Motor Control:
Translating Research
into Clinical Practice, 5th ed
Anne Shumway-Cook
Marjorie Woollacott
_______________________
CHAPTER 1:
Motor Control: Issues and Theories
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Introduction
• What Is Motor Control?
• Studying the nature of movement and how movement is controlled
• Ability to regulate or direct the mechanisms essential to movement
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Introduction
• Why Should Therapists Study Motor
Control?
• Physical and occupational therapists: applied motor control physiologists
• Understanding motor control and nature and control of normal and
abnormal movement critical to clinical practice
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Understanding the Nature of Movement
<Insert Figure 1.1>
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Understanding the Nature of Movement
• Individual Systems Underlying Motor Control
• Motor/Actions Systems: neuromuscular and biomechanical systems
• Study of motor systems that control functional movement
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Understanding the Nature of Movement
• Individual Systems Underlying Motor Control
• Sensory/Perceptual Systems
• Essential to control of functional movement
• Perception: integration of sensory impressions into psychologically
meaningful information
• Provide information about state of the body
• Integral to ability to act effectively within an environment
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Understanding the Nature of Movement
• Individual Systems Underlying Motor Control
• Cognitive Systems
• Essential to motor control
• Attention, planning, problem solving, motivation, and emotional
aspects of motor control that underlie establishment of intent or
goals
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Understanding the Nature of Movement
• Task Constraints on Movement Control
• Type of task performed has great impact on neural organization of
movement
• Open movement: adapt movement strategies to constantly changing
and unpredictable environment
• Closed movement: relatively fixed or predictable environments
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Understanding the Nature of Movement
• Environmental Constraints on Movement Control
• CNS consideration of attributes of environment when planning task-
specific movements
• Regulatory features: aspects of environment that shape movement
itself
• Nonregulatory: features of environment may affect performance,
but movement does not have to conform to these features
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The Control of Movement: Theories of
Motor Control
• Theory of Motor Control
• Group of abstract ideas about control of movement
• Theory
• Set of interconnected statements that describe unobservable structures
or processes and relate them to each other and to observable events
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The Control of Movement: Theories of
Motor Control
• Value of Theory to Practice
• Framework for interpreting behavior
• Guide for clinical action
• New ideas
• Working hypotheses for examination and intervention
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The Control of Movement: Theories of
Motor Control
• Reflex Theory
• Sir Charles Sherrington: complex behavior explained through combined
action of individual reflexes chained together
• Structure of a reflex: receptor, conductor, effector
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The Control of Movement: Theories of
Motor Control
• Reflex Theory
• Limitations
• Reflex activated by outside agent
• Does not explain and predict movement that occurs in absence of
sensory stimulus
• Does not explain fast movements
• Fails to explain single stimulus can result in varying responses
• Does not explain ability to produce novel movements
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The Control of Movement: Theories of
Motor Control
• Reflex Theory
• Clinical Implications
• Strategies to test reflexes should allow therapists to predict function
• Patient’s movement behaviors interpreted in terms of presence or
absence of controlling reflexes
• Enhancing or reducing effect of reflexes during motor tasks
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The Control of Movement: Theories of
Motor Control
• Hierarchical Theory
• Organizational control top down; each successively higher level exerts
control over level below it
• Vertical hierarchy: lines of control do not cross; never bottom-up control
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The Control of Movement: Theories of
Motor Control
• Hierarchical Theory
• Limitations
• Cannot explain dominance of reflex behavior in certain situations in
normal adults
• Clinical Implications
• Explain disordered motor control in patients with neurologic
disorders
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The Control of Movement: Theories of
Motor Control
<Insert Figure 1.5>
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The Control of Movement: Theories of
Motor Control
• Motor Programming Theories
• If motor response is removed from its stimulus, it’s left with concept of
central motor pattern
• Central motor pattern (motor program): more flexible than concept of a
reflex; activated by sensory stimuli or central processes
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The Control of Movement: Theories of
Motor Control
• Motor Programming Theories
• Limitations
• Cannot be considered sole determinant of action
• Clinical Implications
• Allowed clinicians to move beyond reflex explanation for disordered
motor control
