MOVEMENT SYSTEM

INTERCONNECTION OF POSTURAL ONTOGENESIS - NEURO -

MYOFASCIA - SKELETAL
WITH MOVEMENT PATTERN
Wisnu Prasetyo Adhi, Ftr

Neuromechanical interactions underlying neural control of movement.

FCM CONCEPT
Neuro
System
Fluid Musculo -
System BALANCE skeletal
System
the
SYSTEMS

Awareness Fascial
System
Body System
(Calibration)

Hillel J. Chiel et al. J. Neurosci. 2009;29:12807-12814

©2009 by Society for Neuroscience

PHYSIOTHERAPY APPROACH ASSESMENT OF ADULT

Development Kinesiology & neurophysiological aspects of

Maturing POSTURAL-LOCOMOTOR SYSTEM FIVE CORE MOVEMENT
1. RIBCAGE

2. SPINE

IAP regulation

3. PELVIC

4. SCAPULA

5. FEET

ASSESMENT OF ADULT ASSESMENT OF ADULT

DIAFRAGMA
FIVE FLOOR
BREATHING
IAP DISTRIBUTION
1. Mouth Floor WITH
2. Thoracic Inlet Floor CORRECT ACTIVATION OF
DIAPHRAGM
IAP regulation
3. Ribcage Floor
• Physiological movement of the diaphragm should
4. Pelvic Floor be part of all movement and exercise
5. Feet Floor • (feedforward mechanism)
• Central tendon descends
• (abdominals hold the ribs tocreate the fixing point)
• Lower ribs spread apart
• IAP equally increases in all directions
REFLEXTIVE STABILIZATION : BREATHING PRINCIPLESS

Main Principles:
1. Developmental Kinesiology.
Provides framework for regional interdependance &
interlinking of skeleton,muscle,joints..etc during movement.
STABILIZATION Function is as important as DYNAMIC/MOVEMENT
function
2. Functional Joint Centration
Implies the best possible distribution of the load at the
articular surfaces during each position/posture in a course of
Movement.
If CNS Control is adequate – ideal balanced activation of
muscle synergies will automatically bring all the joints into
Functional Centration during Movement.
3 Levels of Motor Control
Spinal (total reflex)
Subcortical (subconscious/automatic)
Cortical (intentional)

PHYSIOTHERAPY CONCEPT APPROACH??? THE CONCEPT????

is a complex approach

! Encompasses principles of developmental

kinesiology during the first year of life

! Define the posture, breathing pattern and functional

joint centration from a neurodevelopmental
perspective

! Derives ideal quality of these functional stereotypes

from central (neurological) programs maturing
during early postural ontogenesis

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OVERVIEW
The assessment is based on the comparison
of the patient´s stabilizing pattern to that of a
healthy infant.

The treatment is based on the ontogenetic

postural locomotor patterns

! Primary goal of the treatment to optimize the

distribution of internal forces of muscles that act on
each segment of the spine and/or any other joints
or segments. (Efficiency of movement)

DEVELOPMENTAL KINESIOLOGY -DEFINITION OF IDEAL FUNCTIONAL PATTERN DEVELOPMENTAL KINESIOLOGY

HOW TO ASSESSMENT DIFFERENT PATHOLOGY - SAME PATTERN
When assessing a patient and searching for
the primary cause of a problem in locomotor
system, the following consequences must be
considered:

! The morphological aspects and external

biomechanical impacts affecting the spine and the
joints as well as the internal forces

! The magnitude of the repeating internal forces

developed by the patient´s own musculature.
(They are massive.)

