MS Week 7 PDF

7.1 motor control motor control: study of processes that underline movement dynamic regulation of posture & movement through collaboration of body systems • system’s theory: collection of systems that produces the human movement system observe motor control through quality of movement • ex: baby...

7.1 motor control motor control: study of processes that underline movement dynamic regulation of posture & movement through collaboration of body systems • system’s theory: collection of systems that produces the human movement system observe motor control through quality of movement • ex: baby learning to walk motor control stimulus identification (1st stage) • underlying meaning placed on initial stimulus • can be subconsciously like central pattern generators • collection of neurons that fxn w/ higher level cerebral cortex • doesn’t need sensory feedback but uses it to adjust movement ex: puppy paddling, or baby stepping reflex when tipped forward purposeful movements (sensory and environmental feedback) • ex: baby learning to stand from chair learned from enviornment motor plan via response selection baby plopping down from chair every time turning • does not occur in hierarchy motor plan = purposeful plan for movement made up of several component motor programs • have response programming portion of motor control -> solidified in motor plan -> less cognitive processing need to finish task ex: autopilot movement occurs through interaction of 3 constructs • individual performing the movements ex: impaired perception or impairment in musculoskeletal system that can impede movement • environment: ex: distractions, firmness, lighting • task: ex: speed movement must occur, or sequence task classifications discrete : definite beginning & end ex: rolling over *require increased cognitive processing for individuals: why infants not great examples serial : series of discrete tasks put together ex: putting on a tie continuous: no definitive beginning or end ex: CPG pattern summary: processes that underlie mvmt, systems theory, collaboration b/w individual task and environment, discrete, serial or continuous task play a role in cognitive processing 7.2 Motor Learning Motor Learning temporary improvement in a skill on the same practice session more of a permanent change where the task • itself can transfer to different situations, environments and times 1. Closed Loop Therapy provided the idea that mvmnt occurred through sensory processing for error detection • As feedback to the CNS and then guiding movement, this theory generated a reference of correctness for patients where they realize the error that was made based on environmental cues and then have the ability to correct that error. Schmidt’s Schema Theory concentrated on more of a generalized motor program that could be developed and can create more subconscious action 2 types of schemas 1. Recall - schema or cognitive process that we utilize in order to recall movement tasks that have been conducted in the past. 2. Recognition -Using those previously learned movement sequences, the individual is able to recognize how a sequence should be modified should a similar task be attempted. Dynamic Systems Theory- Bernstein provides a basis for mvmnt systems theory • the one w interaction of all systems that produce and refine mvmnt • Mvmnt is more of a collaboration rather than stemming from CNS all the time Ecological Theoray- Gibson focus on the environment such that perception is required in order for movement to occur successfully Optimal Theory focused on the need for motivation and attention to task in order to improve motor performance. • motor control is more about neurophysiological basis for acquiring mvmnt motor learning process by which that mvmnt can be modified thru practice ex: tennis player- motor control to swing racket and hit ball - motor learning to modify mvmnts consistently process is contingent on the receipt of feedback from the environment and feedforward processes that body takes in order to be consistent Extrinsic feedback verbal or hand over hand cues Instrinsic feedback body makes an extra move to adjust (ex: stepping forward to not fall) Prediction mechanism comes when you have enough practice and can be a combo of intrinsic and extrinsic feedback that may constrain mvmnt acquisition Intrinsic factors muscle length, tension, jnt mobility, postural alignment, body morphology and etcetra Also consider neuromuscular tone and ability for system processing Extrinsic factors more task and environment surrounding task Temporal or time based requirements such as speed of task Summary Motor learning aspects of practice that allow for mvmnt modifications Constraints of Mvmnt Acquisition internal and external 7.3 The stages of motor learning 3 stages of motor learning • cognitive: external feedback (auditory, visual, tactile assistance) ex: attempt to make sense of or process activity - tries different strategies to complete task and discards strategies that don’t allow for success - external feedback and cues help recognize strategies that work • associative: some external feedback but not as much (occasional verbal, visual, tactile cues to refine task) ex: pt can intrinsically correct mistakes - recognized steps to be successful, practicing refining skills - unable to be done in cognitive stage of learning - “how does it