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Motor Learning
Irfan
Motor Relearning Programme
- Carr & Shepherd(1982)
The elimination of unnecessary muscle activity
Feedback of information about performance
Practice
The MRP was made up of seven sections
representing essential functions of everyday life:
1. Upper limb function
2. Orofacial function
3. Sitting up from supine
4. Standing up
5. Sitting down
6. Standing
7. Walking
Bobath / NDT- Berta & Karel Bobath
A concept of treatment based on the inhibition of
abnormal reflex activity and the relearning of
normal movement, through the facilitation and
handling.
New version is a problem-solving approach to the
assessment and treatment of individuals with
disturbances of tone, movement, and function due to
a lesion of CNS. The goal of treatment is to optimize
function by improving postural control and
selective movement through facilitation (IBITAH,
1995)
BOBATH CONCEPT
is a problem-solving approach to the
assessment and treatment of individuals
with disturbances of tone, movement, and
function due to a lesion of CNS.
The goal of treatment is to optimize function
by improving postural control and selective
movement through facilitation. (IBITA, 1995)
GOALS OF CONCEPT
To identify and address the specific areas of low
tone in the anti-gravity musculature.
To seek to control the amount and diversity of
proprioceptive input.
To identify the primary goals for function in the
individual person, and to understand the nature of
how that function is performed efficiently
“Normally”
GOALS OF CONCEPT
To facilitate specific motor activity without
overflow of irradiation that could elicit associated
reactions.
To minimize compensation and therefore
sensory/motor neglect of the affected body parts.
To identify when and how voluntary controls can
be used effectively.
CONSIDERATION
POSTURAL CONTROL
POSTURAL ORIENTATION
INTERNAL REPRESENTATION
BODY CONCEPT(Awareness, Schema , Image )
SENSORY CHANNEL
MUSCULOSKELETAL COMPONENT
NEUROMUSCULAR COMPONENT
HEAD CONTROL
SHOULDER
SCAPULAR
ELBOW
HAND
PROXIMAL
(ALIGNMENT)
PELVIS
HIP
kNEE
ANKLE
MOVEMENT
STATOKINETIC REACTION
STABILITY/ MOBILITY
= WORKS TOGETHER WHILE DOING
SOMETHING.
( PURPOSEFUL MOVEMENT)
= WE CALL IT POSTURAL CONTROL.
= BASIS OF MOVEMENT
TONE PRODUCED THROUGH
THE ACTIVATION OF MOTOR UNITS
MOTOR UNIT
THE MOTOR NEURON
ALL THE MUSCLE FIBERS
IT INNERVATES
MOTOR UNIT
Relationship between fiber type, motor unit type and
histochemical profiles of muscle fibers
Fiber type
Motor unit type
Histochemical profiles
Myofib. ATPase
NADH dehydro.
SDH
Glycogen
Phosphorylase
Capillary supply
Fiber diameter
I
II
IIB
SO
(Slow O.)
S
FOG
(Fast O & G)
FR
FG
(Fast G.)
FF
Low
High
High
Low
Low
Rich
Small
High
Medium-High
Medium-High
High
High
Rich
Medium-Small
High
Low
Low
High
High
Sparse
Large
FG
Fast-twitch Glycolytic
(involved in phasic movement)
WHITE
FOG
Fast-twitch Oxidative Glycolytic
PINK
SO
Slow-twitch Oxidative
(involved in tonic movement)
RED
B. HWANG 1999
NUMBER OF MOTOR UNIT &
INNERVATION RATIO
Number of Motor
Unit
Innervation
Ratio
2970
9
1st Lumbricals
96
108
Brachioradialis
333
410
Tibialis Anterior
Gastrocnemius
445
562
579
1934
Muscle
Extensor Rectus
RECRUITMENT ORDER
POSTURAL TONE
Gravity
COG
GRF
BOS
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CENTRAL PATTERN GENERATOR
POSURAL ALIGNMENT
MOVEMENT
ACIVATION FROM THE MUSCLES
PROGRAMED MOVEMENT
INFORMATION
Central Pattern Generators.
Spinal circuits act as central pattern generators.
The existence of pacemaker cells within neural
tissue demonstrate the ability for circuits to be
active without sensory input.
The overall stepping pattern consists of a
rhythmic alteration in the contractions of flexor
and extensor muscles.
The pattern of the pattern generator is written
into the CNS map i.e. it is genetic.
ASSESSMENT
MUSCLE
Length
Direction
Strength
Synergist
ROM
SKELETAL
DIRECTION
LENGTH
SIZE
MOBILITY
FETAL MOVEMENT
Body concept
- midline, Each direction
Confidence- Security
Neuromuscular junction
- Motor output unit
Musculoskeletal structual component
ROTATION
SELECTIVE MOVEMENT
Hominid
Primate
Mammalian
Amphibian
Fish
ACTIVE MOVEMENT
Variable
SPEED
ROM
COMPRESSION
ROTATION
DIRECTION
Task-oriented
Active
‘Carry-over or not,
depend on your handling skill’
CONCLUSION
PASSIVE
STEREOTYPE
CONCLUSION
ACTIVE
COMMUNICATION
STABILITY & MOBILITY
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ALIGNMENT
Form & Function
Plasticity
SELECTIVE MOVEMENT
-Fractionation-Against gravity1.Vestibulo-spinal system
2. Reticulo-spinal system
-Selectivity1. rubro-spinal system
2. cortico-spinal system
BASE OF SUPPORT
Accept & Adapt
INTERMUSCULAR
RECIPROCAL INNERVATION
eccentric
concentric
concentric
eccentric
The major problem facing the motor control
system is not only to contract the agonist,
or the prime mover by the correct amount
and at the appropriate time, but to time and
organize the pattern of antagonist, fixator
and postural muscle contractions which are
necessary to company it’s action
(Rothwell, 1994)
Motor plans are implemented through
networks that determine the order, timing
and strength of movement around each
joint, which is translated into a
choreography of motor neuron activity that
drives the individual muscles at the right
amount and with the right force.
(Harris-Warwick & Sparks, 1995)
Only active participation produces
motor improvement or learning, which
passive imposition of postures and
movements can have no practical
values.
(Brooks, 1986)