The document discusses motor control and various theories of motor control. It defines motor control as the ability to regulate movement and discusses five main theories: reflex theory, hierarchical theory, motor programming theory, systems theory, and ecological theory. It also discusses the physiology of motor control in the nervous system and how clinical practice has evolved parallel to developments in scientific theories of motor control. Theories provide frameworks to interpret behavior and guide clinical actions, but no single theory can fully explain motor control.

1. Theories of motor control and therapeutic impliation
Presentar : Ashik Dhakal
Moderator : Sydney Roshan Rebello

2. Learning objectives
• Motor control
• Theories of motor control
• Physiology of control
• Clinical implications

3. Motor control
• Acc to Shumway, motor control is defined as the ability to regulate or direct the
mechanisms essential to movement.
• Field of motor control is directed at studying the nature of movement, how movement
is controlled.
• Motor control evolves from complex set of neural, physical and behavioural process
that governs posture and movement.
• Sensory information about movement is used to guide and shape the development of
motor program.

4. Understanding the Nature of movement
• Movement emerges from the interaction of three factors, the Individual, the Task,
and the Environment.
• The individual generates movement to meet the demands of the task being performed
within a specific environment.
• Individual’s capacity to do so determines that person’s functional capability.

7. Factors within individual that constrain movement
• Within the individual, movement arises from the interaction of multiple processes,
including perception, cognition, and action.

8. 1) Movement and action
• Movement is usually studied in relation to specific actions or activities, which will provi
• Understanding control of action - implies how the motor output from nervous system is c
• Degree of freedom problem - problem in choosing the appropriate movement and then c

9. 2) Movement and perception
• Perception - integration of sensory impressions into psychologically meaningful
information.
• Perception action
• Perception includes both peripheral sensory mechanisms and higher level processing
that adds information and meaning to incoming afferent information.
• Perceptual systems provide information about the state of the body and features within
the environment.

10. 3) Movement and cognition
• Cognitive process includes attention, planning, problem solving, motivation, and
emotional aspects of motor control that underlie the establishment of goal.

11. 2) Task constraints on movement
• Understanding motor control requires an awareness of how to regulate neural
mechanisms controlling movement.
• Pt should develop movement patterns that meets the demand of functional tasks in case
of any sensory, motor and perceptual impairment.
• Re-learn to perform functional tasks - maximum recovery of functional independence.

12. Task can be classified as
• Functional category : bed mobility task, transfer task, ADLs.
• Acc to neural control mechanism : Discrete, continous.
• When BOS is in motion : stability task, mobility task.
• Non moving BOS : sitting and standing.
• Acc to movement variability : open movement task and closed movement task.

13. 3) Environmental constraints on movement
• Task are performed in a wide range of environment, thus CNS must take into
consideration, attributes of the environment when planning task specific movement.
• Attributes of the environment that affect movement - regulatory and nonregulatory
features.
• Regulatory features, eg. size, shape, weight, type of surface on which we walk.
• Non-regulatory features, eg background noise, presence of any distraction.
• These both features are essential in planning effective intervention.

14. Theories of motor control
• A theory of motor control is a group of abstract ideas about the control of movement.
• Jules Henri Poincare (1908) said, “Science is built up of facts, as a house is built of
stone; but an accumulation of facts is no more a science than a heap of stones in a
house.”
• As same stones can be used to make different houses, the same facts are given
different meaning and interpretation by different theories of motor control.
• Different theories of motor control reflect philosophically varied views about how the
brain controls movement.

15. Theories provide
• A framework for interpreting behaviour,
• A guide for clinical action,
• New ideas,
• Working hypothesis for examination and intervention.

16. Theories of motor control
1) Reflex theory
2) Hierarchical theory
3) Motor programming theories
4) System theory
5) Ecology theory

17. 1). Reflex theory
• Sir Sherrington, a neurophysiologist wrote the book The Integrative Action of the
Nervous System in 1906 and formed the experimental foundation for a classic reflex
theory of motor control.
• For Sherrington, reflexes were the building blocks of complex behaviour.
• He believed that complex behaviour could be explained through the combined action
of individual reflexes that were chained together.

19. Clinical implications
• If chained or compounded reflexes are the basis for functional movement, clinical
strategies designed to test reflexes should allow therapists to predict function.
• A patient’s movement behaviours would be interpreted in terms of the presence or
absence of controlling reflexes.
• Retraining motor control for functional skills would focus on enhancing or reducing
the effect of various reflexes during motor tasks.

20. Limitations
• First - the reflex must be activated by an outsider agent, cannot be considered as the
basic unit of behaviour.
• Second - reflex theory does not adequately explain and predict movements that
occurs in the absence of a sensory stimulus.
• Third - the theory does not explain fast movements, that is, sequences of movements
that occur too rapidly to allow for sensory feedback from the preceding movement to
trigger the next.

21. • Fourth - the concept that a chain of reflexes can create complex behaviours fails eg.,
override reflex to do certain activities.
• Fifth - reflex chaining does not explain the ability to produce novel movements.

22. 2). Hierarchical theory
• Many have explained nervous system is organised as a hierarchy.
• Jackson, an English physician, argued that the brain has higher, middle, and lower
levels of control, equated with higher association areas, the motor cortex, and spinal
levels of motor function.
• This theory suggests that motor control/ normal movement results from a chain of
reflexes organised hierarchically within the levels of the CNS.

24. • In the 1920s, Rudolf Magnus found that reflexes controlled by lower levels of the
neural hierarchy are present only when cortical centers are damaged.
• These results were later interpreted to imply that reflexes are part of a hierarchy of
motor control, in which higher centers normally inhibit these lower reflex centers.
• In 1940 Gesell, applied this theory to explain the behaviours they saw in infants.

