Prepared by:
Dr. Qindeel Shafaq
Neurological rehabilitation approaches can be
used to improve motor control and motor
learning in neurological patients
Motor control is ability of CNS to control and
direct the neuromotor system in purposeful
movements and posture adjustment
Motor learning is acquisition of skilled
movement based on previous experience
• Theories of Motor Control describe the
viewpoints regarding how movement is
controlled.
• A theory of motor control is a group of
abstract ideas about the control of
movement.
• A theory is a set of interconnected statements
that describes unobservable structure or
processes and relate them to each other and
to observable events.
Do theories really influence what therapist do
with their patients?
Yes, rehabilitation practice reflects the
theories or basic ideas we have about the
cause and nature of function and dysfunction.
Theory provides;
• A guide for clinical action
• New Ideas; dynamic and evolving
Reflex Theory
Hierarchical Theory
Motor Programing Theory
Systems Theory
Ecological Theory
• Stimulus applied to
muscles or joints results in
responses that are called
reflex movements
• 3 parts:
1.receptor,
2.pathway,
3.effector
• Reflexes were the building
blocks of complex behavior
• Reflexes worked together
or in sequence to achieve a
goal
Movement can be reflexive(a stimulus is
provided and movement occurs without
conscious thought),
Movement can be volitional(A conscious
decision to move like to get out of bed) or
combination
There are number of limitations of a reflex theory of Motor
Control:
1. Reflexes can not be considered as the Basic unit
of behavior Because Reflex must be activated by
an outside agent
2. It does not explain and predict movement that
occurs in the Absence of sensory stimulus as
animal move in a relatively coordinated fashion
in the absence of sensory input.
3. doesnt explain: how people can produce
movements spontaneously, wihtout any change
in sensory input, how diff responses can result
from the same stimulus
There are Higher, Middle, and Lower
levels of motor control
Top down approach
the motor cortex , midbrain and spinal
level of motor function
As the child grows, the movement is
controlled by successively more complex
level of CNS
AT the time of birth SC develop, 6-9
months mid brain develop and 12-15
months cortex matures
Limitations: Only focus on CNS e.g. a
patient comes with frozen shoulder due
to musculoskeletal system pathology
Neuromaturational Theory
doesnt explain why sometimes health
individuals control of motor output is
dominated by lower levels
- examples: some kids learn to walk before
they can crawl
It focus on interaction of many different
systems of body that contribute to movement
Forces needed to generate movement are
different depending upon 2 factors:
1. the environment in which action occurs
2. internal forces generated to complete the
action
E.g. to open a door
Different systems decide how to accomplish
the task
movement patterns or rules of action are stored
in the CNS as motor programs and can either be
triggered by sensory input or initiated centrally
- addresses some of the limitations of the reflex
theory - explains how movements can occur in
the absence of sensory input and allows for
spontaneous and voluntary movements\
there are central pattern generators(CPG) in the
CNS
exist in the organism at birth, such as CPGs or
can be learned, such as postural strategies or
handwriting
Instead of the CNS being just and always “reactive”,
this theory states that CNS can act on its own as a
result of prepared motor programs
There is an abstract motor program stored on the
higher levels and sent down to be interpreted and
carried out depending on the situation and context.
The term motor program may be used to identify a
central pattern generator (CPG) that is a specific
neural circuit represents neural connections
Individual can still act in the absence of a stimulus
Higher level stores the rules for generating
movements patterns so that we can perform the tasks
with a variety of effector systems
Intervention invovles teaching the pt new
motor programs or teaching the pt to apply
surviving motor programs to perform desired
activities
Examples for using motor program theory:
- if patient does not use an ankle strategy
- if a patient who had a stroke can only move
the arm in a flexor synergy
teach the pt to perform this motor program
- teach him a variety of other motor
programs
Motor control evolved so that animals could cope with the
environment around them.
Motor control evolved to enable organisms to interact with
their environments in order to perform goal-oriented
behavior.
