Therapeutic Interventions for Impaired Motor Control - Mobility.pdf

Therapeutic Interventions for Impaired Motor Control - Mobility JILL SEALE, PT, P hD, NCS Objectives Identify the key components of skilled motor control-movement Describe disorders of motor control –movement and resulting impairments Identify and evaluate interventions to improve motor control move...

Therapeutic Interventions for Impaired Motor Control - Mobility JILL SEALE, PT, P hD, NCS Objectives Identify the key components of skilled motor control-movement Describe disorders of motor control –movement and resulting impairments Identify and evaluate interventions to improve motor control movement Motor Control - Stability Motor Control - Mobility Characterizing Movement Discrete versus continuous Base of Support (BOS) ◦ Stability ◦ Mobility Manipulation Interaction of Task with Environment ◦ Open versus closed Overall Goal: Mastering Degrees of Freedom Task (Skill) Characteristics Movement Characteristics Simple to complex Variability What are some movement characteristics? What influences/impacts these characteristics? “To be optimally functional, humans are required to quickly and effectively generate movements in ways that are extremely flexible and adaptable” MOTOR CONTROL (or motor control for movement) Planning, initiating, sustaining, and efficiently and accurately controlling movement Abnormal Motor Control - Movement Impairments ◦ Signs/symptoms ◦ Positive ◦ Negative ◦ Primary v secondary impairments ◦ Primary – Direct result of pathology ◦ Example: paralysis, loss of sensation ◦ Secondary – Consequence of the primary impairment ◦ Example: limited joint ROM, changes in muscle tone 3 Primary Movement Issues Activation and Sequencing Problems ◦ Synergies – normal and abnormal ◦ Coactivation ◦ Impaired interjoint coordination Timing Problems ◦ Reaction time, movement time, termination time Scaling Problems ◦ Dysmetria Effects of Various Pathologies on Movement Stroke ◦ Mostly contralateral to lesion ◦ Abnormal tone and reflexes, decreased force production/weakness, decreased endurance, abnormal postural adjustments ◦ Abnormal synergies, incorrect timing, poor interjoint coordination ◦ Scaling problems if stroke is in cerebellum or BG Effects of Various Pathologies on Movement TBI ◦ Vary by location and extent of injury ◦ Problems with muscle activation, sequencing and timing ◦ Ataxia if pathology in or connected to cerebellum PD ◦ Rigidity, bradykinesia, tremor, postural instability ◦ Problems with initiation and termination ◦ Hypometria CP: more on this in pedi MS ◦ Lots of variability dependent on lesion location ◦ Spasticity, weakness, impaired balance, tremors and other coordination issues Therapeutic Interventions for Impaired Motor Control - Mobility JILL SEALE, PT, P hD, NCS Preparatory Interventions PNF NDT Constraint-induced movement therapy ◦ Repetitive, task-oriented training ◦ Adherence-enhancing behavioral methods ◦ Constraining use of less impaired UE NMES Technology – robotics and VR Some Application Tips Experience success in improving MC with ULTIMATE goal of enhancing motor control during function Manipulate and grade: complexity, environment, timing Single joint is easier initially Midrange tasks are easier Stability, timing, and directional changes add complexity Interventions in Functional Activities UE Functional Activity – progression to functional task and personal control of movement LE Functional Activity – focus on use in functional mobility tasks Locomotor Training – “physiologically based approach to gait rehab CPG incorporating intrinsic mechanisms of spinal cord” VR – Immersive or non-immersive; various environments Mirror therapy – use limb movement of non paretic side to appear as if paretic side is moving https://www.saebo.com/blog/benefits-virtual-reality-strokerehabilitation/ https://www.mayoclinic.org/tests-procedures/locomotortraining-for-spinal-cord-injury/about/pac-20394608 Fell text p 827 Interventions Beyond “Therapy” “transfer package” component ◦ Needs to be safe, able to be done in home/community ◦ Education on movements ◦ Development of problem solving ◦ Caregivers involved – goals, when to assist or not assist How do we make this happen?? In Summary Movement happens on a continuum from simple to complex A wide variety of movement disorders occur in neuromuscular dysfunction - some predictable, some not so much Our patients need to be prepared for movement – need the mobility and stability No matter which intervention utilized, promotion of motor learning is key!