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170 Cards in this Set
- Front
- Back
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What is motor control?
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the ability to regulate or direct the mechanisms essential to movement
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Inputs into motor control
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CNS
- muscles - joints Sensory info from environment and within Perceptions of selves - task - environment |
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3 Factors of Movement
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1. Individual
2. Task 3. Environment |
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Factors that constrain movement (3)
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1. Action
2. Perception 3. Cognition |
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Task constraints on movement (7)
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1. Discrete
2. Continuous 3. Stability 4. Mobility 5. Manipulation 6. Open Movements 7. Closed Movements |
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1. Discrete
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beginning and end
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2. Continuous
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end point not inherent characteristic of task
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3. Stability
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stable base of support
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4. Mobility
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moving base of support
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5. Manipulation
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adding this increases demand for stability
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6. Open Movements
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performer adapts behavior within constantly changing environment
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7. Closed Movements
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stereotyped, fixed, predictable
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Environmental Constraints on Movement (2)
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1. Regulatory - shape the movement itself
2. Nonregulatory - may affect performance but movement does not have to conform |
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Theories of Motor Control (7)
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1. Reflex Theory
2. Hierarchal Theory 3. Motor Program Theory 4. Systems Theory 5. Dynamic Action Theory 6. Ecological Approach 7. Systems Approach |
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Reflex Theory
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- need 1) receptor, 2) conductor, 3) effector
- stimulus = response - movement: combination of reflexes |
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Limitations of Reflex Theory
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- does not explain movement in absence of sensory stimulus
- does not explain fast movement - single stimulus -> varying responses - does not explain novel movement |
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Hierarchal Theory: Hughlings Jackson
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- brain has higher (association area), middle (motor cortex), and lower (spinal levels) of motor function
- organizational control is top down |
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Hierarchal Theory: Rudolf Magnus
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- reflexes controlled by lower levels of neural hierarchy present only with cortical damage
- higher centers inhibit reflexes |
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Hierarchal Theory: Georg Schaltenbrand
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-appearance and disappearance of progression of hierarchically organized reflexes
- pathology results in persistence of primitive reflexes |
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Hierarchal Theory: Stephen Weisz
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- ontogeny of equilibrium reflexes in normally developing child
- relationship between reflexes and ability to walk, sit, stand |
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Hierarchal Theory: Arnold Gesell, Myrtle McGraw
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- detailed description of maturation of infants
- CNS maturation i primary agent for change in development |
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Cortex
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equilibrium reactions
bipedal function |
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Midbrain
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righting reactions
quadrupedal functions |
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Brainstem and SC
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primitive reflex
apedal function |
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Hierarchal Theory:
Current Thinking |
- importance of hierarchy
- each level can act on other levels - reflexes are one of many important processes |
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Hierarchal Theory: Limitations
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- cannot explain dominance of reflex behavior in certain situations in adults
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Motor Program Theory (Bernstein, Keele, Wilson, Grillner)
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- central motor pattern or program
- cats rhythm in absence of sensory - central pattern generators - spinally mediated motor programs |
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Motor Program Theory -
Limitations |
- CPG cannot replace importance of sensory input in control of movement
- cannot be considered as sole determinant of action |
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Systems Theory (Bernstein)
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- described body as mechanical system with many degrees of freedom
- subject to external and internal forces - CNS, musculoskeletal, and external forces |
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Dynamic Action Theory
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- self-organization (orderlessness to orderliness)
- Control Parameter - Attractor States: movement patterns stable or unstable |
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Dynamic Systems Model
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- melds Systems and Dynamic Action
- action results from interaction of physical and neural components - CNS, mechanical aspects of body, and environment |
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Ecological Approach
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- motor control evolved to deal with environment
- sensation not only important, but perception |
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Systems Approach
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- used today
- movement from interaction of individual, task, and environment - movement from interplay between perception, cognition, and action systems |
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Motor Learning
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study of acquisition and/or modification of movement
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Learning: definition
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process of acquiring knowledge about the world
