Map of Essential Concepts Model of PT Practice Model of Disablement Conceptual Framework For Clinical Practice Hypothesis-Oriented Clinical Practice Theory of Motor Control Fall 2006 DM McKeough Conceptual Framework For Clinical Practice Model.
Download ReportTranscript Map of Essential Concepts Model of PT Practice Model of Disablement Conceptual Framework For Clinical Practice Hypothesis-Oriented Clinical Practice Theory of Motor Control Fall 2006 DM McKeough Conceptual Framework For Clinical Practice Model.
Slide 1
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 2
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 3
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 4
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 5
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 6
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 7
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 8
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 9
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 10
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 11
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 12
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 13
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 14
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 15
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 16
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 17
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 18
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 19
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 20
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 21
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 22
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 23
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 24
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 25
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 26
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 27
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 28
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 29
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 30
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 31
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 32
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 33
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 34
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 35
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 36
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 37
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 2
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 3
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 4
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 5
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 6
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 7
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 8
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 9
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 10
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 11
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 12
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 13
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 14
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 15
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 16
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 17
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 18
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 19
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 20
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 21
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 22
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 23
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 24
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 25
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 26
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 27
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 28
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 29
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 30
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 31
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 32
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 33
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 34
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 35
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 36
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
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Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map
Slide 37
Map of Essential Concepts
Model of PT Practice
Model of Disablement
Conceptual Framework
For
Clinical Practice
Hypothesis-Oriented
Clinical Practice
Theory of Motor Control
Fall 2006
DM McKeough
Conceptual Framework
For Clinical Practice
Model of PT Practice
Model of Disablement
Hypothesis-Oriented Clinical Practice
Theory of Motor Control
Last Viewed
Concept Map
Exit
Models of Disablement
Nagi and WHO
International Classification of Functioning,
Disability and Health (ICF)
Model Comparisons
Last Viewed
Conceptual Framework
Concept Map
Exit
Level of Analysis
Cell / Organ
System
Personal
Society
Last Viewed
Nagi and WHO
Nagi
1/2
WHO
Primary Pathology
Disease
Primary Impairment
Primary Impairment
Functional Limitations
Disability
Disability
Handicap
Disablement Models
Concept Map
Exit
Nagi and WHO
2/2
Nagi Model
ACTIVE
PATHOLOGY
Interruption or
interference with
normal processes,
and efforts of the
organism to regain
normal state
IMPAIRMENT
Anatomical,
physiological, mental,
or emotional
abnormalities or loss
FUNCTIONAL
LIMITATION
DISABILITY
Limitations in
performance at the
level of the whole
organism or
person
Limitations in
performance of
socially defined roles and tasks
within a sociocultural and
physical environment
WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)
DISEASE
IMPAIRMENT
DISABILITY
HANDICAP
The intrinsic pathology
or disorder
Loss or abnormality of
psychological,
physiological, or
anatomical structure or
function at organ level
Restriction or lack
of ability to
perform an
activity in normal
manner
Disadvantage due to impairment
or
disability that limits or prevents
fulfillment of
a normal role [depends on age,
sex, sociocultural factors] for
the person
Last Viewed
Disablement Models
Concept Map
Exit
International Classification of
Functioning, Disability and Health 1/2
Last Viewed
Disablement Models
Concept Map
Exit
ICF
2/2
Contextual
Factors
Functioning and disability ("Body Functions and Structures,"
"Activities," and "Participation") are seen as an interaction between
the "Health Condition" ("disorder/disease") and the contextual
factors ("Personal Factors" and "Environmental Factors").
ICF is multidimensional (bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
Analysis
LEVEL
NAGI
WHO
1/2
ICF
Cell
Pathology
Disease
Health Condition
System
(Body)
Impairment
Impairment
Body structure &
function
Person
Functional
Limitation
Disability
Activity (Limitation)
Social
Disability
Handicap
Participation
(Restriction)
Last Viewed
Disablement Models
Concept Map
Exit
Model Comparison
2/2
Nagi is a unidimensional (pathologybased) and unidirectional model of
disability whereas ICF is multidimensional
(bio-psycho-social) and multidirectional
model of human health.
