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define Motor Control:
neural, physical, behavioral process which result in posture and movement
Describe Motor Skills:
- Developed through motor learning
- acquired and modified by the CNS
- gained through interaction & exploration of the environment
response-produced infer received during or after the movement and is used to monitor output for corrective actions
sending of signals in advance of movement to ready the sensory-motor systems give you anticipatory adjustments in postural activity
the ability to execute smooth, accurate, and controlled motor responses
What is a motor program?
an abstract representation that results in the production of coordinated movement sequence
What is a motor plan?
an idea or plan for purposeful movements made up of several motor programs
What is motor memory?
the recall of motor programs
What does motor memory typically include?
- initial movement conditions
- how the movement felt, looked, sounded
- specific parameters
what is motor learning?
A change in the capability of a person to perform a skill which occurs as the result of skilled practice or experience
What does motor learning require?
- spatial organization
- temporal organization
- hierarchical organization in the CNS
what is recovery of function?
reacquisition of movement skills lost through injury.
What is compensation?
adoptions of alternative behavioral strategies to complete a task
the capacity of the brain to adapt to injury through mechanisms of repair and change.
What should be included in the baseline assessment?
- CNS responses
- how the patient reacts to sensory stimulation
- are they using compensatory mechanisms in response to physiological stress?
- how are changes impacting the patient's functional level?
What are factors that may constrain motor function examination?
- consciousness and arousal
- Inverted U-principle
How does the ascending reticular system act?
- in the brainstem, it acts on the cortex to: maintain a conscious state
- control different degrees of wakefulness
- control sleep cycles
How does the descending reticule activating system act?
it monitors baseline body functions and homeostasis through maintenance of the autonomic and somatic motor systems
What does the pontine or medial tract of the descending reticular activating system do?
it enhances spinal cord antigravity reflexes and extensor tone of the LE
What does the medullary or lateral tract of the descending reticular activating system do?
it reduces antigravity control
time frame of a true coma:
Describe a vegetative state:
- irregular sleep/wake cycles
- normalized respiration
- normalized digestion
- normalized blood pressure and temp regulation
Describe a Persistent Vegetative State:
- caused by a severe head injury
- lasts longer than 1 year
What is the Glascow Coma Scale?
- the gold standard for coma assessment
- scores from 3 to 15
What does the Glascow Coma Scale evaluate in it's assessment of a coma?
- Eyes opening
- best motor response
- best verbal response
Describe the Inverted U principle:
- related to motor performance and level of arousal
- low or high levels of arousal may cause deterioration of of motor performance
What are elements of motor function examination?
- muscle performance
- voluntary movement patterns
- activity based task analysis
- taxonomy of tasks
- resistance of muscle to passive elongation or stretch
- steady state of muscle contraction or slight residual contraction
what is hypertonia?
increased above normal resting levels of tone
Types of hypertonia include:
a muscle tone disorder that is characterized by a velocity dependent increase of muscle tone with increased resistance to stretch
- part of an upper motor neuron syndrome
- loss of inhibitory control
- over excitability of alpha motor neurons
What is clonus?
- a form of spasticity in which is:
- spasmodic alternation of muscle contract & relaxin response to sustained stretch of spastic muscle
types of rigidity:
What is Lead-pipe?
a form of rigidity in which there is constant resistance throughout the ROM that is independent of the velocity of movement
How does Lead-Pipe present?
- significant functional limitation
What is Cogwheel?
- ratchet-like jerkiness
- most commonly in UEs
- may have tremor
describe Decorticate rigidity:
- sustained contraction and posturing of:
- UE in flexion
- UE-ext rotated
- LE in extension
seen with significant brain injury and coma
Describe decerebrate rigidity:
- sustained contraction and posturing of:
- UEs in extension
- UE-int rotated
- LEs in extension
- prolonged involuntary movement
- twisting or writhing repetitive movements
- increased muscular tone
- decrease or absent muscle tone
- diminished resistance to passive movements
- decrease stretch reflexes
- most common in LMN or cerebellar lesions
explain the Modified Ashworth Scale:
- measures rigidity of hypertonia
- scale of 0-4
- (0 is no increase in tone)
What is included in examination of tone?
- passive motion testing
What do you not do when examining tone?
- Repeat quick stretches
- reflex testing that produces hypertonicity
What is muscle performance?
- the capacity of a muscle or group of muscles to generate forces
- therefore produce a specific functional task
Patients with UMN lesions typically are unable to do what?
How do you react to this?
- they are unable to recruit motor units or single joint movements in a normal fashion
- estimations of strength or description of function is usually more beneficial than MMT
- CAREFUL documentation
What should you be aware of when testing muscle performance?
- substitution patterns
- stereotypical movement patterns
- abnormal co-activation
- abnormal posturing
In relation to voluntary movement patterns, what is synergy?
- functionally linked muscles by the CNS to produce an intended motor activation
- simplify control & initiate coordinated movement patterns
In relation to voluntary movement patterns, discuss obligatory synergies?
they are primitive highly stereotyped due to CNS damage
What is the purpose of activity based task analysis and what may be involved?
- determine factors that may keep the patient from being successful in motor planning
- factors such as: environment, activity, psychosocial
list the taxonomy of tasks:
- transitional mobility
- dynamic postural control