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Motor Learning: definition
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set of processes associated with practice/experience leading to relatively permanent changes
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Performance
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temporary change seen during practice
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Factors affecting performance
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- fatigue
- anxiety - motivation |
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Types of Memory
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Long Term
- Non-declarative/implicit - Declarative/explicit |
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Non-declarative: Nonassociative
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when given a single stimulus repeatedly
- habituation: decrease in responsiveness - sensitization: increase in responsiveness following threat |
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Nondeclarative: Associative
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learns to predict relationships
- classical conditioning: pair 2 stimuli - operant conditioning: instrumental, trial and error |
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Nondeclarative: Procedural Learning
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learning tasks that can be performed automatically
- lots of attention to little attention |
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Declarative/Explicit
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- info that can be recalled
- requires attention, awareness, and reflection |
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Theories of Motor Learning
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1. Adam's Closed Loop Theory
2. Schmidt's Schema Theory 3. Ecological Theory |
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Adam's Closed Loop Theory
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- sensory feedback for ongoing production of skilled movement
- Memory and perceptual trace - Limitation: movement in the absence of sensory input |
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Memory and Perceptual Trace
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- selection and initiation of movement
- built up over period of practice and became internal reference for correctness |
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Schmidt's Schema Theory:
Schema Generalized Motor Program |
- abstract representation stored in memory following presentations of class of objects
- contains rules for creating spatial and temporal patterns of muscle activity |
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Schmidt's Schema Theory:
Available in STM after movement |
1. initial movement conditions
2. parameters used in generalized motor program 3. outcome of the movement, knowledge of results 4. sensory consequences of movement |
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Schmidt's Schema Theory:
Recall Schema Recognition Schema |
- used to select specific response, initial conditions and desired goals important
- used to evaluate response |
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Predictions of Schema Theory
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1. variability of practice should improve motor learning
2. particular movement may be produced accurately even if it has ever been made before |
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Ecological Theory
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motor learning process that increases coordination between perception and action that is consistent with task and environment
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Theories of Stages of Learning Motor Skills
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1. Fitts and Postner 3-Stage Model
2. Systems 3-Stage Model 3. Gentile's 2-Stage Model |
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Fitts and Postner 3-Stage Model
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1. Cognitive Stage - understand
2. Associative Stage - refine 3. Autonomous Stage - low attention |
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Systems 3-Stage Model
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emphasis on controlling d.o.f.
1. Novice - reduce d.o.f. 2. Advanced - release some d.o.f. 3. Expert - released all d.o.f. |
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Gentile's 2-Stage Model
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1. goal of learner is to develop understanding of task dynamics
2. fixation/diversification stage |
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When to Give Feedback: improvement in performance
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- provide feedback after every trial
- detrimental to learning |
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When to Give feedback: improvement in acquisition
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- provide feedback in summary
- better for learning |
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Massed vs Distributed Practice
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Massed - practice time greater than amount of rest (decreased performance on continuous tasks but increased on transfer tasks)
Distributed - rest =/> practice |
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Constant vs Variable
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constant: no change in order or speed (used with little variability in task)
Variable: change in variable (good for novel task) |
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Random vs Blocked
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random: practiced in no order (better whn task uses different patterns of coordination)
Blocked: specific task in block to another task in block (better during acquisition stage) |
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Whole vs Part Training
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- task can be broken into parts
- generally whole task needs to be practiced for learning to occur |
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Postural Control
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controlling the body's position in space for purposes of stability and orientation
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Postural Orientation
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ability to maintain appropriate relationship between the body segments, and between the body and environment for a task
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Postural Stability
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ability to control center of mass over base of support
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Center of Pressure
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center of distribution of the total force applied to the supporting surface
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Systems for Postural Control
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1. musculoskeletal
2. internal representations 3. adaptive mechanisms 4. anticipatory mechanisms 5. sensory strategies 6. individual sensory systems 7. neuro-muscular synergies |
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Adaptive Postural Control
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modifying the sensory and motor systems in response to changing tasks and environmental demands
