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first step in the acute treatment process
- start discharge planning
- (looking at where pt should go next, monitoring pt's vitals, designing a program for early mobilization)
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4 reasons to have a theory or framework behind what you do
- 1. provides rationale for systematic exam
- 2. provides grounds for effective goal-setting
- 3. provides rationale for selection intervention
- 4. provides foundtion for research
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2 theories for motor control, and the directionality of each and the PT's role in each
- Facilitation Theory: outside --> inside; PT as facilitator
- Motor Control Theory: inside --> outside; PT as trainer
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Facilitation Theory - two fundamental elements in it
Reflex Theory and Hierarchical Theory (that recover of function occurs in a specific sequence)
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Motor Control Theory - 4 theories involved in making this
started w Motor Programming Theories and Systems Theory, progressed to Dynamic Action Theory and Ecological Theory
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the outside-->inside thing in facilitation theory
stim he peripheral sensory receptors to elicit the desired motor response and help the person change the motor behaviour
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basic hypothesis of the facilitation theory
- A pt w CNS injury or failure-to-develop will have abnormal motor, sensory, or perceptual problems, and recover of function will occur in a specific sequence (hierarchical theory). Redundancy exists in the CNS, so nervous tissue can take over function for other tissue that's been injured. PTs can guide this neuroplasticity/recovery by accessing the motor system thru the peripheral/sensory system according to specific rules for each stage of recovery, so proper motor patterns can be facilitated while bad ones inhibited
- Once the pt experiences the new, more efficient patterns, the pt will choose to use them, and each improvement will open the door for the next (heirarchical again)
- PT is facilitator.
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Brunnstrom basic premise
since pts will develop movements via synergy patterns, lets use these patterns to develop more functional movement
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Bobath's theory's name
NDT: neurodevelopmental treatment
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basic premise of Bobath's NDT
- synergy is bad
- you must facilitate normal postural responses (righting and equilibrium responses) from day 1 to impove function
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PNF stands for__? 3 folks behind it?
- prprioceptive neuromusculare facilitation
- Kabat, Knott, Voss
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PNF's basic premise
proprioceptive neurofacilitation: training based on functional synergies (patterns) to facilitate normal movement and inhibit abnormal mvmnt
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Rood's basic premise
she's into sensory stuff to stim mvmnt: neutral warmth, icing, swinging, etc
- "sensory input must be normalized to achieve normal motor output
- sensory systems include cutatneous, auditory, vestibular, visual"
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Jean Ayers is known for....?
sensory integration (can't stand fabrics or other particular touches)
she's the first to identify sensory integrative dysfunction, she developed a tool to test for it, and she developed sensory integration as a treatment
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2 things people disliked about facilitation theories
- 1. some PTs were dissatisfied w functional result because pts found it ieasier to walk arond in the synergy that was initially encouraged than to carry over all the PT taught after that
- 2. PTs needed to move pts thru acute care and rehab, and gain greater functional abilities, faster than the facilitation approaches allowed
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Dynamic Systems Theory - what kind of theory is it? describe its basic premise, name its people
- it's a motor control theory (as opposed to a facilitation theory)
- basic premise: change occurs because one critical control parameter or variable reaches a critical value which causes a change in the entire system
- ex: up the speed on a treadmill slowly, and at a certain threshold you'll have to switch from walking to running
- Heriza, Kelso, Thelen
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generalized motor program theory - what kind of theory is this? name its people
- it's a motor control theory
- Schmidt, Stelmach, Keele & Summers, Taub & Berman
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generalized motor program theory - basic idea
- we have motor systems that store programs for learned tasks
- motor plans are individual and context-specific
- these are learned by repetition, so if you want a pt to develop a new motor pattern, the pt must repeat the action a lot
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sensory input's involvement inthe Generalized Motor Program Theory
GMPT is a motor programming theory, not a facilitory one, so you know it's not dependant on peripheral sensory signals for execution. However, sensory systems are important for the pt's error detection as the pt performs a movement, giving the pt info on how to adjust
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Neuronal Group Selection Theory - who, and what kind of theory is this?
- Edelman and Sporns
- it's a motor programmin theory
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Neurongal Group Selection Theory - tell me about it
The idea is that since groups of neurons are strengthened by the experience of moving and get activated in response to task conditions we should move pts to build these connections. Ex - the Central Pattern Generator for Gait - at Christopher Reeves they move plegic legs on a tredmil hoping to stim this.
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a few basic things required for re/learning movement patterns
- env: an appropriate env
- repetition: continual correct practice to create neuronal patterns
- feedback: appropriate feedback geared to pt's stage of motor learning
- integration: integration of simple and complex mvmnts to achieve ADL goals
- real world: transfer training from therapy env to real world
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acording to the Fitts (and Posner) model, what are the 3 phases for learning a new task?
- cognitive (thinking a lot, trying hard)
- associative (intellectual still, but easier)
- automatic (cruise control)
each stage needs diff feedback
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what triggers mvment in facil theory? in motor programming?
- facil - outside stim
- motor prog - it's inside-->outside, so it's initiated by need or drive of the pt
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