Contemporary Task-Oriented Approaches to Motor Control Training

pgs. 242-243
General Principles/assumptions
a-based on current research & knowledge of motor behavior
b-reject assumptions of the reflex-hierarchical model of motor control & of traditional neurophysiologic therapies
c-includes remediation of performance components & environmental modifications to improve task performance
d-based on a systems model of motor control
e-movement is controlled by the integration & interaction of multiple systems, including environmental influences, sensorimotor factors, musculoskeletal factors, regulatory functions, and behavioral/emotional goals
f-the role of the structures responsible for motor control is to tune & prepare the motor system to respond to changing environmental & task demands
g-interventions are also guided by therapist's understanding of motor learning principles
h-control is not simply over muscle actions, but over the interactions of kinematic variables
i-movement dysfunction following CNS damage reflects the system's best effort to accomplish task goals
*Principles of Carr & Shepherd's Motor Relearning Program (MRP)*
a-person is an active participant whose goal is to relearn effective strategies for performing functional movement
b-postural adjustments & limb movements are linked together in the learning process
c-successful task relearning has occurred when activities are performed automatically & efficiently
d-learning of skills does NOT follow a developmental sequence
e-continued practice of compensatory strategies limits functional recovery
f-interventions not focused on learning specific movements but instead on learning general strategies for solving motor problems
g-obstacles to efficient movement include loss of soft tissue extensibility, balance loss, fixation patterns due to postural insecurity & muscle weakness
h-abnormal movement patterns are attributed to the repeated practice of compensatory movement strategies that become overlearned
*Movement patterns practiced in context of tasks, rather than exercises*
Principles of Contemporary Task-Oriented Approach
a-task performance emerges from interaction of multiple systems including personal & performance contexts
b-individual's behavioral changes reflect his/her attempts to compensate & to achieve functional goals
c-individuals must practice varied strategies to find optimal solutions for motor problems & develop skill in performance
d-functional tasks help organize motor behavior
e-therapist must determine which control parameters/systems (personal, environmental, etc.) have positive or negative influences on motor behavior
f-practice opportunities are provided that are appropriate to the person's stage of learning
*Goal is to develop competency & self-esteem*
*When clients have mastered the foundation capacities, they move on to task-focused interventions*
Principles of Motor Learning
a-focused on remediating motor control in persons with CNS dysfunction
b-ultimate goal is the acquisition of functional skills that can be generalized to multiple situations & environments
c-stages of motor learning (see Table 10.1 pg. 244-245 for more info on the below stages)
1-cognitive stage (skills acquisition stage): initial instruction & practice of a skill
2-associated stage (skill retention stage): involves "carry over" as individuals are asked to demonstrate newly acquired skill after initial practice
3-autonomous stage (skill transfer stage): involves individual demonstrating skill in a new context
1-random practice: practice of several tasks presented in random order encouraging reformulation of the solution to the presented motor problem
2-blocked practice: repeated performance of the same motor skill
3-variable conditions involve practice of skills in various contexts to improve transfer of learning & retention of skills
e-intrinsic feedback (information received from tactile, vestibular & visual systems during & after task performance)
f-extrinsic feedback (feedback provided by an outside source: therapist or machine)
1-knowledge of performance: verbal feedback about the process or performance itself
2-knowledge of results-therapist's provision of feedback about the outcome or end product or results of motor action
g-factors/conditions that promote generalization of motor learning:
1-capacity to generate intrinsic feedback
2-high feedback regarding knowledge of performance
3-low extrinsic feedback regarding knowledge of results
4-practice conditions are variable, random
5-whole task performance as opposed to breaking tasks into contrived parts
6-high contextual interference utilizes environmental conditions that increase difficulty of learning such as noise distractions & crowded environments
7-practice in naturalistic settings or one that closely resembles the one in which the task will ultimately be performed