Advances in Motor Control and Learning for Neurological Rehab – Ben Sidaway

In many rehabilitation settings, therapists are faced with the challenge of how best to teach motor skills to patients. In pediatric settings, the challenge is to optimize the learning of new skills, while in neurologic and geriatric settings, therapists primarily focus on changing inappropriate motor behavior and the re-learning of motor skills.

Successful therapists must be able to accurately determine the cause of motor skill impairments and then design treatment approaches that facilitate the learning or re-learning of motor skills. In today’s fast paced health care environment, therapists must be adept in structuring the learning environment to promote the quickest and longest lasting changes in a patient’s motor skills.

In this course, you will examine current theoretical and applied perspectives in the field of motor control and learning and will discuss their implications for therapeutic evaluation and treatment. Course discussion will be focused at the behavioral level and will compare and contrast information processing and dynamic systems models in understanding normal and pathological human motor behavior. Implications for treatment stemming from both approaches will be examined.

You will constructively criticize current assumptions underlying motor control rehabilitation and discuss how theoretical frameworks bias evaluation and treatment options. Given an understanding of past and current approaches to motor control and learning, you will be able to flexibly design their own unique treatment approaches to optimize functional outcomes in each patient.

1. Integrate recent developments in motor control and learning into interventions for pediatric, geriatric, and neurologic rehabilitation.
2. Assess underlying causes of motor skill impairments.
3. Differentiate between changes in performance and motor learning.
4. Utilize the constraints theory to promote the re-emergence of motor skills in stroke patients.
5. Describe instructional techniques that will facilitate motor skill learning during treatment.
6. Incorporate a holistic approach to promote the re-emergence of motor skills.
7. Design flexible evaluation and treatment programs for patients with neurological involvement based on current motor control and learning research.
8. Utilize the process of perception-action coupling to help facilitate movement.

MODELS OF MOTOR CONTROL

• Reflex models
• Peripheral control
• Spinal control
• Hierarchical and information processing models
• The role of cognition
• Motor programs
• Mass-spring models
• Dynamics systems and ecological models
• The degrees of freedom problem

CASE STUDIES

• Treating spastic gait in children with cerebral palsy
• Gait onset in children

APPROACHES TO NEUROLOGICAL REHABILITATION

• Facilitation approaches
• Manual guidance
• Current motor control approaches
• Bimanual coordination

CASE STUDIES

• Treating asymmetric weight-bearing in patients with hemiparesis
• Improving performance of hemiparetic limbs
• Improving Parkinsonian gait
• Treadmill training in Down syndrome gait
• Treadmill training for patients with neurologic insults
• Improving motor coordination in patients with stroke

ASSESSING MOTOR LEARNING

• Acquisition
• Retention
• Transfer
• Dual-task

TRANSFER OF LEARNING VS. SPECIFICITY OF PRACTICE

PART-WHOLE PRACTICE TECHNIQUES

STUCTURING THE LEARNING ENVIRONMENT

• Modeling
• Verbal cues and instructions
• Feedback
• Contextual interference
• Spacing of treatment
• Mental practice
• Motivation and goal setting

CASE STUDIES

• Improving motor skills in patients with Parkinson’s disease
• Dorsiflexion strengthening for foot drop

PERCEPTION-ACTION COUPLING

• The role of optic flow
• Perspective control
• Affordances