feel” • autonomous: minimal cognitive processing (no external cues, correct themselves) - intrinsically correct - errors still made on occasion task change can change the motor stage! summary: cognitive: extreme processing needed, lot of external feedback for successs associative: some processing still need, external reminders neede on some occasion, but individual utilizes intrinsic feedback autonomous: subconscious activity with little to no processing required, intrinsically correc 7.4 OPTIMAL Theory of Motor Learning OPTIMAL theory Optimizing Performance Thru Intrinsic Motivation & Attention Theory strives to incorporate things that are meaningful to individual learning the more challenged the pt is at task the more they learn • seek to integrate the social, cognitive, and affective behaviors for a more well rounded understanding of motor learning. theory is rooted in self efficacy, where individuals feel they can affect task • outcomes positively Can do this by thru positive feedback - enhances learning and allow for pt to self reflect and self evaluate - increased perceived confidence We want to start easy and eventually add in harder skills Last, alleviate concerns that pt may have 2 principles of OPTIMAL 1. Autonomy- gives pt options while still getting therapy done 2. Enhanced expectancies - we want to try to teach client how to be proactive rather than just reactive w the task in hand ex: multiple mini goals to work up to a big goal Summary OPTIMAL theory of motor learning • Emphasizes motivation and environment • Optimizes learning through increased autonomy and self-efficacy • Allow for patients to have choices • Use external focus of attention • Proactive strategies 7.5 Motor memory & learning styles long term memory (2) declarative: explicit memory • recognize things that have already been observed or encountered • requires verbal expression of process ex: sit on chair scoot forward bring legs back etc • recall facts or sequences • mental practice too non declarative: implicit memory trying to modify task or concept • • non associative learning: CNS reacts to stimuli habituation sensitization decrease response to repetitive • stimuli decrease in amplitude of excitatory • • if enough repetition can result in • PT need to desensitize pt with skin brush (peds), • repetitions of an activity lasts for several minutes heightened awareness to noxious or painful stim pt walk or touch different textured surfaces neural responses after multiple • • occurs bc prolonged AP conductance w/ underlying genetic factors & increased synaptic connections ex: sunburn, more sensitive to touch structural changes and persist for weeks/months ex: scent plug ins don’t let you get used to smell associative learning • allows pt to predict • operant/classical conditioning bc modification of proteins resulting in synaptic efficiency ex: pavlov procedural learning • subconscious, develop slowly over # of repetitions until becomes autopilot • enhances motor performance of individual • dementia pts have limited capacity for motor learning but can subconsciously learn through procedural learning by having complete task over and over with little break understand how your pt learns • read & write • auditory • visual analytical/objective way to learn • list, organization, structure intuitive/oglobal • some like real world application summary: long term memory (declarative - factual, non declarative - reflexive, subconscious, “autopilot” learning styles - analytical/objective (list structure) intuitive/global (real world examples/experiences) 7.6 Motor Skills thru-out the Lifespan Motor skills are purposeful behaviors that are learned by repetitive practice and modified based on the changing environment Infancy from birth to 1 year First few days or weeks from birth- primitive reflexes predominate: are involuntary motor responses originating in brainstem ex: baby thinking your finger is bottle to feed Rooting reflex- disappears around 4 month • infants develop visual tracking, symmetry and reaching skills Progress includes: -grasping skills, followed by rolling, sitting, crawling or creeping & pulling to stand and bipedal lococomotion Childhood 1.5-5 yo Rapid growth focuses on cognitive growth and perceptual developments ex; playing pretend, speech, independent ambulation (stating at a 1.5 to 2 years of age) After 2 yo children are able to run for short distances & walk backward • also learn to how to jump on both feet and kick ball 3-5 yo can hop on one foot, climb and jump over objects 5-6 yo can skip w alternating feet Note: in order to fully understand mvmnt, we have to know where it originated from by looking back at how children acquire movement skills, we can better challenge and regress patients of all ages who have movement abnormalities. 