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PTP 512

Neuroscience in Physical
Therapy
Motor Control: Issues and
Theories
Min H. Huang, PT, PhD, NCS

Objectives
Identify individual, task, and
environmental movement constraints
Compare and contrast contemporary
motor control theories
Compare and contrast neurologic
rehabilitation approaches with respect
to assumptions underlying normal and
abnormal movement control, recovery
of function, and clinical practices.

Reflection
What is a theory?
What is the value of theory to
clinical practice?

HOW DOES MOVEMENT


EMERGE?

Movement Emerges from


the Interaction between
Task, Individual,
Environment

Environmental Constraints
on Movement
Regulatory
Essential elements that
determine the
movement, e.g. chair
height
Non-regulatory
Feature that are not
essential but may
affect the performance,
e.g. background noise

Individual Constraints on
Movement
Action
goal-directed
movements
Perception
Sensory integration
Cognition
Mental functions
underlying the
establishment of a goal

Task Constraints on
Movement

The nature of tasks determine


the movement required.
Classify tasks by
Functional category, e.g.
gait, bed-mobility, transfer
Discrete (definite ending)
vs. continuous (no end
point), e.g. grasping vs.
walking
Stable vs. mobility, e.g.
sitting vs. walking

Gentiles Taxonomy for Task


Classification

M: manipulation, Variability: inter-trial


variability

Gentiles Taxonomy for Task


Classification

BodyStability
M

+M

BodyTransport
M

+M

Closedpredictableenvironment
Variability
+ Variability

Openunpredictableenvironment

Variability

M:
manipulation, Variability: inter-trial
+ Variability
variability

MOTOR CONTROL
THEORIES
A TOUR THROUGH
HISTORY

Discuss at your table group


1) What did the therapist do?
2) What did the patient do? How did
the patient perform the tasks?

http://www.youtu
be.com/watch?v=m
CiBehv_FOw&featu
re=related

http://www.yo
utube.com/wat
ch?v=r5o5S9zGpE

Reflex Theory
Reflexes are the building blocks of
complex motor behaviors or
movements

Reflex Theory
Sir Charles Sherrington, the integrative
action of the nervous system (1906)
Reflex chaining: complex movements
are a sequence of reflexes elicited
together
This is based on the observation that
monkeys were unable to their arm after
resection of one side of dorsal root
ganglia. Therefore, sensory inputs must
be essential in initiating movements.

Limitations of Reflex Theory


Unable to explain
Spontaneous and voluntary movements
Movement can occur without a sensory
stimulus
Fast sequential movements, e.g. typing
A single stimulus can trigger various
responses (reflexes can be modulated)
Novel movements can be carried out.

Limitations of Reflex Theory


Taub demonstrated that monkeys
with bilateral deafferentation were
able to move the arms. If with
unilateral deafferentation, the
monkey relearned moving the
affected arm when the good arm
was constrained in a sling. His
findings
lead toConstrained-Induced
the constraintStroke
Rehabilitation:
Movement
inducedTherapy
movement therapy.

http://www.youtube.com/watch?v=MMTh2hWvB2g
Taub Therapy Clinic: Constrained-Induced
Movement Therapy

Hierarchical Theory

Hierarchical Theory
Higher centers are always in control of
lower centers
Higher centers inhibit the reflexes
controlled by lower centers
Reflexes controlled by lower centers are
present only when higher centers are
damaged
Neuromaturational theory of development
The brain determines infant behavior!

Hierarchical Theory

Hierarchical Theory
Based on the observation of motor
development in children and adults
A childs capacity to sit, stand, and
walk is related to the progressive
emergence and disappearance of
reflexes
Brain stem reflexes (associated with
head control) emerge before midbrain
reflexes (associated with trunk
control)

Current Concepts Related to


Hierarchical Theory
Each level of
the motor
system can
act on other
levels
Reflexes are
one of many
processes of
motor control

Clinical Implications of
Hierarchical Theory
When the influence of higher centers is
temporarily or permanently interfered
with, normal reflexes become exaggerated
and so called pathological reflexes
appear Brunnstrom, 1970
The release of motor responses
integrated at lower levels from restraining,
influences of higher center, especially that
of the cortex, leads to abnormal postural
reflex activityBobath, 1965

Limitations of Hierarchical
Theory
Environment and other non-CNS
factors can affect movement, e.g.
Thelens experiments showed that
babys stepping response reemerges with body weight support
Normal adults exhibit lower level
reflexes, e.g. flexor withdrawal

Body Sense. Scientific America Frontier. (1:00-2:40,


5:10-7:30)
http://vsx.onstreammedia.com/vsx/pbssaf/search/P
BSPlayer?
assetId=68932&ccstart=235620&pt=0&preview=u

Motor Programming
Theories
Concept of a central motor pattern
or motor program
Many studies found that
movement is possible even in the
absence of stimuli or sensory input
Sensory inputs are not required to
produce a movement but they are
important in adapting and
modulating the movement

General setup for studies of


locomotion in cats with spinal
lesions

Rossignol, 2011

Central Pattern Generator


(CPGs)
F flexor
motoneuron
s
E extensor
motoneuron
s
DC dorsal
columns
DRG dorsal
root
Rossignol, 2011
ganglion

Evidence of a Motor
Program:
Central Pattern Generator
(CPGs)

CPGs are spinal networks capable of


generating bilateral rhythmic
movements, such as swimming or
walking, in the absence of descending
and sensory inputs
CPGs are network of interneurons
that alternatively activate flexors and
extensors on one side, and coordinate
with CPGs on the other side

