Motor Control & Motor Learning

Motor Control: the strategies and techniques that teach a person how to move; process, conditions, and rate at which a person learns to move

• refers to how the CNS organizes, sequences, & executes movement

• OTPs focus on the mechanisms & development of movement

• when kids are young, we focus on motor skill acquisition through play

• as kids develop & grow older, the focus may shift, but is always focused on occupation & function

• Includes:

  • Coordination

  • Timing

  • Sequencing

  • Bilateral Control

  • Force Production

  • Balance

  • Motor Planning

• motor performance is the interaction between all of the systems -- cognitive, musculoskeletal, neurologic, sensory, perceptual, social-emotional -- in addition to the environment & task demends

• all of the child's systems interact with one another (holistic view), are adaptable & flexible (nothing is static, everything can change)

• task demands & environment are also adaptable & flexible

• children with motoric issues move in a way that is inefficient, sequenced wrongly, inflexible, uncoordinated

• lack variability, adaptability, & flexibility in their movements for a wide range of movements required to interact with the world

• compensatory movements - are the result of motoric dysfunction

  • present as rigid, impaired, & inflexible

• adapt the task/environment & facilitate success

• whole-task training

  • Real-life and relevant training (Some “variability”)

  • Practice sequences are randomly ordered (“Variability”)

  • Repetitive

  • Whole-task focused (“Occupation-focused”)

  • Positive reinforcement (“Feedback”)

• part-task training

  • Learning to shape the child’s ability to perform a task.

  • Forward or backward chaining is an example

• variability

• problem-solving

  • Allow the child to make errors (or get close to it) and figure it out on his/her own.  This helps…

  • Retention of motor skills

  • Leads to self-correction

• Error-based learning - learning from mistakes 

  • improving child's ability to create the correct adaptive response - learning what they did wrong to learn the correct adaptive response/motor plan

• meaning

• transfer of learning

  • Natural context must be included

  • Can do simulated, but then transition to “real life”

  • Start simple 🡪 complex

• modeling - demonstration

  • **video modeling - record the movements and watch them back to learn from past experiences

• verbal cues

  • brief, not too many words

  • emphasize movement

• feedback - discuss results & performance

  • Can discuss the errors and the correct movements

  • Must occur right after the action/movement occurs

• mental practice/imagery

  • Skill practice

    • Shorter, more frequent practice is better

    • Allow for variability

    • More isn’t always better

  • Mental practice

    • Similar to Cog interventions

    • Can use imagery

    • Can include role playing, video modeling, or imagining

• Cognitive Orientation to Daily Occupational Performance (CO-OP)

  • Goal, plan, do, check

  • Problem solving approach to learn skills through use of strategies and guided discovery

  • First, Help them to discover strategies to function/perform

  • Second, Teach strategies to help them achieve their objectives

  • Generalize learning to other environments

  • Transfer learning to other occupations

• Constraint-induced Movement Therapy (CIMT)

• Intensive Bimanual Therapy

Motor Development in CP

• Brain tells muscle to inappropriately contract or remain inactive

• Children compensate with movement & postures to overcome deficit

• Atypical movement patterns lead to difficulties with normal motor skill development

• Children end up relying on primitive and automatic reflex movement patterns to move

Typical Impairments with CP

• muscle tone & ROM

  • muscle tone - 

    • Muscle tone is the resistance to passive stretch.  What the general muscle stiffness is AT REST

    • Has to do with the brain’s innervation of the muscle

    • can be impacted by emotions and mental state.  

    • Hypertonia - body is ready to move at rest (flexor or extensor)

    • Hypotonia - body is not ready to move at rest

    • Common - more flexor in UB with scissoring gait - work on breaking up the patterns & spread out (hippotherapy)

• reflex activity

• postural instability

• fine motor

  • hand function - weak shoulder, Upper Limb contractures, synergistic movement patterns, inability to isolate finger movement

• gross motor

• secondary issues

  •  depending on where the brain lesion is…

    • Cognition

    • Speech

    • Vision impairment

    • Hearing impairment

    • **Contractures, deformity, skin breakdown!!

    • Many experience pain, associated seizure d/o, swallowing and GI issues, etc

Interventions

• Co-treatment with other disciplines may be necessary 

• Adaptive equipment training 

  • AAC, mealtime tools, adaptive materials

  • has to suit the family & the school

  • take into consideration the environment, feasibility, learning ability of those involved

• Casting, orthotic, & splinting

  • serial static splints lengthen muscle & correct deformity & reduces spasticity

  • can build into the "conditions" of a goal/objective

• Constraint-induced movement therapy (CIMT)

• Bimanual therapy

• Therapeutic taping (strapping) 

  •  supports weakened muscle, improves circulation, reduces pain, improves joint alignment

  • inhibits inaccurate movements, facilitating proper movement & supporting joint alignment

• PAMs 

  • E-stim, cold, or vibration to increase tone to muscle that needs activation; Heat to relax activated muscles

• Positioning/handling

  • Wheelchairs, standers, activity chairs, bath chairs, side-lyers; seating and mobility equipment, slant-boards, foot boards

• Preparatory techniques 

  • slow rocking, rotational movements, stretching and relaxation, warmth 🡪 reduces arousal and tone

  • fast bouncing and movements, vibration, cold 🡪 increases arousal and tone

• Complementary & alternative medicine (CAM) 

  • yoga, massage, guided imagery, myofascial release, meditation (all may require advanced certification)

• Gaming, robotics, virtual reality

  • creates the experience of typical movement

• Medical interventions 

  • baclofen pump or botox - reduce tonicity