• Retraining movements important to functional task, not just on
reeducating specific muscles in isolation
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The Control of Movement: Theories of
Motor Control
• System Theories
• Bernstein: you cannot understand neural control of movement without
understanding of system you are moving and the external and internal
forces acting on the body
• Coordination of movement: process of mastering redundant degrees of
freedom of moving organism
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The Control of Movement: Theories of
Motor Control
• System Theories
• Bernstein: synergies play role in solving degrees of freedom problem
• Principle of abundance: synergies not used by nervous system to
eliminate redundant degrees of freedom, but to ensure flexible and
stable performance of motor tasks
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The Control of Movement: Theories of
Motor Control
• System Theories
• Principle of self-organization: when a system of individual parts comes
together, its elements behave collectively in an ordered way
• Nonlinear system: output is not proportional to its input
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The Control of Movement: Theories of
Motor Control
• System Theories
• Dynamic theory: new movement emerges because of a critical change in
one of the systems (control parameter)
• Control parameter: variable that regulates change in behavior of entire
system
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The Control of Movement: Theories of
Motor Control
• System Theories
• Dynamic theory: variability not considered result of error, but as
necessary condition of optimal function
• Small amount of variability indicates highly stable behavior
• Attractor states: highly stable, preferred patterns of movement
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The Control of Movement: Theories of
Motor Control
• System Theories
• Limitations
• Presumption nervous system less important role in determining
animal’s behavior
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The Control of Movement: Theories of
Motor Control
• System Theories
• Clinical Implications
• Stresses understanding body as mechanical system
• Movement is emergent property
• Retraining movement in patients with neural pathology
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The Control of Movement: Theories of
Motor Control
• Ecological Theory
• Motor control evolved so animals could cope with environment around
them
• Broadened understanding of nervous system function
• Perception/action system actively explores environment to satisfy its own
goals
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The Control of Movement: Theories of
Motor Control
• Ecological Theory
• Limitations
• Research emphasis shifted from nervous system to
organism/environment interface
• Clinical Implications
• Describing individual as active explorer of environment
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The Control of Movement: Theories of
Motor Control
• Which Theory of Motor Control Is Best?
• There is no one theory that has it all
• Best theory of motor control: one that combines elements from all
theories presented
• Systems approach: movement emerges from interaction between
individual, task, and environment in which task is being carried out
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Parallel Development of Clinical Practice
and Scientific Theory
• Scientific Theory
• Provides framework that allows integration of practical ideas into
coherent philosophy for intervention
• Clinical Practice
• Evolves in parallel with scientific theory, as clinicians assimilate changes in
scientific theory and apply them to practice
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Parallel Development of Clinical Practice
and Scientific Theory
• Neurologic Rehabilitation: Reflex-Based Neurofacilitation Approaches
• Neurofacilitation: retraining motor control through techniques designed
to facilitate and/or inhibit different movement patterns
• Facilitation: intervention techniques that increase patient’s ability to
move in ways judged to be appropriate by clinician
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Parallel Development of Clinical Practice
and Scientific Theory
• Task-Oriented Approach
• Normal movement: interaction among many different systems, each
contributing different aspects of control
• Movement organized around behavioral goal and constrained by
environment
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Parallel Development of Clinical Practice
and Scientific Theory
• Task-Oriented Approach
• Abnormal motor control: movement problems result from impairments
within one or more of systems controlling movement
• Adaptation to changes in environmental context critical part of recovery
of function
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Parallel Development of Clinical Practice
and Scientific Theory
• Task-Oriented Approach
• Underlying Assumptions
• Normal movement interaction among different systems, each
contributing aspects of control
• Movement organized around behavioral goal and constrained by
environment
• Movement problems from impairments within one or more of
systems controlling movement
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Parallel Development of Clinical Practice
and Scientific Theory
• Task-Oriented Approach
• Clinical Applications
• When retraining movement control, essential to work on identifiable
functional tasks
• Assumes patients learn by actively attempting to solve problems
inherent in a functional task
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