength, pwoer, endurance

Relaxation training

Feedback (Knowledge of result/preformance)

Practice: type, sequence, order (i.e. random, blocked, distributed etc)

Transfer training

Problem solving

Initial mobility

Stability

Controlled mobility

Skilled movement

Static postural control (sitting or standing)

Tonic holding

Co-contraction

Dynamic postural control

Static-dynamic control

Consistency

Efficiency

Flexibility

Interaction between body structures(nervous system) and fucntion

* feedback between sensory inputs and motor outputs, modifying movement with sensory stimulation

sensory input controls sensory output

Repetition: of muscle responses creates pattern

Intention: goal direction influences movement

Real Life Context: increase treatment effectiveness and generalizability

Interaction between PT and client

Vestibular stimulation promotes what

what approach to improving motor was this a part of?

Vestibular stimulation promote extension of neck, trunk, & limbs

Rood's approach

IN peds: increase Vest. Stim by swinging, jumping, slides, merry-go.rnd, bouncing or rocking on ball

vestibular stimulation causes extension

Vestibular stimulation prmoting extension of neck, trunk, limbs

Approximationthroguh WBing- joint compression creates co-contraction

Resistance

Quick Stretch: increase responsiveness of muscle spindles (PNF)

Tapping/vibration: to maximize/maintain response

Neutral warmth

Slow stroking: 3 min/rebound

Slow Rocking: mobility on stability

To prevent contractures

To increase ROM

To increase sensory inputs (warm air into splint cause relaxation)

Braces joint to facilitate WBing

Positioning in reflex inhibiting pattern

PNF: Emphasizes patients abilities/potential so that stronger componenets assist weaker ones

Also has components of normal movment

Repeated Contractions

Reveresal of antagonists:

slow reversal

Rythmic stabilization

Relaxation:

Contract-relax (isotonic-passive)

Hold-relax (isometric-active)

slow-reversal-hold relax

Rhythmic rotation

What is brunnstroms motor therapy used for?

What is the motor therapy by brunnstroms based on?

What model of motor control were they based on?

To treat motor dysfunction after CVA

Brunnstrom motor therapy is based on:

Neurophysiology; mechanisms of CNS

Effects of CNS damage

Sensory Systems

Clinical Observation

Intervention Strategies

Hierarchical theory of motor control

which states when there is damage to the CNS it regressed to an early form of movement

If the person was unable to do any voluntary movement then the PT woudl eliciate reflexed that they had regressed to such as:

Spinal Level: Flx W/draw, extensor thrust, crossed extension

Brainstem Level: TNR, TLR, associated rxn, support rxn

Cortical level:  Equilibrium rxn

How many stages are there in Brunnstrom's stages of recovery?

What is stage 1?

6

Stage 1 : Flaccidity during acute phase

No movement can be elicited

Stage 2:

Basic limb synergies

Minimal vol movmeent

Spasticity

Some voluntary control of movement synergies

Spastivity has further increased

Stage 4:

Movement out of synergies

spasticity begins to decrease

Stage 5:

More difficult movement combinations

Limb Synergies not dominant anymore

Disappearance of spasticity

Individual joint movement and coordination near normal

In Brunsstrom moveemnt therapy are synergies a necessary part of recovery?

Why or Why not?

Synergies are a necessary part of recovery

Bc to make movement recovery you have to start moving whatever the patient has whether is hiarchial reflexes or synergy patterns and then move onto more complex movement as the patient progresses

What are the early stages of recovery in the Brunnstroms model?

What should you facilitate during this stage?

Stage 1-3

Early stages of recovery:

Facilitation tech used to help patient gain control of limb synergies

Use of afferent stumuli (sensory inputs) i.e. STNR where UE and LE follow the movement of the head. UE do the motion that the head does and LE do the motion opposite the head

Children with CP

Adult hemiplegia (typicall CVA)

Should abnomal response be use when using NDT?

Why or Why not?

No

Abnormal responses should not be used bc you want them to make new and strong neurological pathways for normal posture and movement

Slow controlled movement

Key points of control

Weight bearing over affected side

Positioning and disassociation are also important

Dynamic systems theory of motor control

Other information about Task oriented MOdels:

Individual-task-environment

Functional Training:

Postural Control/Balance

Locomotion

Reach & Grasp

Motor Learning Priniciples

Decreased ability to generate force

Activation & sequencing problems:

Abnormal synergies

Inapropriate coactivation

Impaired inter-joint coordination

Timing Problems:

Problems initiating movement

Slowed movement time

Problem terminating a movement

Force grading problems:

overshooting

undershooting

Altered neural activity (UMN (hyper)/LMN (hypo) lesion)

Change in muscle properties (atrophy)

Decreased strength agonist/antagonist muscles

Is our PT to inhibit reflexes in order to normalize tone?

WHy ar why not?

No

Goal: to alter sensory feedback provided by abnormal movement while considering

* Joint alignment

* Muscle Length

*Strength

 Goals that are Patient-centered and meaningful to the patient (optimizes motivation)

PTs: Problem-solving ability:

Knowledge and understanding of current litature

Realistic expectations fo clients optimal potential based on PTs expertise

Clinical experience

Actor: who

Behavior: description of task

Condition: circumstances

Degree: quantitation expectation

Expected time: how long to reach goal