Motor & Postural Control

Question 1

What are the different motor control theories?

Answer 1

• Reflex Theory
• Hierarchical Theory
• Motor Programming Theories
• Systems Theories
• Dynamical Action Theory
• Ecological Theory

Question 2

Describe the systems model of motor control.

Answer 2

• The ability to regulate & direct mechanisms of movement
• What characteristics of task, individual + environment will influence movement?
• Requires good underlying postural control
• Lateral descending tracts (corticospinal + rubrospinal + lateral reticulospinal)
• Many systems, subsystems + multiple connections within the nervous system working in parallel + hierarchy to produce movement
• Focus therefore clinically on functional tasks rather than trying to ‘fix’ the damaged pathway or circuit

Question 3

What are some features of postural control?

Answer 3

• Posture
• Balance
• Recovery from instability
• Ability to anticipate + correct for potential instability
• A combination of postural orientation (maintaining alignment) & postural stability (balance – maintaining CoG with in BoS)
• Requires some motor control
• Related to medial descending systems (vestibulospinal, medial reticulospinal + tectospinal)

Question 4

What does normal movement require?

Answer 4

Integration and co-ordination of both postural & motor control (as well as ascending sensory information)

Question 5

What is motor learning?

Answer 5

How we learn new movement patterns in healthy people

Question 6

What is habituation?

Answer 6

Learned suppression of a non-noxious response
- Decrease in synaptic activity

(E.g. some vestibular exercises, wearing a new watch)

Question 7

What is sensitisation?

Answer 7

Increased response to one stimulus that is consistently preceded by a noxious stimulus
- Increase in synaptic activity

(E.g. respond more to gentle rub on the arm if you have just caught your arm on a door handle)

Question 8

What stages can motor learning be broken down into?

Answer 8

Fitts and Posner (1967):
- Cognitive phase
- Associative phase
- Autonomous phase

Gentile (1972):
- Acquire a movement pattern (regulatory and non-regulatory conditions) (explicit)
- Adaptation, consistency and economy (implicit)

Question 9

What are methods of associative learning?

Answer 9

• Classical conditioning
• Operant conditioning
• Procedural learning
• Declarative learning

Question 10

Describe classical conditioning.

Answer 10

• Predicting relationship between two stimuli
• An extension of sensitisation
  (E.g. Pavlov’s Dogs)

Question 11

Describe operant conditioning.

Answer 11

• Relationship of behaviour to a consequence (positive or negative)
• Similar neural mechanism to classical conditioning
  (E.g. being rewarded for good behaviour)

Question 12

Describe procedural learning.

Answer 12

• Implicit knowledge
• Cerebellar circuitry

Question 13

Describe declarative learning.

Answer 13

• Explicit knowledge
• Temporal circuitry
• Long term potentiation

Question 14

What do you need to be able to do in order to learn a motor skill?

Answer 14

• Acquire it
• Retain it
• Transfer it

Question 15

Describe motor learning in relation to physiotherapy.

Answer 15

Use dependent learning
- Repeated task specific practice
- Needs cognition & some motor output

Instructive motor learning
- Knowledge of performance
- Change achieved through intentional movement strategies
- Change in response to explicit feedback
- Needs cognition

Reinforcement motor learning
- Knowledge of results
- Driven by binary outcome-based feedback
- Feedback from success or failure

Sensori-motor adaptation-based motor learning
- Change driven by sensory prediction errors
- Not reliant on cognition
- Cerebellum!

Need to select the most appropriate (or mix of appropriate) strategies to manage the patient in front of you.

Question 16

What enhances motor learning?

Answer 16

Practice
- More is better
- Massed v distributed practice
- Constant v variable
- Random v block

Specificity
- Be task specific

Transferability
- Whole v part training
- Any impairment focussed work must be transferred to function

Feedback
- External focus but move from external to internal feedback
- Knowledge of results rather than knowledge of performance

Mental Practice

Modelling

Allow choice