DEVELOPMENTAL KINESIOLOGY-POSTURAL ONTOGENESIS USE IN THERAPY DEVELOPMENTAL KINESIOLOGY-POSTURAL ONTOGENESIS USE IN THERAPY
DEVELOPMENTAL KINESIOLOGY
- Understanding of developmental kinesiology
provides a framework to appreciate the regional
interdependence and the interlinking of the
skeleton, joins, and musculature during movement.
- Muscles must be trained in both their stabilization
and dynamic (movement producing) functions.
DEVELOPMENTAL KINESIOLOGY - STABILIZING SYSTEM
! Research* addresses the importance of the
deep spinal stabilizing system
! More than just the “deep muscles” provide
spinal and extremity joint stabilization
! Through postural- locomotion kinematic chains,
nearly every muscle is involved in stabilizing
function.
* Bouche 2011, Kim 2010, Watanabe 2010 www.rehabps.com www.rehabps.com
 POSTURAL STABILIZATION

! The QUALITY of postural stabilization depends

on the QUALITY of sensorimotor control

ANY PURPOSFUL MOVEMENT IS PRECEDED

BY THE AUTOMATIC ACTIVATION OF THE
POSTURAL STABILIZERS.

Borghuis 2008, Hodges 2004, McGill 2009

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POSTURAL STABILIZATION POSTURAL FUNCTION

! Postural stabilization is an automatic, ! „Postural function is interdependent with

subconscious function that is frequently respiratory function.“ Karel Lewit
compromised in patients with musculoskeletal
pain and with various neurological diagnoses
! Incorrect posture results in abnormal
breathing pattern and vice versa

! The postural-respiratory function is not

completely under voluntary control → may be
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difficult to resolve with traditional rehabilitation
approaches.

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THE GOAL OF PHYSIOTHERAPY APPROACH - DNS DEVELOPMENT OF POSTURE

# To improve or normalize the

quality of… ! Posture is based on
motor ontogeny
! postural stabilization patterns
! respiratory patterns
! locomotion patterns ! The goal of the
ontogeny is
# Integrate the proper postural- independent social
locomotion and respiratory bipedal locomotion
function within ADL and sport
performance

DEVELOPMENT OF POSTURE FUNCTIONAL JOINT CENTRATION

Maintaining the spine in a lordo- kyfotic curvature

Setting the pelvic and chest alignment for optimal ! Assumes that core stability and
stabilization in the sagittal plane basic extremity locomotor
function are mainly under the
control of the subcortex.

FIRST PART OF THE DEVELOPMENT ! If CNS control is adequate, and

muscles are activated in
balance, then each posture and
Followed by the development of phasic movement each spontaneous movement
(grasp, task oriendted movement) and locomotion automatically brings all the joints
(step forward or support during locomotion) into a FUNCTIONALLY
CENTRATED POSITION.
FUNCTIONAL JOINT CENTRATION BIOMECHANIC OF MUSCLE CONTRACTION
0PEN KINETIC CHAIN

If the proximal muscle

attachment is stabilized PF = punctum fixum
[punctum fixum (PF)], then
the distal end of the muscle
moves toward the proximal
part [punctum mobile (PM)]

Proximal muscle pull =

stepping forward movement. PM= punctum mobile

(Neumann, 2002)
Diagram by DNS instructor
Richard Ulm, DC. Rintala M, Ulm R, Jezkova M, Kobesova A. Czech
Get-up. NSCA Coach. 2016;3(2):30-8.ISSN 2376-0982 Online. https://www.nsca.com/publications/reports-and-
journals/nsca-coach/

BIOMECHANIC OF MUSCLE CONTRACTION BIOMECHANIC OF MUSCLE CONTRACTION

CLOSE KINETIC CHAIN

If distal muscle attachment

is fixed [punctum fixum PM= punctum mobile
(PF)], then the proximal
end of the muscle moves
toward the distal part
[punctum mobile (PM)]

Distal muscle pull =

supporting function. PF = punctum fixum

(Neumann, 2002)
3 LEVEL OF SENSORIMOTOR CONTROL IN ASSESMENT AND TREATMENT 3 LEVEL OF MOTOR CONTROL

! Three different levels of sensorimotor control strategy Level Neuroanatomical

structures
Postural reflex
development
Motor
development

within the CNS can be distinguished during

examination and assessment. High Cortex Equilibrium
reactions
Bipedal function

Middle Midbrain Righting reactions Quadrupedal

tactics function
! During the neonatal stage, general movements Low Brain stem, spinal cord Primitive Apedal function
and primitive reflexes are controlled MAINLY at reflex