Motor Programming
Theories
Motor programs are
Hardwired and stereotyped neural
connections such as central pattern
generators (CPGs)
Abstract rules for generating
movements at the higher level
Motor program can be activated by
sensory stimuli or by central
processes

Motor Programming
Theories
Writing

Limitations of Motor
Programming Theories
Does not consider that the nervous
system must deal with both
musculoskeletal and environmental
variables to produce movements
e.g. identical neural commands
to elbow flexors can produce
different movements depending
on the initial position of the arm
and the force of gravity

Clinical Implications of
Motor Programming
Theories
Movement problems are caused by
abnormal CPGs or higher level
motor programs
It is important to help patients
relearn the correct rules for action
Focus on retraining movements that
are critical to a functional task, not
just specific muscles in isolation

Systems Theory:
Bernsteins Degree of
Freedom Problem

How does the CNS select


a
solution from an infinite
number of possibilities for
a task?
Solution
Higher levels activate lower levels
while lower levels activate synergies,
i.e. groups of muscles that are
constrained to act together as a unit

Systems Theory:
Bernsteins Degree of
Freedom Problem

Viewed body as a mechanical


system, involving the interaction
between mass, external force (e.g.
gravity), internal force
Coordination of movement is the
process of mastering the
redundant degrees of freedom of
the moving organism (Bernstein,
1967)

Systems Theory: Latashs


Principle of Abundance
Synergy is a task-specific covariation of
elemental variables with the purpose to
stabilize a performance variable, i.e.
minimize errors of a performance variable
Reaching: joint rotation angle stabilize
hand position
Grasping: individual finger force
stabilize total grasp force
Standing stability: postural muscle
activation stabilize COP

Systems Theory: Latashs


Principle of Abundance
A muscle belongs to more than one
synergy. Within a synergy, each
muscle has a unique weighting factor
that specifies the level of activation of
that muscle within that synergy.
Synergies assure small variability of
the performance variable while
allowing relatively large variability of
each elemental variable

Postural perturbation study: each


muscle may be activated to a
different degree by each muscle
synergy

Ting, 2005

Dynamic Systems Theory:


Principle of SelfOrganization

Movement emerges as a result of


interacting elements. No needs for
specific neural commands or
motor programs.
Variability of movement is normal.
Optimal amount of variability
allows for flexible, adaptive
strategies to meet the
environmental demand

Dynamic Systems Theory:


Principle of SelfOrganization

A new movement emerges when a control


parameter reaches a critical value

Limitation of Systems
Theory
Nervous system is fairly
unimportant
How do we apply mathematics and
body mechanics to clinical
practice?

Clinical Implications of
Systems Theory
Body is a mechanical system. Consider
musculoskeletal factors underlying a
patients movement problem
Changes in movements may not
necessarily result from neural changes,
e.g. faster vs. slow gait, speed during
sit to stand
Encourage the patient to explore
variable movements

Ecological Theory: Gibsons


Perception-Action Coupling
Action is specific to the task goal
and the environment
Perceptual information of the
environmental factors relevant to
the task goal is necessary to guide
the action
Limitations:
emphasis on nervous system

Clinical Implications of
Ecological Theory
Individual is an active explorer of
the environment for learning
Individual discovers multiple ways
to solve movement problems in
environment
Fundamental to the play-based
therapy
for pediatric
patients
Baby
Sense. Scientific
America Frontier.
(1:00-2:40,

5:10-7:30)
http://vsx.onstreammedia.com/vsx/pbssaf/search/P
BSPlayer?
assetId=68932&ccstart=235620&pt=0&preview=u

Discuss at your table group


What are the assumptions of
movement control underling each of
these treatment approaches?
http://www.youtu
be.com/watch?
v=mCiBehv_FOw
&feature=related

http://www.yo
utube.com/w
atch?
v=r5o5S9zGpE

NEUROLOGIC
REHABILITATION
APPROACHES

Motorcontrolmodels
Reflex

Hierarchical

Systems

Muscle
reeducation

Neurotherapeutic
facilitation

Contemporary
task-oriented

Neurologicrehabilitationmodels

Muscle Reeducation
Change function at
the level of muscle
Vera Carter, a
practitioner
beginning her
work with muscle
treatment of polio
patients in
Australia in the
early 1930s
Kendall Historical Collection

Assumptions of
Neurofacilitation
Approaches

Abnormal movement is a direct


result of the neurologic lesion
Inhibit abnormal movement
patterns to facilitate the normal
movement patterns will lead to the
return of functional skills
Repetition of normal movement
patterns will automatically transfer
to functional tasks

Reflex- and Hierarchical


Based Neurofacilitation
Approaches

Brunnstrom, Rood, Proprioceptive


neuromuscular facilitation (PNF),
Bobaths neurodevelopmental
treatment (NDT)
Retraining motor control through
techniques to facilitate and/or
inhibit different movement patterns
e.g. PNF UE D1 Flexion/Extension
http://davisplus.fadavis.com/kisner/C
hapter06.cfm

Task-Oriented Approach
(motor control of motor
learning approach)

Task-Oriented Approach
Movement is organized around a behavioral
goal and is constrained by the environment
Patients learn by actively attempting to
solve the movement problem rather than
by repetitively practicing normal patterns of
movement.
e.g. RIC constraint-induced movement
therapy camp
http://www.youtube.com/watch?
v=NhLsh1SW4Ak

Moving forward
.currently available evidence of
doseresponse relationships in motor
learning, time-dependency of neuronal
and functional recovery, and task
specificity of treatment effects.the
lack of evidence as well as major
changes over time in our understanding
of underlying mechanisms about stroke
recovery, which do not concur with the
obsolete and constantly changing
assumptions used to explain the
Bobath ConceptKollen, 2009