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Quiet Stance
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postural stability or balance ability to maintain the projected COM within the limits of BOS
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Quiet Stance
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- small amounts of postural sway
- Alignment - Muscle Tone - Postural Tone |
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Perturbed Stance
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- Feedback Control
- Feedforward Control - Synergy |
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Ankle Strategy
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forward: gastrocs, hamstrings, paraspinal
backward: anterior tib, quads, abdominals - used when perturbation is small and support surface is firm |
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Hip Strategy
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- forward: abdominal muscles and quads
- faster perturbations or when support surface is smaller |
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Stepping Strategy
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- used when other strategies are not enough
- organized distal to proximal |
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Mediolateral Stability
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- mostly hip
- proximal to distal - active muscles: glut medius and tensor fascia latae and adductors |
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Multidirectional Stability
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- uses muscle synergies
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Perceptual Systems
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1. Senses (visual, vestibular, proprioception)
2. Somatosensory (proprioception, cutaneous, joint receptors) 3. Vestibular (position and movement of head with respect to gravity and inertial forces) |
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Intermodal Theory of Sensory Organization
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- all 3 systems are equal
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Sensory Weighting Hypothesis
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dependent upon situation, each system may carry a different weight
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Preparatory phase for movement
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- postural muscles activated more than 50 msecs in advance of prime movers
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Compensatory Phase
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- postural muscles again activated after prime movers, in feedback manner
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Central Set
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state of the nervous system that is influenced or determined by the context of the task
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Theories of Developing Postural Control
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1. Reflex Hierarchal Theory
2. New Models Based on Examination |
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Reflex Hierarchal Theory
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- attitudinal reflexes
- righting reactions - balance and protective reactions |
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ATNR
STNR TLR |
asymmetric tonic neck reflex
symmetric tonic neck reflex tonic labyrinthine reflex |
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Righting Reactions (5)
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1. optical righting
2. labyrinthine righting 3. body on head righting 4. neck-on-body righting 5. body-on-body righting |
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Three stages of adolescence
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1. Early adolescence (10 to 13 y/o)
2. Middle adolescence (14 to 16 y/o) 3. Late adolescence (17 to 21 y/o) |
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Four major changes associated with puberty
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1. rapid physical growth
2. changes in body proportions 3. development of primary sex characteristics 4. development of secondary sex characteristics |
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asynchrony
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growth is in different rates for different parts of the body
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Major endocrine axes affecting growth
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1. hypothalamic-pituitary-gonadal (HPG)
2. hypothalamic-pituitary-adrenal (HPA) 3. growth hormone (GH) |
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gonadarche
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girls: thelarche (onset of breast budding)
boys: testicular enlargement |
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adrenarche
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girls: pubarche - terminal sexual hair (influence of androgens)
boys:both testicular and adrenal androgens contribute to growth of terminal hair |
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Thelarche
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earliest sign of puberty in girls (lasts about 4 years)
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menarche
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first menstruation (age 9-15 years)
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Height velocity
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boys - 13 cm average per year
girls - 8.3 cm average per year |
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Puberty weight gain accounts for about ___% of an individual's ideal adult body weight
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50%
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Determinants of BMD
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1. physical activity level
2. heredity 3. nutrition 4. endocrine function 5. other lifestyle factors |
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Brain weight
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- last brain spurt is around 18 years of age
- reaches 100% of weight by end of adolescence |
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Early Adolescence (psychosocial)
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1. beginning of the shift from dependence on parents to independence
2. preoccupied with own image 3. peer group involvement 4. identity development |
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Middle Adolescence
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1. independence-dependence struggle more prevalent
2. greater acceptance and comfort with body 3. role of peer group is most apparent |
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Late Adolescence
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- firmer identity
- greater ability to delay gratification - better ability to think ideas through - more stable interests - greater ability to make independent decisions and compromises |
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Top 3 leading cuses of death in adolescents
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1. accidents
2. homicide 3. suicide |
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obesity
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BMI of 30 or higher
(wt/ht^2 = kg/m^2) |
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obesity in children
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children with BMI at or above 95% of age and gender references
