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MOTOR CONTROL AND MOTOR LEARNING APPROACH

General Concepts:
Incorporates theories of motor control and motor learning.
Used with combinations with task-related learning.
Consideration is given to both intrinsic and environmental constraints.

MOTOR CONTROL
“An area of study dealing with the understanding of the neural, physical, and
behavioral aspects of movement.

Stages of Movement Control

Within the CNS


Stimulus Stimulus Identification Response Response Movement
Selection Programming Output
Sensing Interpreting Translating
Perceiving Planning Structuring
Memory contact Deciding Initiating
response
Sensitive to: Sensitive to: Sensitive to:
Clarity No. of alternatives Complexity
Intensity Compatibility of Duration
Pattern of complexity stimulus & Compatibility
of the stimulus response. Of responses

MOTOR PLAN
An idea or plan for purposeful movement that is made up of component motor
programs.
MOTOR PROGRAM
An abstract representation that, when initiated, results in the production of
coordinated movement sequence.
FEEDFORWARD
The sending of signals in advance of movement to ready the system, allows for
anticipatory adjustments in postural activity.
FEEDBACK
Response-produced information received during or after the movement, in used
to monitor output for corrective actions.
MOTOR LEARNING
“A set of internal processes associated with practice or experience leading to
relatively permanent changes in the capability for skilled behavior.

School of Physical Therapy-Therapeutic Exercises 3 (O’Sullivan & Schmitz: Physical Rehabilitation-Assessment & 1
th
Treatment, 5 ed.)| helenjudymaban09
Measures of motor learning:
1. Performance: determine overall quality of performance, level of automaticity,
level of effort, speed of decision making.
2. Retention: provides a better measure of learning. Ability of the learner to
demonstrate the skill over time and after the period of no practice (retention
interval).
3. Generalizability: The ability to apply a learned skill to the learning of other
similar tasks (transfer test).
4. Resistance to contextual change: This is the adaptability required to perform a
motor task in altered environmental situations.

STAGES OF MOTOR LEARNING


Provides a useful framework for describing the learning process and for
organizing training strategies. (table).

STRATEGIES TO ENHANCE MOTOR LEARNING (table)

FEEDBACK

INTRINSIC: sensory information normally acquired during performance of a task.


EXTRINSIC AUGMENTED: externally presented feedback that is added to that
normally acquired during task performance.

Concurrent feedback: given during the task performance.


Terminal feedback: given at the end of task performance.

KNOWLEDGE OF RESULTS: augmented feedback about the end result of overall


outcome of the movement.
KNOWLEDGE OF PERFORMANCE: augmented feedback about the nature or quality
of the movement pattern.

Varied feedback Schedules:


1. Summed feedback: given after a set number of trials.
2. Faded feedback: feedback given at first after every trial and then less frequently.
3. Bandwidth feedback: feedback given only when performance is outside a given
error range
4. Delayed feedback: feedback given after a brief time delay can also be beneficial
in allowing the learner a brief time for introspection and self-assessment.

PRACTICE
The second major influence on motor learning.
The more the practice, the greater the learning (ENGRAM).

School of Physical Therapy-Therapeutic Exercises 3 (O’Sullivan & Schmitz: Physical Rehabilitation-Assessment & 2
th
Treatment, 5 ed.)| helenjudymaban09
MASSED versus DISTRIBUTED PRACTICE

MASSED PRACTICE: refers to a sequence of practice and rest times in which the rest time is
much less than the practice time.

DISTRIBUTED PRACTICE: refers to spaced practice intervals in which the practice time is
equal to or less than the rest time.

BLOCKED versus RANDOM PRACTICE

BLOCKED PRACTICE: refers to a practice sequence organized around one task performed
repeatedly, uninterrupted by practice of any other task; repetitive practice.

RANDOM PRACTICE: refers to a practice sequence in which a variety of tasks are ordered
randomly across trials.

PRACTICE ORDER: refers to the sequence in which tasks are practiced.


1. Blocked order: refers to the repeated practice of a task or group of tasks in
order.
2. Serial order: refers to a predictable and repeating order.
3. Random order: refers to a non-repeating and non-predictable order.

MENTAL PRACTICE
Is a practice strategy in which performance of the motor task is imagined or
visualized without overt physical practice.
Has consistently been found to facilitate the acquisition of motor skills.
It should be considered for patients who fatigue easily and are unable to sustain
physical practice.
It is also effective in alleviating anxiety associated with initial practice by
previewing the upcoming movement experience.
Generally contraindicated in patients with profound cognitive, communication,
and/or perceptual deficits.