6 yo Gain finger dexterity 7-8 yo Jump rope 9-10 Hobbies Adolescence Movements become much more skilled for complex motor tasks such as sports Hand eye-coordination refined and this age group is able to improve mvmnt w/in demands of environment • concepts of abstract though come into play w mvmnt • become more talented w dual tasking where 2 tasks are performed simultaneously Front lobe of brain isn’t fully formed until after adolescence • still a lack of execute fxning big picture of this age group, is such that motor skills are refined particularly related to sports and higher skills as a beginning adults. Adult 20-59 better able to navigate challenge w/in the environment Middle adulthood bw 40-59 yo aging starts to kick in w sarcopenia which is age related muscle decline ~ a 10-15% decline in muscle per decade After 5th decade- over 60 years sacropenia increases more extensively after age of 75 Sarcopenia progresses in older adults w concurrent force generation decline - individuals display slow information processing and overall mvmnt times • decrease in size and # of motor units occurs w noticeable decrease in coordination in aging adults Fall risk is also increased due to balance deficits - this is why we might see geriatrics move slower w age Summary Motor Skills: learned by repetitive practice; modified with environment • Infancy; Birth – 1 year Rapid development; Primitive Reflexes • Childhood; 1–10 years Increasing movement awareness/skill • Adolescence; 11–19 years Complex motor skills; abstract thought; sports • Adulthood; 20–59 years Continued complex motor skills that wane after 40 years old • Older Adulthood; 60+ years Sarcopenia; Motor degradation; Speed deficits 7.7 Categories of motor skills stability: need this before moving through other stages ability to maintain static postural control where pt has fixed base of support or fixed center of mass • ex: maintaining stability in prone position w/ head erect, or excelling in sports static postural control: needed before movements can be controlled • fixed BOS • fixed COM • postural orientation with COM over BOS documentation in relation to stability • look @ base of support: feet, bottom, or hands • document actual position of patient (recognize if COM is in BOS) - noting loss of balance or amount of sway - document UE/LE stabilization - assistance required & environment play roles in amount of stab pt can achieve memorize controlled mobility/dynamic postural control = subset of stability/defined as ability to maintain postural stability while parts of body moving relative fixed base while limbs move • ex: reaching with feet planted Documentation: controlled mobility • stability maintained in weight bearing segments • control of dynamically moving segments • level/type assistance • environmental constraints min assist: 25 % PT help mod assist: 50% assist max assist: 75% mobility: individual able to move/change position that both base of support & center of mass moving ex: baby rolling to sitting up from supine requirements for mobility • dynamic postural control (roll from supine to prone) • reactive balance: ability to respond to environmental stim (somebody shoves u, or predict upcoming challenge like deciding how much is going to weigh when u pick it up) • movement initiation / termination • any hesitancy toward movement or difficulty in stopping a movement skill • coordinated sequences for attaining an action goal • require voluntary control • direct result of practice • adaptation of task demands w/ environment • include categories of discrete, serial & continuous • high quality performance skill/mob documentation more emphasis on environmental factors • summary: stability postural control • static: ability to maintain appropriate posture and control in non moving situations • dynamic: ability to maintain COM within a relatively fixed BOS while some body aspects moving mobility • both COM and BOS moving skill • complex motor tasks with an environmental influence 7.8 Motor Skills Classification Motor skills purposeful behaviors that are learned by repetitive practice and modified based on changing environments 1st Classification- Gross Motor Skills skills involve large muscle groups that are typically acquired in childhood • skills are not meant to for precise mvmnts like walking, standing and rolling 2nd Classification- Fine Motor Skills more precise in nature as compared to gross motor skills • more related to activities of daily living (ADLs) like: teeth brushing , buttoning pants/shirt, and typing skills require hand-eye coordination for things like bouncing a tennis ball • involve much smaller muscles of hands or feet 3rd Classification- Closed Motor Skills easiest type of skills to begin with as they occur w/in a relatively unchanging environment • there is stability w/in the environment w regard to a quiet, predictable environment that does not have obstacles • Best to begin with for many pts as they allow for concentration & they decrease the rigor associated with an intervention ex: walking in a hallway that is quiet and flat or ex: limiting noise and lights for someone who has suffered a concussion during their time of intervention. 4th Classification- Open Motor Skills are unpredictable in nature • w this tasks, the environment becomes more of a challenge • in order to make a task harder for pts, we can think of trying to veer more toward an open environment Degrees of freedom number of separate independent dimensions of mvmnt that must be controlled by an individual Gentiles Taxonimy provides structure to changes in both the inherent characteristics of a task or activity • difficulty level is such that the easier tasks are toward the top left, and the task get harder as you move Summary • Gross vs Fine motor skills • Closed vs Open motor skills • Increased degrees of freedom increase complexity • Challenge/regress interventions using Gentile’s Taxonomy Remind me look for chart bc hers is covered