Post on 07-Apr-2018
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Motor Control
Approaches
Neurodevelopmental Theorists/Theories:Catherine Trombly, Task-Focused,
Motor Learning, Margaret Rood,The Bobaths (NDT), Signe Brunnstrom, PNF,
Carr & SheppardReference: Cole & Tufano
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
FOCUS
Neuroanatomy & Neurophysiology
Principles of Neuroscience
Treatment of paralysis, flaccidity & spasticity
of muscles resulting from damage or diseaseto the central nervous system
Treatment of Movement disorders
Framework focus: body structures, bodyfunctions, process skills, contexts, and activitydemands.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Basic Assumptions
Each theorist has a somewhat differentapproach, assessment technique, andintervention strategies.
Most neurodevelopmental approachesrequire specialized training.
These theorists use a behavioral learningapproach to motor control based on thesequence normal developmental.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Assumptions: Traditional Theories
The remainder of the theories are currentlyknown as hierarchical or traditional theories
of motor control, including
Rood The Bobaths NDT
Brunnstrom
Proprioceptive Neuromuscular Facilitation (PNF) Carr & Shepherd
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Basic Assumptions, cont.
Margaret Rood, the earliest theorist, is bothan occupational and physical therapist. Shestresses the importance of early reflexes inthe relearning of motor control.
Rood first used her techniques effectively withchildren with cerebral palsy.
She believed that a baby uses reflexes to
move initially but modifies them andeventually replaces the reflexes withvoluntary movement.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Rood, 4 Basic Principles
Sensory input is required for normalization oftone and evocation of desired muscularresponses.
Sensory motor control is developmentallybased.
Movement is purposeful, engagement inactivities is required to produce a normal
response. Repetition of movement is necessary for
learning.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Rood, cont.
Facilitation techniques: light stroking,brushing, icing, and joint compression areused to facilitate movement.
Inhibition techniques: joint approximation(light compression), neutral warmth, pressureon tendon insertion, and slow rhythmicalmovement are used to inhibit unwanted
movement (i.e., spasticity).
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Rood identified 8 ontogenetic motor
patterns in the following sequence
1. Supine withdrawal
2. Segmental rolling
3. Pivot prone (prone extension)
4. Neck co-contraction
5. Supporting self on elbows
6. All fours movement patterns
7. Standing
8. Walking
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Rood, cont.
Positioning is a primary concern, especiallywhen little voluntary control exists.
Extensive use of mats, bolsters, balls, and
other specialized equipment is common in theRood approach.
Movement patterns can be incorporated intogames, such as tug of war, to provide anoccupational focus to regaining motor control.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
The Bobaths, Drs. K. (physiologist) &
B. (physiotherapist), British - 1948
AKA Neurodevelopment Treatment (NDT)
Originally designed their therapy techniquesfor persons with hemiplegia (caused by CVA,
or stroke) Also worked with children with cerebral palsy
NDT focuses on the sensation of movement;
it is not movement itself, but the sensation ofmovement, that is learned and remembered
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Bobaths, cont.
Reflex inhibiting postures are used to inhibit primitivereflexes (RIPs).
Sensory stimulation is regulated with great care.
Weight bearing, placing and holding, tapping andjoint compression are used to activate normalmovement and posture.