VARIABLE PRACTICE: practice of varied motor skills in which the performer is required to
make rapid modifications of the skill in order to match the demands of the task.

SERIAL PRACTICE: practice of a group or class of motor skills in serial or predictable


order.

TRANSFER OF LEARNING
The effects of having previous practice of a skill or skills upon the learning of a new
skill or upon performance in a new context; transfer may be either positive
(assisting learning) or negative (hindering learning).
Refers to the gain (or loss) in the capability of task performance.
School of Physical Therapy-Therapeutic Exercises 3 (O’Sullivan & Schmitz: Physical Rehabilitation-Assessment & 3
th
Treatment, 5 ed.)| helenjudymaban09
PART-WHOLE TRANSFER: a learning technique in which a complex motor task is broken
down into its component or subordinate parts for separate practice before practice of the
integrated whole.
BILATERAL TRANSFER: learning can be promoted through practice using contralateral
extremities.

TASK-RELATED TRAINING APPROACH

General Concepts.
a. Emphasis is on focusing use of the affected body segments/limbs using task-related
experiences and training.
1. Patients practice important functional tasks essential to independence.
2. Patients practice tasks in appropriate and safe environments; focus is on
anticipated environments for daily function.
b. Patients practice under therapist’s supervision and independently.
1. Therapists provide assistance through guided movement and verbal cueing.
2. Therapists serve as motor learning coaches, encouraging correct performance.
3. Exercise/activity logs can help organize the patient’s self-monitored practice.
4. Repetition and extensive practice are required.
c. Promotes use-dependent cortical reorganization (neural plasticity) and recovery.
d. Prevents learned non-use of the affected body segments/extremities.

CONSTRAINT-INDUCED MOVEMENT THERAPY (CI)


A task-oriented training approach for patients recovering from stroke in which the
unaffected UE is restrained with use of an arm sling and resting hand splint while
training is focused on the affected UE.
Uses massed practice (up to 6 hours/day) with repetitive training of functional
tasks.
Operant conditioning techniques are used to shape responses.

BODY WEIGHT-SUPPORTED TREADMILL TRAINING (BWSTT)


Task-oriented training approach in which the patient walks with assistance on a
treadmill with body weight partially supported.
Slow treadmill speeds (typically 0.01-2.25 m/s) and light support using an overhead
harness (typically 30% of body weight to start) are used during initial practice;
speeds are gradually increased and weight support is gradually reduced.
One or two therapists provide manual assistance in stabilization of trunk/pelvis and
in movement of the paretic limb.
Progression is to over ground walking; body weight support can be used to start
with progression is to no weight support.

School of Physical Therapy-Therapeutic Exercises 3 (O’Sullivan & Schmitz: Physical Rehabilitation-Assessment & 4
th
Treatment, 5 ed.)| helenjudymaban09
COMPENSATORY TRAINING APPROACH

General Concepts
a. Indications: to offset or adapt to residual impairments and disabilities.
b. Focus is on early resumption of functional independence with reliance on
uninvolved segments for function.
c. Changes are made in the patient’s overall approach to tasks.
1. Patient is made aware of movement deficiencies, alternate ways to accomplish
tasks.
2. Patient relearns functional patterns and habitual ways of moving.
3. Patient practices functional skills in variety of environments.

Issues with the compensation approach


a. Focus on uninvolved segments to accomplish daily tasks may suppress recovery and
contribute to learned nonuse of the impaired segments.
b. Focus on task specific learning may lead to the development of splinter skills in
patients with brain damage; skills cannot be easily generalized to other tasks or
environmental situations.
c. May be the only approach possible.
1. If no additional recovery is anticipated.
2. If severe motor deficits are present or if sensorimotor recovery has plateaued.
3. If patients exhibits extensive co-morbidities and poor health.

Strategies
a. Simplify activities.
b. Establish a new functional pattern; identify key task elements, residual segments
available for control of movements.
c. Repeated practice; work toward consistency, efficiency.
d. Energy conservation and activity pacing techniques are important to ensure
completion of all daily movement requirements.
e. Adapt environment to facilitate relearning of skills, ease of movement.
1. Simplify; set up for optimal performance.
2. Use environmental adaptations to enhance performance.

School of Physical Therapy-Therapeutic Exercises 3 (O’Sullivan & Schmitz: Physical Rehabilitation-Assessment & 5
th
Treatment, 5 ed.)| helenjudymaban09