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Neurofacilitation Approaches
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
Reflex Theory
Hierarchical Theory
Hierarchical Theory
Movement is controlled by a system consisting of 3 levels with a rigid top down organization Higher centers control lower centers via inhibition
Movement emerges spontaneously from the interaction of the individual, the task, and the performance environment
Individual
Movement
Task
Environment
I T E
Mobility
Regulatory
Stability
Manipulation
Nonregulatory
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
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
Assumptions
Abnormal
Caused Cortical Release
movement
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
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
Assumptions
Recovery
Requires
of function
that higher centers once again control lower
centers
Recapitulates
Functional Repetition
Clinical Implications
Examination Intervention Intervention
should identify abnormal reflexes controlling movement should modify abnormal reflexes modifies the CNS through sensory
input
1/2
Assumptions
Normal
movement
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**
Assumptions
Recovery
of function
Recovery
Clinical
Implications
Recovery
is best produced by practice of purposeful, goal-oriented tasks that are meaningful to pts goals (task specificity)
Motor Hierarchy
S1
Concern: specifying spatial, temporal, and force parameters of the motor plan
Lowest level: LMNs, motor plant, FB about sensory consequences of the movement
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