Motor Learning

Irfan
Motor Relearning Programme
- Carr & Shepherd(1982)
The elimination of unnecessary muscle activity
Feedback of information about performance
Practice
The MRP was made up of seven sections representing
essential functions of everyday life:

1. Upper limb function

2. Orofacial function
3. Sitting up from supine
4. Standing up
5. Sitting down
6. Standing
7. Walking
Bobath / NDT- Berta & Karel Bobath

A concept of treatment based on the inhibition of

abnormal reflex activity and the relearning of
normal movement, through the facilitation and
handling.

New version is a problem-solving approach to the

assessment and treatment of individuals with
disturbances of tone, movement, and function due to
a lesion of CNS. The goal of treatment is to optimize
function by improving postural control and
selective movement through facilitation (IBITAH,
1995)
 BOBATH
BOBATH CONCEPT
CONCEPT

is a problem-solving approach to the

assessment and treatment of individuals
with disturbances of tone, movement, and
function due to a lesion of CNS.

The goal of treatment is to optimize function

by improving postural control and
selective movement through facilitation. (IBITA,
1995)
 GOALS
GOALS OF
OF CONCEPT
CONCEPT

To identify and address the specific areas of low

tone in the anti-gravity musculature.

To seek to control the amount and diversity of

proprioceptive input.

To identify the primary goals for function in the

individual person, and to understand the nature of
how that function is performed efficiently
“Normally”
 GOALS
GOALS OF
OF CONCEPT
CONCEPT

To facilitate specific motor activity without

overflow of irradiation that could elicit associated
reactions.

To minimize compensation and therefore

sensory/motor neglect of the affected body parts.

To identify when and how voluntary controls can

be used effectively.
 CONSIDERATION
POSTURAL CONTROL
POSTURAL ORIENTATION
INTERNAL REPRESENTATION
BODY CONCEPT(Awareness, Schema , Image )
SENSORY CHANNEL
MUSCULOSKELETAL COMPONENT
NEUROMUSCULAR COMPONENT
 SHOULDER
HEAD CONTROL SCAPULAR
ELBOW
HAND

PROXIMAL
(ALIGNMENT)

PELVIS
ANKLE
HIP
MOVEMENT
kNEE
STATOKINETIC REACTION
STABILITY/ MOBILITY
= WORKS TOGETHER WHILE DOING
SOMETHING.
( PURPOSEFUL MOVEMENT)
= WE CALL IT POSTURAL CONTROL.
= BASIS OF MOVEMENT
 TONE
TONE PRODUCED
PRODUCED THROUGH
THROUGH
THE
THE ACTIVATION
ACTIVATION OF
OF MOTOR
MOTOR UNITS
UNITS

MOTOR
MOTOR UNIT
UNIT

THE
THE MOTOR
MOTOR NEURON
NEURON

ALL
ALL THE
THE MUSCLE
MUSCLE FIBERS
FIBERS
IT
IT INNERVATES
INNERVATES
 MOTOR
MOTOR UNIT
UNIT
Relationship between fiber type, motor unit type and
histochemical profiles of muscle fibers

Fiber type I II IIB

SO FOG FG
(Slow O.) (Fast O & G) (Fast G.)
Motor unit type S FR FF
Histochemical profiles
Myofib. ATPase Low High High
NADH dehydro. High Medium-High Low
SDH High Medium-High Low
Glycogen Low High High
Phosphorylase Low High High
Capillary supply Rich Rich Sparse
Fiber diameter Small Medium-Small Large
 FG
Fast-twitch Glycolytic
(involved in phasic movement)
WHITE

FOG
Fast-twitch Oxidative Glycolytic
PINK

SO
Slow-twitch Oxidative
(involved in tonic movement)
RED
B. HWANG 1999
 NUMBER
NUMBER OF
OF MOTOR
MOTOR UNIT
UNIT &
&
INNERVATION
INNERVATION RATIO
RATIO

Number of Motor Innervation

Muscle Ratio
Unit
Extensor Rectus 2970 9

1st Lumbricals 96 108

Brachioradialis 333 410

Tibialis Anterior 445 562

Gastrocnemius 579 1934
RECRUITMENT ORDER
POSTURAL TONE

Gravity

COG
GRF

BOS
10/19/23 16
CENTRAL PATTERN GENERATOR

POSURAL ALIGNMENT
MOVEMENT
ACIVATION FROM THE MUSCLES
PROGRAMED MOVEMENT
INFORMATION
 Central Pattern Generators.
Spinal circuits act as central pattern generators.
The existence of pacemaker cells within neural
tissue demonstrate the ability for circuits to be
active without sensory input.
The overall stepping pattern consists of a
rhythmic alteration in the contractions of flexor
and extensor muscles.
The pattern of the pattern generator is written
into the CNS map i.e. it is genetic.
 ASSESSMENT

MUSCLE SKELETAL
Length DIRECTION
Direction LENGTH
Strength SIZE
Synergist MOBILITY
ROM
 FETAL MOVEMENT
Body concept
- midline, Each direction
Confidence- Security
Neuromuscular junction
- Motor output unit
Musculoskeletal structual component
ROTATION
SELECTIVE MOVEMENT

Hominid

Primate

Mammalian

Amphibian

Fish
ACTIVE MOVEMENT
 Variable
SPEED
ROM
COMPRESSION
ROTATION
DIRECTION
Task-oriented
Active

‘Carry-over or not,
depend on your handling skill’
CONCLUSION

PASSIVE
STEREOTYPE
CONCLUSION

ACTIVE
COMMUNICATION
STABILITY & MOBILITY

10/19/23 27
 ALIGNMENT

Form & Function

Plasticity
SELECTIVE MOVEMENT
-Fractionation-

-Against gravity-
1.Vestibulo-spinal system
2. Reticulo-spinal system

-Selectivity-
1. rubro-spinal system
2. cortico-spinal system
BASE OF SUPPORT

Accept & Adapt

 INTERMUSCULAR
RECIPROCAL INNERVATION

eccentric
eccentric concentric
concentric

concentric
concentric eccentric
eccentric
The major problem facing the motor control
system is not only to contract the agonist,
or the prime mover by the correct amount
and at the appropriate time, but to time and
organize the pattern of antagonist, fixator
and postural muscle contractions which are
necessary to company it’s action
(Rothwell, 1994)
Motor plans are implemented through
networks that determine the order, timing
and strength of movement around each
joint, which is translated into a
choreography of motor neuron activity that
drives the individual muscles at the right
amount and with the right force.
(Harris-Warwick & Sparks, 1995)
Only active participation produces
motor improvement or learning, which
passive imposition of postures and
movements can have no practical
values.
(Brooks, 1986)