1. Map of Essential Concepts Definition and levels of analysis
Neurofacilitation
Approaches
Motor
Hierarchy
Theories of
Motor Control
Task-Based
Approaches
Map of Essential
Concepts
Complex
Systems
Theory
Reflex
Theory
Fall 2006
DM McKeough

2. Theories of Motor control
Definition and levels of analysis
Reflex theory
Hierarchical theory
Complex systems theory
Neurofacilitation Approaches
Motor Re-learning, Task-Based Rehabilitation
Motor Hierarch
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3. Description
The discipline of Motor Control is the study of human movement and the systems that control it under normal and pathological conditions.
Levels of analysis (study)
Environmental result of the movement (Outcome)
Movement pattern
Neuromotor processes underlying movement
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4. Reflex Theory Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a series of chained reflexes (e.g. Frog)
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5. Hierarchical Theory Hierarchical Theory (Hughlings Jackson 1930s)
Movement is controlled by a system consisting of 3 levels with a rigid top down organization
Higher centers control lower centers via inhibition
“Disinhibition”
“Release phenomenon”
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6. Complex Systems Theory 1/3
Movement emerges spontaneously from the interaction of the individual, the task, and the performance environment
Individual
Task
Environment
Movement
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7. Factors within the Individual, Task, and Environment 2/3
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Taxonomy of tasks
Discrete/ continuous
Attentional demands
Physical
Socioeconomic
Cultural
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8. Factors within the Individual, Task, and Environment 3/3
Cognition
Perception
Action
Mobility
Stability
Manipulation
Regulatory
Nonregulatory I T E
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9. Neurofacilitation Approaches 1/7
Developed during the s in parallel with increasing knowledge of anatomy and physiology of the nervous system
Bobath (NDT); Brunnstrom; Kabat, Knott & Voss (PNF); Ayers (Sensory Integration Therapy) developed the “Neurofacilitation Approaches” that replaced the muscle re-education approach used to treat the effects of Polio during the s
Neurofacilitation approaches were designed to treat the movement effects of stroke (UMN lesion) by attempting to affect the CNS directly through the manipulation of sensory input
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10. Neurofacilitation Approaches 2/7
Assumptions
Normal movement
Results from a chain of reflexes organized hierarchically within the CNS (Control of movement is top down – cortex controls brainstem and spinal cord)
Normal development
Characterized by the emergence of behavior organized at sequentially higher levels of the nervous system
Driven by sensory input
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11. Neurofacilitation Approaches 3/7
Assumptions
Abnormal movement
Caused by disruption of normal reflex mechanisms
Cortical lesions cause the release of abnormal reflexes organized at lower levels of the central nervous system
Release of abnormal reflexes constrains the patient’s ability to move normally
Abnormal movement is the direct result of lesion not secondary or compensatory actions**
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12. Neurofacilitation Approaches 4/7
Assumptions
Abnormal movement
In both children and adults, movement is dominated by primitive reflexes
In children, cortical lesions interrupt normal corticalization thus motor control is dominated by primitive reflexes organized at lower levels of the CNS (primitive reflexes are never constrained)
In adults, with acquired motor cortical lesions, damage to the higher levels of the CNS release lower levels and movement is dominated by primitive reflexes (primitive reflexes are constrained then released)
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13. Neurofacilitation Approaches 5/7
Assumptions
Recovery of function
Requires that higher centers once again control lower centers
Recapitulates normal development, therefore, intervention should proceed along a developmental sequence
Functional skills will automatically return once abnormal movement is inhibited**
Repetition of normal movement patterns will automatically transfer to functional tasks**
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14. Neurofacilitation Approaches 6/7
Clinical Implications
Examination should identify abnormal reflexes controlling movement
Intervention should modify abnormal reflexes
Intervention modifies the CNS through sensory input
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15. Neurofacilitation Approaches 7/7
Current changes to Neurofacilitation Approaches
Increased emphasis on directly training functional tasks as opposed to “normal movement”
Decreased emphasis on inhibiting abnormal reflexes
Increased consideration of motor learning principles (stages of motor learning, feedback, practice schedules, etc…)
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16. Motor Re-learning Task-Based Rehabilitation 1/2
Assumptions
Normal movement
Performer + Task + Environment
Abnormal movement results from impairment in one or more of the systems controlling movement
Abnormal movement pattern is the performer’s best solution to the task given the systems remaining after damage not just the result of the lesion itself**
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17. Motor Re-learning Task-Based Rehabilitation 2/2
Assumptions
Recovery of function
Recovery is produced by plastic reorganization of undamaged control centers (neural plasticity)
Clinical Implications
Recovery is best produced by practice of purposeful, goal-oriented tasks that are meaningful to pt’s goals (task specificity)
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18. Motor Hierarchy MC system consists of 3 levels
Highest level: association cortex, sensory, and motor areas
Concern: select movement goal and strategy
Middle level: BG, Cb, and brainstem motor centers
Concern: specifying spatial, temporal, and force parameters of the motor plan
Lowest level: LMNs, motor plant, FB about sensory consequences of the movement
Concern: producing the movement pattern and supplying sensory FB S1
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19. The End
© DM McKeough 2009
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