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Motor Control Approaches

Neurodevelopmental Theorists/Theories: Catherine Trombly, Task-Focused, Motor Learning, Margaret Rood, The Bobaths (NDT), Signe Brunnstrom, PNF, Carr & Sheppard Reference: Cole & Tufano, Chapter 19
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

FOCUS
 Neuroanatomy & Neurophysiology  Principles of Neuroscience  Treatment of paralysis, flaccidity & spasticity

of muscles resulting from damage or disease to the central nervous system  Treatment of Movement disorders  Framework focus: body structures, body functions, process skills, contexts, and activity demands.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Basic Assumptions
 Each theorist has a somewhat different

approach, assessment technique, and intervention strategies.  Most neurodevelopmental approaches require specialized training.  These theorists use a behavioral learning approach to motor control based on the sequence normal developmental.

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Assumptions: Traditional Theories


 The remainder of the theories are currently

known as hierarchical or traditional theories of motor control, including


    

Rood The Bobaths NDT Brunnstrom Proprioceptive Neuromuscular Facilitation (PNF) Carr & Shepherd

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Basic Assumptions, cont.


 Margaret Rood, the earliest theorist, is both

an occupational and physical therapist. She stresses the importance of early reflexes in the relearning of motor control.  Rood first used her techniques effectively with children with cerebral palsy.  She believed that a baby uses reflexes to move initially but modifies them and eventually replaces the reflexes with voluntary movement.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Rood, 4 Basic Principles


 Sensory input is required for normalization of

tone and evocation of desired muscular responses.  Sensory motor control is developmentally based.  Movement is purposeful, engagement in activities is required to produce a normal response.  Repetition of movement is necessary for learning.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Rood, cont.
 Facilitation techniques: light stroking,

brushing, icing, and joint compression are used to facilitate movement.  Inhibition techniques: joint approximation (light compression), neutral warmth, pressure on tendon insertion, and slow rhythmical movement are used to inhibit unwanted movement (i.e., spasticity).

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Rood identified 8 ontogenetic motor patterns in the following sequence


1. Supine withdrawal 2. Segmental rolling 3. Pivot prone (prone extension) 4. Neck co-contraction 5. Supporting self on elbows 6. All fours movement patterns 7. Standing 8. Walking

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Rood, cont.
 Positioning is a primary concern, especially

when little voluntary control exists.  Extensive use of mats, bolsters, balls, and other specialized equipment is common in the Rood approach.  Movement patterns can be incorporated into games, such as tug of war, to provide an occupational focus to regaining motor control.

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

The Bobaths, Drs. K. (physiologist) & B. (physiotherapist), British - 1948


 AKA Neurodevelopment Treatment (NDT)  Originally designed their therapy techniques

for persons with hemiplegia (caused by CVA, or stroke)  Also worked with children with cerebral palsy  NDT focuses on the sensation of movement; it is not movement itself, but the sensation of movement, that is learned and remembered

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Bobaths, cont.
 Reflex inhibiting postures are used to inhibit primitive

reflexes (RIPs).  Sensory stimulation is regulated with great care.  Weight bearing, placing and holding, tapping and joint compression are used to activate normal movement and posture.  Compensation (such as one-handed feeding and dressing) using the noninvolved side is discouraged during recovery from stroke because it results in inactivity and poor recovery on the involved (paralyzed) side.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Brunnstrom, Signe - physical therapist, 1950-1970s


 Focuses on reflexes which provide the components 

  

of normal movement Proprioceptive (resistive) & exteroceptive (tactile) stimulation are used to elicit reflexes in the recovering adult hemiplegic Patients are encouraged to think about the movement and to gain control Brunnstrom also uses associated reactions and synergies A synergy is a total flexion or extension movement of a joint or limb

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Brunnstroms 6 Stages of Recovery


1. Flaccidity, no voluntary movement 2. Synergies or minimal voluntary movement 3. Synergies performed voluntarily 4. Some deviation from synergy 5. Independent or isolated movement 6. Individual joint movement nearly normal with

minimal spasticity

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Proprioceptive Neuromuscular Facilitation (PNF)


 Developed by Herman Kabat, PhD, MD and

modified by many contributors since the 40s  Uses diagonal & spiraling patterns of movement  Guides thinking about the sequence of normal development  Eleven basic principles (see Cole, p. 242)  Uses two diagonal patterns crossing the midline for each major body part, often incorporating verbal commands.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Carr & Shepherds Motor Relearning Programme (for persons with stroke)
 Contemporary approach (1990s)  Uses dynamical systems model of motor

control  Emphasize interaction between performer and environment  Does not accept the hierarchical sequence of motor relearning proposed by other theorists  Like other theorists, Carr & Shepherd discourage the early use of compensatory strategies
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Carr & Shepherd, cont.


 Clients taught to avoid abnormal

compensation for weak muscles  Treatment techniques based on extensive study of how normal movement occurs during functional tasks  Acknowledge critical role of cognition in motor learning  Movement patterns practiced in context of tasks, rather than exercises
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Carr & Shepherd, 7 Categories of Functional Daily Activities


1. Upper limb function 2. Orofacial function 3. Sitting up over the side of the bed 4. Balanced sitting 5. Standing up & sitting down 6. Balanced standing 7. Walking

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Function and Dysfunction


 Function assumes the ability to plan and

execute normal voluntary movement  Dysfunction is viewed as neurophysiologically based; CNS deficits result in abnormal muscle tone and lack of voluntary purposeful movement  Each theorist has a separate way to measure the extent of dysfunction

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Change
 Changes in motor control are physiologically induced.  Engagement in activity can produce physiological

change leading to motor control  Individuals relearn movement patterns in a predictable developmental sequence  Theorists differ in the use of early reflexes to produce movement  Handling, sensory stimulation, and manipulation of affected muscles can facilitate motor relearning

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Assessment and Treatment


 Specific to each theorist  These traditional models have also been

called reflex-hierarchical or neuromaturational because they are based on relearning movement in a normal developmental sequence.  New evidence tends to disprove the effectiveness of these approaches.

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Transition from Motor Control to Motor Learning


 Began in 1990s with classic article by

Mathiowetz & Bass Haugen, and Tromblys Slagle Lecture.  The following introduces Tromblys model as changing OTs thinking about establishing or restoring voluntary movement.

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Task Focused Approach: Trombly


 Occupational Functioning Model introduced

in 1995  Descending hierarchy of tasks & roles  Goal is to develop competency & self-esteem  Context & environment surround and permeate all levels of the hierarchy  When clients have mastered the foundation capacities, they move on to task-focused interventions (individual or group)  Trombly calls this occupation as end
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Task Focused Approach, cont.


Five general principles:  1. Client centered focus  2. Occupation based focus  3. Person & Environment enablers/barriers  4. Practice & Feedback - encoding  5. General treatment goals role fulfillment, problem-solving skills re: best way to accomplish valued tasks

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Dynamical Systems Theory & Trombly


 Applied to physical disabilities, this theory

combines reflexive and voluntary motor control  CNS receives/interprets multiple cues from the environment and involves multiple subsystems when planning to reach desired goals (preferred tasks & roles)  Occupational performance is a product of the interaction between the person, the task, and multiple environmental factors.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

Assumptions: Task Focused Approach


 Tromblys task focused approach is based on

theories of motor learning and dynamical systems theory.  Meaningful tasks are graded and sequenced according to each clients needs & abilities.  Each task requires experimentation using different strategies & contexts in order for motor skills to be learned.  Currently the preferred approach in OT for intervention after stroke/CNS damage
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

The End
 Next time: Motor Learning Frame of

Reference in OT

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.