Compensation (such as one-handed feeding anddressing) using the noninvolved side is discouragedduring recovery from stroke because it results ininactivity and poor recovery on the involved(paralyzed) side.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Brunnstrom, Signe - physical therapist,
1950-1970s
Focuses on reflexes which provide the componentsof normal movement
Proprioceptive (resistive) & exteroceptive (tactile)stimulation are used to elicit reflexes in therecovering adult hemiplegic
Patients are encouraged to think about themovement and to gain control
Brunnstrom also uses associated reactions andsynergies
A synergy is a total flexion or extension movement ofa joint or limb
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Brunnstroms 6 Stages of Recovery
1. Flaccidity, no voluntary movement
2. Synergies or minimal voluntary movement
3. Synergies performed voluntarily
4. Some deviation from synergy
5. Independent or isolated movement
6. Individual joint movement nearly normal with
minimal spasticity
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Proprioceptive Neuromuscular
Facilitation (PNF)
Developed by Herman Kabat, PhD, MD andmodified by many contributors since the 40s
Uses diagonal & spiraling patterns of
movement Guides thinking about the sequence of
normal development
Eleven basic principles (see Cole, p. 242)
Uses two diagonal patterns crossing the mid-line for each major body part, oftenincorporating verbal commands.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Carr & Shepherds Motor Relearning
Programme (for persons with stroke)
Contemporary approach (1990s)
Uses dynamical systems model of motorcontrol
Emphasize interaction between performerand environment
Does not accept the hierarchical sequence ofmotor relearning proposed by other theorists
Like other theorists, Carr & Shepherddiscourage the early use of compensatorystrategies
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Carr & Shepherd, cont.
Clients taught to avoid abnormalcompensation for weak muscles
Treatment techniques based on extensive
study of how normal movement occurs duringfunctional tasks
Acknowledge critical role of cognition in motorlearning
Movement patterns practiced in context oftasks, rather than exercises
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Carr & Shepherd, 7 Categories of
Functional Daily Activities
1. Upper limb function
2. Orofacial function
3. Sitting up over the side of the bed
4. Balanced sitting
5. Standing up & sitting down
6. Balanced standing
7. Walking
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Function and Dysfunction
Function assumes the ability to plan andexecute normal voluntary movement
Dysfunction is viewed as neurophysiologically
based; CNS deficits result in abnormalmuscle tone and lack of voluntary purposefulmovement
Each theorist has a separate way to measurethe extent of dysfunction
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Change
Changes in motor control are physiologically induced.
Engagement in activity can produce physiologicalchange leading to motor control
Individuals relearn movement patterns in apredictable developmental sequence
Theorists differ in the use of early reflexes to producemovement
Handling, sensory stimulation, and manipulation ofaffected muscles can facilitate motor relearning
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Assessment and Treatment
Specific to each theorist
These traditional models have also been
called reflex-hierarchical or
neuromaturational because they are basedon relearning movement in a normal
developmental sequence.
New evidence tends to disprove theeffectiveness of these approaches.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Transition from Motor Control to
Motor Learning
Began in 1990s with classic article byMathiowetz & Bass Haugen, and Tromblys
Slagle Lecture.
The following introduces Tromblys model aschanging OTs thinking about establishing or
restoring voluntary movement.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Task Focused Approach: Trombly
Occupational Functioning Model introducedin 1995
Descending hierarchy of tasks & roles
Goal is to develop competency & self-esteem
Context & environment surround and -permeate all levels of the hierarchy
When clients have mastered the foundation
capacities, they move on to task-focusedinterventions (individual or group)
Trombly calls this occupation as end
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Task Focused Approach, cont.
Five general principles:
1. Client centered focus
2. Occupation based focus
3. Person & Environment enablers/barriers
4. Practice & Feedback - encoding
5. General treatment goals role fulfillment,
problem-solving skills re: best way toaccomplish valued tasks
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Dynamical Systems Theory &
Trombly
Applied to physical disabilities, this theorycombines reflexive and voluntary motorcontrol
CNS receives/interprets multiple cues fromthe environment and involves multiplesubsystems when planning to reach desiredgoals (preferred tasks & roles)
Occupational performance is a product of theinteraction between the person, the task, andmultiple environmental factors.
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Assumptions: Task Focused Approach
Tromblys task focused approach is based ontheories of motor learning and dynamicalsystems theory.
Meaningful tasks are graded and sequencedaccording to each clients needs & abilities.
Each task requires experimentation usingdifferent strategies & contexts in order for
motor skills to be learned. Currently the preferred approach in OT for
intervention after stroke/CNS damage
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,b d C l M (2008) A li d h i i i l h i l h Th f NJ SLACK I d
The End
Next time: Biomechanical and RehabilitationFOR