LIMITATION:
Emphasis has shifted from the nervous system
to the organism- environment interaction
doesnt address other aspects of neuromotor control
Affordance n opportunity for action that the environment
offers to the organism (living thing)
- the concept of affordances takes into account
characteristics of the organsim as well as characteristics of
the environment
Movement in the environment allows the
individual to translate meaningless sensory input
(eg color and light) into meaningful perception
(objects and surfaces)
Therapists must:
Evaluate pt's ability to perceive the relevant
features of the environment
provide intervention to facilitate pts perception
evaluates the extent to which a pt is interpreting
the environment in a way that enables the pt to
be successful at goal-oriented behavior
Neurological treatment to improve motor control have been
developed taking into consideration:
1-Primitive approaches
CNS is hierarchically organized.
Movement is controlled by sensory stimulation and through
encoded motor programs of higher centers.
Development and learning results from changes in CNS
2-Contemporary approaches
Emphasize on systems theory.
It stresses learning the entire task rather than discrete parts.
Enhance problem solving abilities by allowing persons to find
their own solutions to motor problems rather than relying on
instructions.
Focus on functional tasks performed in most efficient way
Neurodevelopmental approaches focus on
learning through:
1. task repetition
2. with constant assistance
3. and feedback from therapist
Emphasize developmental progression from
learning parts of task to combine parts into
whole and perform movement
Recovery occurs from proximal to distal
control and from reflex to voluntary control
Remediation and facilitation approaches
Roods approach
Bobath approach(neurodevelopmental theory)
Kabat, Knott, Voss (Proprioception
neuromuscular facilitation PNF Approach).
Bernstorm Approach.
Sensory Integration Therapy
• Motor Control / Motor Learning Approach
• Neural plasticity/ adoptability
• Constraint induced movement therapy (CIMT)
• Modified Constrained Induced Movement Therapy
(mCIMT)
• Task-Related Training Approach
• Compensatory Training Approach
• Normal Reach, Grasp and Manipulation.
Rood Approach – develop by Margret Rood (1967)
Bobath Approach – developed by Karl and Berta
Bobath (1975).
Brunnstrom Approach – Developed by Signe
Brunnstrom (1966).
Proprioception Neuromuscular facilitation (PNF) -
developed by Kabat and Knott. (1954) and expanded
by Voss et al (1985).
Sensory Integration Therapy developed by Ayres
(1972).
These approaches were based largely on assumptions
drawn from both the reflex and hierarchical theories
of Motor Control.
Concept of neuro-facilitation
• Retraining motor control through techniques
designed to facilitate and/or inhibit different
movement patterns.
• Facilitation refers to intervention techniques that
increase the patients ability to move in a way
judged to be appropriate by the clinicians.
• To encourage normal reflexes, muscle tone,
movement
• Inhibitory Techniques decrease the patient’s use
of movement pattern considered to be abnormal.
• To inhibit abnormal reflexes, muscle tone,
movement
Clinical Practice developed based on
assumptions regarding:
1. The nature and cause of Normal motor
Control
2. Abnormal Motor Control
3. And Recovery of Functions.
Then key assumptions are :
1. Functional skills will automatically return once
abnormal moment patterns are inhibited and normal
movement pattern facilitated.
2. Repetition of these normal movement pattern will
automatically transfer to functional tasks.
Examination of motor control focus on:
1. The presence or absence of normal and abnormal
reflexes.
2. Interventions directed at modifying reflexes.
3. The importance of sensory input for stimulating
normal motor output suggest an intervention
focuses on modifying the CNS through sensory
stimulation.
This approaches suggest that normal
movement results from the chain of reflexes
organized with CNS
Thus the emphasis on incoming sensory
information stimulates and drive normal
moment pattern
The physiological basis for abnormal motor
control suggest a disruption of normal reflex
mechanism resulting in abnormal moment
control.