- 85-94% at great risk |
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avg % of calories from fat
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children 6-11: 32.9%
children 12-19: 32% |
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Top 10 items consumed by adolescents
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1. soft drinks
2. low fat milk 3. fruit drinks 4. whole milk 5. pizza/pasta 6. hamburgers 7. french fries 8. sugars/sweets 9. cakes/cookies 10. non-citrus juices |
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Causes for Obesity
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- eating out
- decreased physical activity - increased caloric consumption |
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3 types of idiopathic scoliosis
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1. infantile scoliosis (birth to 3 yo)
2. Juvenile scoliosis (3-9 yo) 3. Adolescent Idiopathic Scoliosis ( most common - 10 yo to skeletal maturity) |
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What measures degree of abnormality of spine
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- Cobb method of radiographic measurement of scoliosis
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Management for mild scoliosis curve
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- exercise to improve flexibility and strength of spinal muscles
- follow-up every 6 mos - may stay same, get better, or worse |
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Management for moderate scoliosis curve
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- getting worse rapidly
- exercise + brace |
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Treatment for severe scoliosis curve
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- surgery
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The Risser Sign:
Risser 1 Risser 2 Risser 3 Risser 4 Risser 5 |
estimate of how much skeletal growth remaining
- ossification of the lateral quarter - ossification of the lateral half - ossification of the lateral 3/4 - complete ossification without fusion - fusion of the ossified apophysis to the ilium |
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Slipped Capital Femoral Epiphysis
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- weak link in adolescent musculotendinous unit
- more common in overweight/obese - walk with external rotation and abduction |
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Apophyseal avulsion fractures
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- occur more frequently than those to the epiphysis
- occur when traction applied to apophysis - common at ASIS, AIIS, lesser trochanter, ischium |
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apophysis
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tendon insertion into bone
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Osgood-Schlatter Disease
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pull ossified piece of bone off tibia
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Lower Legs
presentation |
- common presentation - medial shin pain
- medial tibial stress syndrome - shin splints - lower 1/3 medial side of tibia |
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Contributing factors in injury
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- augmented speed sports
- collision sports - contact sports - noncontact sports |
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Principles of the 4 phases of rehabilitation after a musculoskeletal injury
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1. limiting additional injury and controlling pain and swelling
2. improving strength and flexibility of the injured structures 3. progressive improvement in strength, flexibility, proprioception and endurance of the injured structures 4. returning to the sport gradually through functional rehabilitation |
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Seeing adolescent for injury
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H ome/Friends
E mployment/Education A lcohol D rugs D epression S ex S uicide |
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Hypothalamus and Pituitary Gland
- Gonadotropin-releasing Hormone (GnRH) - Follicle Stimulating Hormone - Luteinizing Hormone |
1. anterior pituitary gland
2. stimulates follicles (estradiol) 3. ovulation (thickens endometrium) |
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Hormones important in maintaining pregnancy
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- estrogen
- progesterone - relaxin |
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Estrogen
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- increased 30 times above baseline
- contributes to joint laxity |
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Progesterone
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- small quantities secreted to initiation of pregnancy
- primary role: early nutrition for embryo |
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Relaxin
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- produced by ovary during pregnancy and menstruation
- augments delivery (softens cartilage, ligamentous laxity) - generalized to whole body |
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Relaxin levels
1. soon after conception 2. 1st trimester 3. postpartum |
1. increase soon after
2. highest in 1st trimester 3. 3 to 5 mos postpartum (longer if breastfeeding |
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Nerve Impengements
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- sciatic nerve
- brachial nerves - median nerve (carpal tunnel) |
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Posture Changes
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- kyphosis
- lordosis - head forward - rounded shoulder - knees hyperextend - ant pelvic tilt - flat feet - pronation of feet |
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COG changes
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-higher
-more forward |
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when picking up
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- COG close to spine
- active engagement of abs - COG close to floor - pelvis neutral position |
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Pelvic Floor
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Levator Ani
- puborectalis - pubococcygeus - iliococcygeus coccygeus |
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Fibers of Pelvic Floor
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- fast twitch: keep dry/orgasm
- slow twitch - maintain bladder control |
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Function of Pelvic Floor
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- support pelvic contents
- sphincter control - sexual function |
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Pelvic Floor Strength Testing:
Muscle Strength |
-max force that a muscle can generate
- wt the muscle can lift once |
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Methods to measure ability to contract
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- clinical observation
- vaginal palpation - ultrasound - MRI - electromyography |
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methods to quantify strength
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- manometry
- MMT using vaginal palpation - dynamometers - vaginal cones 1RM - functional testing |
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Pelvic Floor - why bother
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- inc sex response