the SPINAL AND BRAIN STEM LEVELS

execution

William & Wilkins 2001

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1. SPINAL & BRAIN STEM LEVEL (0-6 W) 2. SUBCORTICAL LEVEL

Primitive reflexes become inhibited and
integrated into higher levels of motor control.
“Immaturity“ Functional and Structur
Maturation of postural-locomotion patterns
No Balance, no Postural function ! Stabilization
! Equilibrium
! Muscle co-contraction
! Stepping forward & supporting function
Primitive reflex +
! This level of the CNS motor control emerges
and matures mainly during the first year of life.
! This allows for basic trunk stabilization, a
prerequisite for any phasic movement and for the
locomotor function of the extremities.
! At the subcortical level, orofacial muscles and
afferent information are automatically
integrated into postural-locomotor patterns.

Crucial to early diagnosis www.rehabps.com

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DEVELOPMENT IN 1ST TRIMENON LIMB FUNCTION DEFERENTIATION

Development from the newborn stage (holokinetic mvt, no

purposeful mvt, asymmetry) to a posture which allows the child to
stop a movement in the middle, stabilize the trunk and pelvis in the
sagittal plane, and start to develop voluntary grasp.

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! Development from the global (holokinetic) mvt to

more localized control IPSILATERAL PATTERN
CONTRALATERAL PATTERN
6 M, side lying position-ipsilateal pattern of locomotion extrimity
! From untargetted mvt to precise movements function
Contralateral postural-locomotion pattern

Right leg, left arm : supporting; left leg, right armh : steping forward
based on optimal core stabilization : bottom extrimities serve for
recahing
www.rehabps.com support, top extrimities are stepping forward/reaching

TWO PATTERN DISPLAYED ON ONTOGENY TWO PATTERN DISPLAYED ON ONTOGENY

Contralateral Pattern Ipsilateral pattern
! Developed from a
! Developed from a
prone position
supine position
! Diagonal extremities
are in supporting ! Initially see in the child
function, the other rolling over
two in phasic function
! Underlying extremities
! Presents after the are in supporting function,
ipsilateral pattern upper lying in phasic function
develops.
KEY MILESTONE POSITION TRANSFER DURING LOCOMOTOR FUNCTION

POSITION TRANSFER DURING LOCOMOTOR FUNCTION 3. CORTICAL LEVEL

! MOTOR LEARNING

Individual qualities and characteristics of

movement

Allows for isolated segmental movement and

relaxation

It incorporates
! Gnostic function (multisensory integration)
! Motor function
! Ideal-motor function
CORTICAL LEVEL DYNAMIC NEUROMUSCULAR STABILIZATION (DNS)

! Human ontogenetic
models (i.e.,
! Should not be ignored developmental motor
patterns) can be used in
! A child with impaired cortical both DIAGNOSIS and
motor control may be diagnosed with TREATMENT of locomotor
system dysfunction.

1. Just maintaining the

developmental coordination disorder (DCD) position
2. Initial muscle activity
3. Transitional movements

DYNAMIC NEUROMUSCULAR STABILIZATION (DNS) ASSESMENT IN ADULT

! In principle, any kind of movement can be used as an

functional assessment
! Because we believe that development shows us an ideal
posture, follows can be assessed:
! Every position displayed in development
! Every transitional phase
! from one position to another
! forward or backward (reverse) movement
! During postural assessment we are interested in the
deviation from the ideal postural model and the
ethiopathogenic consequences
TREATMENT TREATMENT
Manual therapy
! Exercise in open kinetic chain: Phasic movement
with low/adequate resistance (beginning)
! Soft tissue ! Work in close kinetic chain: Improve support
! Spine & rib mobilization function
Sagittal stabilization training ! Exercise in developmental positions (just hold it)
combined with breathing ! Move from one developmental position to another.
! Manage the difficulty by changing the resistance
function (TB, PT, Kettlebell), or by assisting the movement

“LEARN THE CONCEPT,

DON’T JUST LEARN THE TECHNIQUE”

TERIMA KASIH

WISNU PRASETYO ADHI, FTR