OTH 204 Lecture 6-2 Motor Control PDF

Chapter 20 Motor Control Frames “If the client gives in to his neurological disorder, he will become an invalid. If he learns to retrain his hemiplegic side, he returns to life.” NATHAN, 1970  Motor Control Theories Use principles...

Chapter 20 Motor Control Frames “If the client gives in to his neurological disorder, he will become an invalid. If he learns to retrain his hemiplegic side, he returns to life.” NATHAN, 1970  Motor Control Theories Use principles of normal neurological development in a reflex-hierarchical or neuromaturational sequence for establishing or restoring functional movement. In today’s practice, traditional motor control approaches provide a backdrop for the occupational therapy task- oriented FOR's described in the next chapter.  Theorists Neurodevelopmental Theory (NDT) – Bobath, 1990 o 2nd most often used frame of reference in U.S. Sensorimotor approach – Rood, 1954 Proprioceptive neuromuscular facilitation (PNF) – Knott and Voss, 1968 Movement therapy – Brunnstrom, 1970  Focus: NDT Restoration of skilled voluntary movement for both children and adults with developmental or acquired neurological health conditions o Cerebral palsy o Hemiplegia caused by CVA Considered a preparatory or problem-solving approach  Theoretical Base Reductionism: Restoration of voluntary movement unrelated to occupation Bottom-up approach Theoretical concepts came from neurology, medicine, PT, and human development  Theoretical Base (cont.) Normal growth and development o Motor milestones o Reflex hierarchies o Attitudinal reflexes o Righting reflexes o Protective reflexes  Basic Assumptions of Neurodevelopmental Therapy Movement control progresses from head to foot (cephalocaudal), from trunk to limbs (proximal to distal), and from large to small (gross to fine) Children gradually gain control over primitive reflexes Children internalize the sensation of movement in recovery of movement; stability precedes mobility Stability is created by co-contraction of complementary (opposite) muscle groups Mobility represents a way to engage the environment After brain injury, abnormal movement and tone must be inhibited before normal movement and sensation can be restored Flaccidity Spasticity Splinter skills  Philosophical Tenets of Neurodevelopmental Therapy Treatment should be functionally oriented and integrated into ADL. Evaluation and treatment are an ongoing problem-solving process. Client and family needs should be respected and addressed in the treatment process. NDT treatment is based upon knowledge of normal movement, posture, tone, biomechanics, and sensorimotor processes, such as praxis. When possible, generalization of treatment should be sought by training the client and family in appropriate everyday activities. NDT is a holistic approach involving an interdisciplinary team. NDT is an individualized approach.  Function & Dysfunction Functional motor control: Capacity to perform voluntary skilled movements needed for everyday life Dysfunction: Unable to control their own movements o Lack of postural control o Abnormal tone o Generalized spasticity o Poor inhibition of nonfunctional movements o Sensory disturbances  Change & Motivation Change occurs through the application of specific techniques and strategies. o Handling o Inhibition techniques o Facilitation o Placement o Reflex-inhibiting patterns or postures (RIPs) Motivation is not addressed specifically.  Evaluation Assess and record functional movement capacities and limitations o Observation o Handling Evaluation involves collaborative goal setting with client and family  Intervention Stroke o NDT has typically discouraged compensation o Occupations are used as both means (to practice movement) and end (to accomplish desired tasks) Developmental Disabilities o Handling o Inhibition and facilitation to encourage normal movement Using Neurodevelopmental Therapy as a Problem Solving Strategy Case Study: Kenzie, p. 304-305