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Neurofacilitation Approaches
Definition and levels of analysis Reflex theory Hierarchical theory Complex systems theory Neurofacilitation Approaches Motor Re-learning, Task-Based Rehabilitation Motor Hierarch
Description
The discipline of Motor Control is the study of human movement and the systems that control it under normal and pathological conditions. Levels of analysis (study)
Environmental result of the movement (Outcome) Movement pattern Neuromotor processes underlying movement
Reflex Theory
Hierarchical Theory
Hierarchical Theory
Movement is controlled by a system consisting of 3 levels with a rigid top down organization Higher centers control lower centers via inhibition Disinhibition Release phenomenon
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Movement emerges spontaneously from the interaction of the individual, the task, and the performance environment
Individual
Movement
Task
Environment
2/3
3/3
Perception
Action
I T E
Mobility
Regulatory
Stability
Manipulation
Nonregulatory
Neurofacilitation Approaches
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Developed during the 1950-1960s in parallel with increasing knowledge of anatomy and physiology of the nervous system Bobath (NDT); Brunnstrom; Kabat, Knott & Voss (PNF); Ayers (Sensory Integration Therapy) developed the Neurofacilitation Approaches that replaced the muscle re-education approach used to treat the effects of Polio during the 1940-1950s Neurofacilitation approaches were designed to treat the movement effects of stroke (UMN lesion) by attempting to affect the CNS directly through the manipulation of sensory input
Neurofacilitation Approaches
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Assumptions
Normal movement
Results from a chain of reflexes organized hierarchically within the CNS (Control of movement is top down cortex controls brainstem and spinal cord) Characterized by the emergence of behavior organized at sequentially higher levels of the nervous system Driven by sensory input
Normal development
Neurofacilitation Approaches
3/7
Assumptions
Abnormal movement
Caused by disruption of normal reflex mechanisms Cortical lesions cause the release of abnormal reflexes organized at lower levels of the central nervous system Release of abnormal reflexes constrains the patients ability to move normally Abnormal movement is the direct result of lesion not secondary or compensatory actions**
Neurofacilitation Approaches
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Assumptions
Abnormal movement
In both children and adults, movement is dominated by primitive reflexes In children, cortical lesions interrupt normal corticalization thus motor control is dominated by primitive reflexes organized at lower levels of the CNS (primitive reflexes are never constrained) In adults, with acquired motor cortical lesions, damage to the higher levels of the CNS release lower levels and movement is dominated by primitive reflexes (primitive reflexes are constrained then released)
Neurofacilitation Approaches
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Assumptions
Recovery of function
Requires that higher centers once again control lower centers Recapitulates normal development, therefore, intervention should proceed along a developmental sequence Functional skills will automatically return once abnormal movement is inhibited** Repetition of normal movement patterns will automatically transfer to functional tasks**
Neurofacilitation Approaches
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Clinical Implications
Examination should identify abnormal reflexes controlling movement Intervention should modify abnormal reflexes Intervention modifies the CNS through sensory input
Neurofacilitation Approaches
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Assumptions
Normal movement Performer + Task + Environment Abnormal movement results from impairment in one or more of the systems controlling movement Abnormal movement pattern is the performers best solution to the task given the systems remaining after damage not just the result of the lesion itself**
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Assumptions
Recovery of function
Recovery is produced by plastic reorganization of undamaged control centers (neural plasticity) Recovery is best produced by practice of purposeful, goaloriented tasks that are meaningful to pts goals (task specificity)
Clinical Implications
Motor Hierarchy
S1
Concern: specifying spatial, temporal, and force parameters of the motor plan
Lowest level: LMNs, motor plant, FB about sensory consequences of the movement
Click to Animate
The End