- dec episiotomy - inc awareness - inc continence - inc circulation/healing - maintain pelvic contents - dec hemorrhoids - dec incontinence |
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Diastasis Recti
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separation of rectus abdominis
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Sacroiliac Dysfunction
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- relaxin and muscle imbalance
- manual therapy to reduce misalignment - stretch iliopsoas, quadriceps, hamstrings - SI support garments |
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pubic symphysis dysfunction
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- softens and widens - pain
- can rupture during delivery |
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Pulmonary System Changes
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- Resting Respiratory Rate unchanged
- Vital Capacity unchanged - O2 consumption increases 15-20% - dyspnea at rest/ hyperventilation of pregnancy |
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Cardia output
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- inc early, slight dec later
- RHR inc gradually up to 10-15 bpm mostly in later pregnancy |
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BP
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-dec first trimester than inc to normal levels
- should never be greater than pre-pregnancy levels |
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Effects of Valsalva
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- inc BP, blood pooling in legs, diastasis recti in mom
- acidosis and hypoxia, ascent of baby |
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Diastasis Recti
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- 66% of women experience
normal separation: - umbilicus - 2 cm above umbilicus - 2 cm below umbilicus - none |
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Causes of Diastasis Recti
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- abdominal muscles stretched to near elastic limit
- hormonal softening of connective tissues - excessive strain in late pregnancy - valsalva maneuver during pushing - relaxin and estrogen |
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Risk Factors of Diastasis Recti
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- expecting multiple babies
- very petite women - excessive lordosis and poor muscle tone - genetics - obesity - large baby - separation in previous pregnancy |
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Consequences
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- reduces integrity and strength of ab wall
- aggravate lower back pain and pelvic instability - poor posture - weakened pelvic floor - pelvic floor dysfunctions |
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Measuring during 3rd trimester of pregnancy
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1" above umbilicus
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Measurement postpartum
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- 2" above
- at umbilicus - 2" below |
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Topics of Childbirth Education
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- healthy pregnancy
- anatomy/physiology - nutrition - body mechanics - physical fitness - elimination of fear - relaxation/breathing - continuous support by familiar person |
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Approaches to Childbirth Education
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- Lamaze
- International Childbirth Education Association (ICEA) - Bradley method (husband coached) |
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Stages of Labor
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Stage One
- early labor - active labor - transition Stage Two - birth Stage Three - placenta |
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Stage One - Early Labor
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- cervix efface 100% and dilate 3 cm
- contractions vary - every 5 minutes, last 60 seconds - mild contractions - backache - emotional |
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Stage One - Active Labor
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- intensity of contractions increases
- 45-60 secs every 2 minutes - cervix dilates from 4-7 cm - inc backache - inc concentration, emotions |
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Stage One - Transition
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- intense contractions
- 60-90 sec every 1-3 minutes - cervix dilates 8-10 cm - nausea and vomiting, hot flashes, chills and shaking legs, mood change, severe low back pain |
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Stage Two
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- contractions slow, 60-90 secs every 3-5 minutes
- uterus tightens around the body - uncontrollable urge to push - back and rectal pressure - stretching sensation |
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Stage Three
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- placenta detaches from uterus
- mild contractions - joy - fatigue - relief |
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Peripheral Pain Management:
1. Merkel's Disks 2. Meissner's corpuscles 3. Pacinian corpuscles 4. tactile hair-end organs 5. joint receptors 6. thermoreceptors 7. chemoreceptors |
1. lips, palms and soles (steady pressure)
2. fingertips (light touch) 3. around muscles (rapid vibration) 4. hair follicle (directional touch) 5. joint capsule (movement) 6. skin (temperature) 7. taste buds and olfactory bulb (lollipops) |
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Modalities: OB patients
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- heat and cold
- biofeedback - TENS |
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Modalities: GYN patient
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- biofeedback
- e-stim - ultrasound - shortwave diathermy - cold laser |
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Puerperium
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period of adjustment back to normal until period resumes (6-8 weeks)
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Back to Normal
1. Uterus 2. Cervix 3. Vagina 4. Ovarian Function |
1. 6 weeks
2. 2 weeks 3. 6-8 weeks 4. non-lactating - 10 weeks |
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Cardiovascular Changes
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normal within 2-3 weeks
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musculoskeletal changes
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3-6 months to return to pre-pregnancy state
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Post-natal posture
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takes over 3 months
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Role of PT in puerperium: Exercise
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- return maximal muscle function
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Role of PT in puerperium: Urinary Incontinence
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PFM exercises, biofeedback, e-stim
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Role of PT in puerperium: Diastasis Recti
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abdominal exercises
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Role of PT in puerperium: Pain Control
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TENS around area of C-section
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