26. Current concept related to Hierarchical concept
• The concept of a strict hierarchy, in which higher centres are always in control, has
been modified.
• It is explained, the reflexes are not considered the sole determinant of motor control,
but only as one of many processes important to the generation and control of
movement.

27. Clinical implication
• Brunnstrom stated “When the influence of higher centres is temporarily or
permanently interfered, normal reflexes become exaggerated and so called
pathological reflexes appear”
• Bobath, in her discussions of abnormal postural reflex activity in children with cp,
stated that “the release of motor responses integrated at lower levels from restraining
influences of higher centres, especially that of the cortex, leads to abnormal postural
reflex activity”

28. Limitations
• It cannot explain the dominance of reflex behaviour in certain situations in normal
adults.
• For example, stepping on a pin results in an immediate withdrawal of the leg.

29. 3). Motor programming theories
• Most recent theories have expanded our understanding of the CNS.
• They have moved away from views of the CNS as a mostly reactive system and have
begun to explore the physiology of actions rather than the physiology of reactions.
• Reflex can be obtained still by removing the stimulation, or the afferent input, and still
have a patterned motor response.

30. • If motor response removed from its stimulus, concept of central motor pattern will be
left.
• This concept of CMP or motor program is more flexible than the concept of reflex as it
can either be activated by sensory stimuli or by central process.
• eg. cutting of afferent nerve in cat for locomotion.

32. Clinical implications
• If higher levels of motor programming are affected - helps patients relearn the correct
rules for action.
• Intervention should focus on retraining movements important to a functional task, not
just on reeducating specific muscles in isolation.

33. Limitations
• Central motor program cannot be considered to be the sole determinant of action.
• If your muscles are fatigued, similar nervous system commands will yield different
results.
• Thus, this concept does not explain that the nervous system must deal with both
musculoskeletal and environmental variables in achieving movement control.

34. 4) Systems theory
• Previously, neurophysiologists had focused primarily on neural control aspects of
movement.
• Bernstein, recognised that you cannot understand the neural control of movement
without an understanding of the characteristics of the system you are moving and the
external and internal forces acting on the body
• Bernstein said, “Coordination of movement is the process of mastering the redundant
degrees of freedom of the moving organism” . Converting the body into a controllable
system.

36. • DST suggest, new movement emerges because of a critical change
in one of the systems, called as a control parameters.

37. • Degree to which flexibility exist to change a preferred pattern.

38. Clinical implications
• Movement is an emergent property.
• Shifts or alterations in movement behaviour can often be explained in terms of
physical principles rather than necessarily in terms of neural structures.

39. Limitations
• This model explains the nervous system has a less important role in determining the
animal’s behaviour.
• Understanding the application and relevance of this type of analysis to clinical practice
can be very difficult.

40. 5) Ecological theory
• Psychologist, Gibson stated motor systems allow us to interact most effectively with
the environment in order to perform goal-oriented behaviour.
• It suggests that motor control evolved so that animals could cope with the
environment around them, moving in it effectively in order to find food, run away
from predators, build shelter, and even play.

41. Clinical implications
• Adapt ability is important not only in the way we organize movements to accomplish
a task, but also in the way we use perception.
• An important part of intervention is helping the patient explore the possibilities for
achieving a functional task in multiple ways.

42. Limitations
• It has tended to give less emphasis to the organisation and function of the nervous
system that led to this interaction.

43. Parallel Development of clinical practice and scientific theory.
• Scientific theory provides a framework that allows the integration of practical ideas
into a philosophy for intervention.
• A theory is not right or wrong in an absolute sense, but it is judged to be more or less
useful in solving the problems presented by patients with movement dysfunction.
• Clinical practice evolves in parallel with scientific theory, as clinicians understand
changes in scientific theory and apply them to practice.

45. Muscle re -education
• Refers changing function at the muscle level
• Was found effective in managing movement disorder resulting from polio.
• But found to be less impact in altering movement patterns in patients with UMN
lesions.

46. Neuro facilitation approach
• Clinicians working with pt of UMN lesion began to direct clinical efforts towards
modifying the CNS itself.
• Techniques designed as facilitate or inhibit different movement patterns.
Key assumptions
• Functional skills will automatically return once abnormal movement patterns are
inhibited and normal patterns are fascilitated.
• Repetitions of these normal movement patterns will automatically transfer to
functional tasks.

47. Task- oriented approach
• Newer approach before referred as system approach.
• Normal movement emerges as an interaction among many different systems, each
contributing different aspects of control.
Assumptions
• Patient learns by actively attempting to solve task rather than by repetitively
practicing normal patterns of movement.

48. Physiology of motor control
• Some neuroscience research suggests that movement control is achieved through the
cooperative effort of many brain structures that are organised both hierarchically and
in parallel.
• Hierarchically within ascending levels of the central nervous system, same signal
may be processed simultaneously among many different brain structure showing
parallel distributed processing.

50. Sensory inputs perform many functions in the control of movement. They:
(a) serve as the stimuli for reflexive movement organized in the spinal cord.
(b) modulate the output of movement that results from the activity of pattern generators
in the spinal cord.
(c) modulate commands that originate in higher centers of the nervous system.
(d) contribute to the perception and control of movement through ascending pathways in
much more complex ways.

51. • Model of nervous system

52. Summary
• What is motor control?
• Theories of motor control?
• Which theory is best among theories of motor control?
• Model of nervous system?

53. • Anne Shumway-cook, Motor Control.
• Susan B. O’Sullivan
• Darsi A Umphred

54. Thank you