Intro to Ndt

GOAL OF THERAPY TO THE Px WITH CNS DAMAGE: 1. Enhanc Enhancee the the functi functional onal moveme movement nt 2. Prom Promot otee indep indepen ende dence nce General Function of the CNS 1. Determines Determines the muscle muscle to be be activated activated and their their extent extent of activation activation 2. Cont Contro rols ls volun volunta tary ry move moveme ment nt Maintaining posture o Carrying a load o Playing a piano o Brain Control Movement  Movement production does not begin and end with the motor system  CNS structures contribute to the development of movement (sensory in function and motor in function)  Four General Processes Related to Movement 1. Motivation 2. Ideation 3. Progr rogram ammi ming ng 4. Execution CNS Structures involve in movement 1. Lim Limbic bic Sy System stem 2. Cort Cortic ical al Asso Associ ciat atio ion n Areas Areas 3. Premotor  4. Basa Basall Gang Gangli liaa 5. Cerebel bellum 6. Motor Ar Area 7. Brainstem 8. Spinal Cord Limbic System  feeding behavior   "fight-or-flight" responses  aggression  expressions of emotion  autonomic, behavioral, and endocrine aspects of the sexual response Cortical Association Areas  Visual Areas,  Somatosensory areas,  auditory   proprioceptive sensation SENSORIMOTOR CORTEX

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the major integrating center of sensory input and motor output. Composed of cortical areas located immediately anterior and posterior to the central sulcus The 3 principal motor regions (located in the frontal lobe): 1. 1° motor are Determine the consequences of movement strategies 2. supplementary area (SMA) 3. premotor area 1° motor area - responsible for movement initiation (execution of  movement) SMA - responsible for planning of movement Premotor area - responsible for planning of movement

AREA 6 – combination of Pre-motor area and supplementary area 

The 2 principal sensory regions (located in the parietal lobe): Responsible for the interpretation of mental image of the body 1. 1° somatosensory area ts relation ° sensory 2. posterior parietal cortex (2and area)to the surrounding space. e.g. Lesion of this area demonstrate impairment of body image and its relation to the surrounding space, and in extreme situation a neglect of  the contralateral body segments.

Components of CNS and their levels for movement 1. higher level a. Limbic sytem  b. Cortical association areas 2. middle level a. sensorimotor areas  b. basal ganglia c. cerebellum 3. lower level a. brainstem b. spinal cord

Reflex and Hierarchical Models of Motor Control Two major fundamentals 1. The basic units of motor control are reflexes 2. Motor control is hierarchically arranged

1. The basic units of motor control are reflexes Reflexes  Motor responses that occur in response to specifi sensory stimuli  Can be automatic, predictable and stereotypical  They are normal responses that are seen from early infancy.  Believed to form the fundamental volitional motor control when CNS matures  Volitional Movement – summation and integration of reflexive movement. 2. Motor control is hierarchically arranged  CNS has specifis Organizational Structure → TOP-DOWN ORIENTATION  TOP-DOWN ORIENTATION – describe as the highest center of the brain regulate and extent control over lower centers of the CNS.  Highest Centers (CORTICAL AND SUBCORTICAL AREAS) - responsible for  regulating and controlling volitional and conscious movement.  Lower levels – regulate and control reflexive, automatic, and responsive movement. e.g Damage to the CNS, motor control will become function of the next lower functioning level of the CNS → more reflexive and primitive movements. Traditional Senosrimotor Approaches to Motor treatment  Patients need to be taught motor strategies or compensatory mechanisms to adapt to the deficits  Compensatory emchanism is brought about by use of sensory inputs  Early phase of tx: emphasis on the use of external sensory stimuli → until movement response is obtained → shifts to the use of intrinsic sensory information by encouraging voluntary motor control.  targets: 1. middle sensorimotor level (motor planning strategy formulation process) 2. lower level execution process (reintegrating a complete motor control hierarchy) FOUR (4) TRADITIONAL SENSORIMOTOR APPROACH 1. Rood 2. Brunnstrom (movement therapy) 3. Proprioceptive neuromuscular approach (PNF) 4. Bobath (Neurodevelopmental Approach) 

With this 4 strategies, frequently involve: a. Application of sensory stimulation - stimulate the muscles and joints to evoke specific motor responses, handling and positioning techniques to effect changes in muscle tone  b. Use of development posture

- to enhance the ability to initiate and carry out movement

OVERVIEW: THE TRADITIONAL SENSORIMOTOR TEATMENT APPROACHES 1. Rood Approach  Designs based on the reflex and hierarchical models  Key components: a. Sensory stimulation Applied to muscle and jts o o Use of inhibitory and facilitatory technique o Type of sensory stimulation: - Slow rolling - Neutral warmth, - Deep pressure - Tapping - Prolonged stretch  b. Use of developmental sequence o Usually proximal to distal in pattern and cephalocaudal 

Usually rood technique is used as adjunctive or preliminary interventions

2. Brunnstrom  Designs based on the reflex and hierarchical models  Concept of “evolution in reverse” – the early reflex movement present maybe normal process of this evolution  Reflex movement is necessary intermediate steps in regaining voluntary movement  Use of flexor synergy and externsor synergy  Emphasis in facilitating the progress of patient by promoting movement from reflexive movement  Early stages, incorporation of reflex and associated reactions 3. PNF  Approach is grounded in both the reflex and hierarchical models  Major emphasis: developmental sequencing of movement and balanced interplay  between agonisy and antagonist  Describes MASS MOVEMENT PATTERNS, which diagonal in nature  Use of sensory stimulation is incorporated 4. Bobath  Based on normal development and movement  Based on the hierarchical models

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Primary Objective: inhibit tone primititve reflexes and normalize tone and facilitate normal postural reactions

Key treatment strategies Sensory Stimulation

Rood Approach

Brunnstrom

PNF

Bobath

YES (uses direct SI to ms and jts.)

YES Movement occurs in response to stimuli

YES (Tactile, auditory, visual SI to promote motor response)

Reflexive Movement Treatment directed toward influencing ms tone Developmental Patterns

YES

YES

YES

YES Abnormal muscle tone occurs, in part  because of  abnormal sensory experiences) NO

YES

YES

YES

YES

YES (ontogenic motor patterns)

Flexion and extensor  synergy,  proximal to distal

YES  NO Patterns used to facilitate prox. to distal motor  control)