Last Viewed
Disablement Models
Concept Map
Exit
Hypothesis Oriented Clinical Practice
Once an activity (functional) limitation has
been determined by a function test an
hypothesis regarding cause must be
formulated
Hypothetical causes in body function or
structure (impairment) must be evaluated
with an impairment test
Last Viewed
Conceptual Framework
Concept Map
Exit
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 Hierarchy
Last Viewed
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
Reflex Theory
Reflex Theory (Charles Sherrington, early 1900s)
Complex behavior (movement) is controlled by a
series of chained reflexes (e.g. Frog)
Last Viewed
Motor Control Theories
Concept Map
Exit
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”
Last Viewed
Motor Control Theories
Concept Map
Exit
Complex Systems Theory
Movement emerges
spontaneously from the
interaction of the
individual, the task, and
the performance
environment
Individual
Task
Last Viewed
1/3
Motor Control Theories
Movement
Environment
Concept Map
Exit
Factors within the
Individual, Task, and Environment
2/3
Individual
•
•
•
•
Sensorimotor
Psychosocial
Cognitive
Stage of Motor Learning
Environment
Task
• Taxonomy of tasks
• Discrete/ continuous
• Attentional demands
Last Viewed
Motor Control Theories
• Physical
• Socioeconomic
• Cultural
Concept Map
Exit
Factors within the
Individual, Task, and Environment
3/3
Cognition
Perception
Action
I
T
E
Mobility
Stability
Last Viewed
Manipulation
Motor Control Theories
Regulatory
Nonregulatory
Concept Map
Exit
Neurofacilitation Approaches
1/7
Developed during the 1950-1960s 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 1940-1950s
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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
Last Viewed
Motor Control Theories
Concept Map
Exit
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…)
Last Viewed
Motor Control Theories
Concept Map
Exit
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**
Last Viewed
Motor Control Theories
Concept Map
Exit
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)
Last Viewed
Motor Control Theories
Concept Map
Exit
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
S1
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
Last Viewed
Motor Control Theories
Click to Animate
Concept Map
Exit
APTA
Model of Physical Therapy Practice
Diagnosis
Prognosis
Evaluation
Examination
Intervention
Outcomes
Patient Centered Care
Last Viewed
Motor Control Theories
Concept Map
Exit
Model of PT Practice
APTA model of PT practice: defines scope
of PT practice and standardizes practice
activities
1.
2.
3.
4.
5.
6.
Examination: data collection
Evaluation: data interpretation
Diagnosis: identifies movement limitation
Prognosis: outcome functional level + time
Intervention: treatment plan
Outcomes: treatment results
Last Viewed
Motor Control Theories
Concept Map
Exit
Examination
History
Systems Review
Demographics, chief complaint (CC), past medical
history (PMHx), patient goals
Also: medications, living environment/ support
system, employment, activity level (exercise
frequency)
Screening tests
Tests and Measures
Special tests to rule in/out functional limitations and
impairments
Last Viewed
Model of PT Practice
Concept Map
Exit
Evaluation
Process of making clinical judgments
based on the data gathered during
examination
Hypothesis-oriented clinical practice
Last Viewed
Model of PT Practice
Concept Map
Exit
Diagnosis
MDs diagnose pathology
PTs diagnose movement dysfunction
PT diagnosis names the primary
dysfunction toward which the PT directs
treatment (Sahrmann 1988)
Guide Patterns
Politically “correct” terminology
PT assessment
PT judgment
Clinical impression
Last Viewed
Model of PT Practice
Diagnosis
Concept Map
Exit
Prognosis
Prognosis and plan of care
Prognosis
Level of functional independence patient is
expected to achieve following treatment and
2. Time required to reach that level
1.
Plan of care
Anticipated goals and outcomes
Interventions
Expected duration and frequency
Last Viewed
Model of PT Practice
Concept Map
Exit
Intervention
Purposeful and skilled intervention of the
therapist with the patient
1.
2.
Coordination, communication, documentation
Patient/ client-related instruction
3.
Client: consultation
Procedural interventions (PT “treatments”)
Last Viewed
Model of PT Practice
Concept Map
Exit
Outcomes
Treatment goals
Short-term goals (STG 1-2 wks)
Impairment level
Long-term goal (LTG - Discharge)
All goals must be objective and measurable
Functional level
Goals may also include:
Risk reduction (prevention)
Impact on societal resources ( # of visits)
Patient/ client satisfaction (quality of living)
Last Viewed
Model of PT Practice
Concept Map
Exit
APTA Model of
Physical Therapy
Practice
Outcomes
INTERVENTION
Re-examination
Referrals
Coordinate Communicate Document
Patient/client instructions
Procedural interventions
PROGNOSIS & PLAN OF CARE
Projection of optimal level & time frame for improvement
Description of patient/client management
Anticipated goals and expected outcomes
Frequency & duration of interventions & discharge plans
DIAGNOSIS
Identification of dysfunctions that will direct intervention.
Signs & Symptoms Impairments Functional Limitations Disability
EVALUATION
Interpret findings to determine diagnosis, prognosis, & plan of care
EXAMINATION
History Systems Review Tests & Measures
Last Viewed
Model of PT Practice
Concept Map
Exit
The End
© DM McKeough 2009
Last Viewed
Motor Control Theories
Concept Map