Therapeutic Interventions for Motor Control - Stability PDF

Therapeutic Interventions for Motor Control - Stability JILL SEALE, PT, P hD, NCS Preparatory Interventions Address Mobility ◦ Joint and neural mobility ◦ Muscle length Strength Sensory awareness What is the right approach? ◦ Neurofacilitation ◦ Task oriented approach, emphasis on motor learning PNF...

Therapeutic Interventions for Motor Control - Stability JILL SEALE, PT, P hD, NCS Preparatory Interventions Address Mobility ◦ Joint and neural mobility ◦ Muscle length Strength Sensory awareness What is the right approach? ◦ Neurofacilitation ◦ Task oriented approach, emphasis on motor learning PNF Example NDT Example Interventions Resistance exercise Weightbearing/Closed Chain Activities Postural exercise Biofeedback/E-stim Taping/strapping Splinting/bracing Pressure garments Body weight supported treadmill training WHY? Interventions Resistance exercise – build activation, possible irradiation of activation Weightbearing/Closed chain activities– approximation, increase activation Postural exercise- strengthening core muscles; often focus on extensors and cocontraction Biofeedback/E-stim – to increase activation and for motor learning Taping/strapping Decrease Degrees of Freedom Splinting/bracing Pressure garments – provide approximation, increase sensory stimulation Body weight supported treadmill training – decrease degrees of freedom, decrease task difficulty A Deeper Look at Closed vs Open Chain Functional Activities Why in the text are patients in lots of different positions to work on stability? ◦ ◦ ◦ ◦ ◦ ◦ ◦ Supine Side lying Quadruped Kneeling ½ kneeling Sitting Standing Focus on transitions ◦ Supine sit ◦ Sit stand ◦ QuadrupedKneelingHalf kneel Video Example In Summary Most (probably all) functional tasks require some degree of motor control – stability We (rehab therapists) often jump to the movement, neglecting the stability Requires more than just “strength” ◦ Grading of activation ◦ Coordination ◦ Sustaining ◦ Low degree of attention (mostly subconscious) Therapeutic Interventions for Motor Control - Stability JILL SEALE, PT, P hD, NCS Objectives Identify the functional impact of instability on motor control Discuss the origins of instability Plan how to examine and evaluate impaired motor control stability Identify strategies for intervention in persons with impaired motor control of stability Overview Motor Control – “neural regulation of motor behavior” – Fell text Motor control-stability (MC Stability): allows joint or segment to be stable when movement is not supposed to occur Coordination of neuromotor and musculoskeletal Joint stability: dynamic interactions of all muscles that surround target joint and gravitational forces to produce MC-Stability Graded co-activation in graded manner to prevent joint movement Joint stability = “foundation of purposeful and functional movements” – Fell text Paralysis = complete lack of ability to activate muscles to stabilize joint Where is damage? Primary motor cortex down through corticospinal tract Cerebellum Basal ganglia Sensory input from vestibular system, mechanoreceptors through dorsal columns Rood’s Sequence of Motor Development I. Mobility: free, flexible motion; range and speed II. Stability: co-contraction of agonists and antagonists; fixes part for weightbearing; allow for dynamic holding necessary for controlled mobility and skill III. Controlled Mobility: distal parts are fixed on support surface and proximal segment moves over fixed distal segment IV: Skill: distal part of extremity is free from support surface and coordinated movement of segment is superimposed on proximal stability Stability… where movement begins! Imagine… Trying to paint a picture with an unstable shoulder girdle… Attempting to stand on an ankle with medial/lateral instability Ascending or descending stairs with hip and/or trunk instability Kicking a soccer ball with R foot, but L knee is unstable “Experts do the basics well” Determining best treatment: Identify the limitations in function Should sound familiar! Determine the specific underlying impairments Prioritize the problems in an effective plan of care Examination How is instability impacting function? What is impact of this instability on specific movement components? On the rest of the body? Above and below instability? What is the likely cause versus the consequence? What other systems are involved? Tests and measures? Impairment measures? Evaluation Is instability direct cause of functional limitation? What are contributing factors? What are consequences (real and potential) of instability? Prioritize and address those that most limit function and can cause secondary impairments. Suggested Practice Patient Application – Examination, p 774 Complete the “Contemplate Clinical Decisions” questions I will provide my discussion over this in Week 3 Discussion Forum