Working the late-shift at the Nerdery- more research based musings…
Motor Control (MC) is a huge topic and encompasses many aspects of PT, although not everyone has a clear understanding of what it is. I will certainly not be able to touch on all topics of MC in one or two posts, but let me start with my researched concepts (Part 1 of …) and move on to a clinical algorithm and balance an pain (a later part…) to help you decide if Motor Control is something you need to address.
What is Motor Control?
- the systematic transmission of nerve impulses from the motor cortex to motor units, resulting in coordinated contractions of muscles. – (Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier.)
What we are mainly concerned about in OutPatient PT is the motor planning, cerebellar processing and sensory input aspects of coordinating motor patterns. (Neuro inpatient rehab and TBI, etc, have different concerns no doubt, my focus is on OutPatient)
Quickly, let’s talk about what MC is not.
- It’s not just reflexes. Reflex is a component: Asymmetrical Tonic Neck Reflex may help you rehab an Olympic archer, but perhaps that’s not all you need, and Tony Blauer has created a self-defense system off natural “reflexes” that we as humans naturally have, but this is simply part of a larger whole.
- It’s not just Central Control; meaning an output of motor signal from the brain. If this were the case, we could write our name exactly the same way 2x in a row… our brain-body connection can’t make that happen, there will be differences!
- It’s not just Self Organization: This means that just because your arm raises doesn’t mean that all the RTC muscles kick in (well they should, but…). In defense of self organization; getting some to kick in can help movement of the scapulae, it’s variable. Also we notice that if you contract the upper extremities you may get move firing of muscles in the trunk or control over the lower extremities. But the body does not just self-organize for all motor tasks.
- It’s not just Pattern Formation: which is how some people describe gait, once you get going it’s just a spinal cord firing pattern. Yes the body looks for patterns (tap your hands on your knees with a 2:1 ratio [for every one tap on the right, the left taps twice]. Easy right? Now try 3 taps on the left for every 5 taps on the right. That’s still a pattern… but we don’t do that one too easy.) Follow Steve Reich’s Clapping Music pattern Here.
- It’s not just Perceptual Detection : this deals with how you move in hot weather vs when you are wearing a new suit vs walking on ice. You body perceives the environment (visual, auditory, etc) and reacts accordingly. Yeah, this again, is just part of the whole.
- It’s not just Task Demands: for example, if steps are steeper you flex your hips more; if a ball is big, you need need to use two hands, etc. We are not simply reacting to a task constraint.
MC is parts from the above phenomena in combination with motor, cerebellar and sensory aspects. MC is being able to move in a way that you, the individual, want to move and in a way that the environment and task demand, dependent on the constraints.
- Environmental Constraints: Your patient’s movements must change depending on if they are in a home setting, sports, busy or crowded, indoor/outdoor, etc.
- Individual Constraints: Your patient may have a joint contracture, some peripheral nerve damage, pain, be very tall, left-had dominant, etc.
- Task Constraints: Your patient’s task may require fine motor, or two hands, or a strength or balance component, etc
Motor Control is Learning:
Learning is a process of acquiring the capability for skilled action. Learning is promoted through experience and practice. Learning is inferred from performance: Learning cannot be directly observed but is inferred from repeated observations of performance. Learning produces relatively permanent changes. For more on motor learning, see these links: Fitts & Posner, Bernstein, Gentile
Here are the classic skill acquisition guidelines:
- Classen J, Liepert J, Wise S, Hallett M, Cohen L. Rapid plasticity of human cortical movement representation induced by practice. J Neurophysiol1998;79:1117-23.
- Doyon J, Penhune V, Ungerleider LG. Distinct contribution of the cortico-striatal and cortico-cerebellar systems to motor skill learning. Neuropsychologia2003;41:252-62.
- Doyon J, Song AW, Karni A, Lalonde F, Adams MM, Ungerleider LG. Experience-dependent changes in cerebellar contributions to motor sequence learning. Proc NatlAcadSci U S A 2002;99:1017-22.
- Molinari M, Leggio MG, Thaut MH. The cerebellum and neural networks for rhythmic sensorimotor synchronization in the human brain. Cerebellum 2007;6:18-23.
- Manzoni D. The cerebellum may implement the appropriate coupling of sensory inputs and motor responses: evidence from vestibular physiology. Cerebellum 2005;4:178-88.
- Manzoni D. The cerebellum and sensorimotor coupling: looking at the problem from the perspective of vestibular. Cerebellum 2007;6:24-37.
- Dr. Russel. PT826 Motor Control Slides PowerPoint Presentation: 2013
- Manto M, Bastian A. Cerebellum and the deciphering of motor coding. Cerebellum 2007;6:3-6.
- Dr. Russel: Motor Learning Slide PowerPoint Presentation: 2013
- Dr. Russel PT628 Motor Learning Slides PowerPoint Presentation: 2013.
- Dr. Russel PT884 Learning Motor Skills PowerPoint Presentation: 2013.