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Thepublisherdoesnotprovidemedicaladviceorguidanceandthisworkismerelyareferencetool. Healthcareprofessionals,andnotthepublisher,aresolelyresponsiblefortheuseofthiswork includingallmedicaljudgmentsandforanyresultingdiagnosisandtreatments.

Givencontinuous,rapidadvancesinmedicalscienceandhealthinformation,independent professionalverificationofmedicaldiagnoses,indications,appropriatepharmaceuticalselectionsand dosages,andtreatmentoptionsshouldbemadeandhealthcareprofessionalsshouldconsultavariety ofsources.Whenprescribingmedication,healthcareprofessionalsareadvisedtoconsulttheproduct informationsheet(themanufacturer'spackageinsert)accompanyingeachdrugtoverify,amongother things,conditionsofuse,warningsandsideeffectsandidentifyanychangesindosagescheduleor contraindications,particularlyifthemedicationtobeadministeredisnew,infrequentlyusedorhasa narrowtherapeuticrange.Tothemaximumextentpermittedunderapplicablelaw,noresponsibilityis assumedbythepublisherforanyinjuryand/ordamagetopersonsorproperty,asamatterofproducts liability,negligencelaworotherwise,orfromanyreferencetoorusebyanypersonofthiswork.

LWW.com

It is with great love and gratitude that we dedicate this book to the many people, including professional colleagues and patients, who have contributed to the development of the ideas presented here. We also gratefully acknowledge the divine source of our enthusiasm, wisdom, and joy. The sweet mix of inspiration and effort involved in the creation of this book was truly a delight.

PREFACE

In recent years, there has been a growing emphasis on evidence-based clinical practice, which is characterized by the integration of the best available research with expert clinical judgement and patient preferences regarding assessment and treatment of motor control problems. However, theintegrationofresearchintoclinicalpracticeiseasiersaidthandone.The explosion of new research in the field of neuroscience and motor control has created an ever-widening gap between research and clinical practice. Thisbookisdedicated toreducingthisgapbyreviewingcurrentresearchin the area of motor control and exploring the translation of this research into bestclinicalpractices.

AN OVERVIEW OF THE FIFTH EDITION

The overall framework of the fifth edition has not changed and contains four parts. Part I, the Theoretical Framework, reviews current theories of motor control, motor learning, and recovery of function after neurological insult. The clinical implications of various theories of motor control are discussed, as are the physiological basis of motor control and motor learning. This section also includes a suggested conceptual framework for clinical practice (Chapter 6) and a chapter on the pathophysiology of sensory,motor,andcognitiveimpairmentsaffectingmotorcontrol.Thefirst section is the foundation for the major thrust of the book, which addresses motor control issues as they relate to the control of posture and balance (PartII),mobility(PartIII),andupper-extremityfunction(PartIV).

Thechaptersineachofthesesectionsfollowastandardformat:

The first chapter in each section discusses issues related to normal controlprocesses.

The second and third chapters describe development and age-related issues,respectively.

Thefourthchapterpresentsresearchonabnormalfunction

The final chapter in each section discusses clinical strategies related to assessment and treatment of problems in each of the three functional areas and reviews the underlying research that supports these strategies.

This book will be of use in several ways. First, we envision it as a textbook used in both undergraduate and graduate courses on normal motor control, motor development across the life span, and rehabilitation in the area of physical and occupational therapy, as well as kinesiology and exercise science. We also envision that the book will assist clinicians in staying connected to some of the research that serves as the foundation for evidence-based clinical practice. A strength of Motor Control: Translating Research into Clinical Practice is its summary of a broad range of research papers and the translation of this research into clinical practice. However,

reading summaries cannot replace the insights that are gained by delving into the original research papers. A book by its very nature summarizes only research available before its publication; therefore, it is critical that cliniciansandstudentsalikecontinuetoreademergingresearch.

CHANGES TO THE FIFTH EDITION

This fifth edition of Motor Control includes updated research and significant revisions to the three key areas: postural control, mobility, and upper extremity function. In order to emphasize essential knowledge, more detailed information has been removed from the main text and placed into Extended Knowledge boxes. Laboratory activities have been expanded, and the Answer Keys are at the end of each chapter. Several Case Studies with associated videos have been added, including a person with moderatelysevererelapsingremittingmultiplesclerosis,achildwithsevere cerebral palsy, and a longitudinal case study examining recovery from an acute stroke, with examinations at 4 days, 1 month, and 6 months poststroke. Two treatment videos have been developed including treatment of motor control problems in a woman who is 1 month poststroke, and assessment and treatment of segmental trunk control in a child with severe cerebralpalsy.

ONLINE RESOURCES FOR STUDENTSANDFACULTY

Videos associated with the case studies, and referred to throughout the text, may be found at thePoint.lww.com. These are intended to be used along withthebookandareavailabletobothstudentsandfaculty.

Teachingmaterialsavailabletofacultyonlyarethefollowing:

Animagebank

PowerPointslides

Testgenerator

Linkstojournalarticles

Additionalcasestudieswithstudentexercises

For more information, please visit the text's companion Web site (http://thepoint.lww.com/)orcontactyourlocalrepresentative.

AFINALNOTE

Motor Control: Translating Research into Clinical Practice, Fifth Edition, seeks to provide a framework that will enable the clinician to incorporate current theory and research on motor control into clinical practice. More importantly, it is our hope that the book will serve as a springboard for developing new, more effective approaches to examining and treating patientswithmotordyscontrol.

Anne Shumway-Cook

Marjorie H. Woollacott

Preface

PARTI

TheoreticalFramework

1MotorControl:IssuesandTheories

INTRODUCTION

WhatIsMotorControl?

WhyShouldTherapistsStudyMotorControl?

UNDERSTANDINGTHENATUREOFMOVEMENT

IndividualSystemsUnderlyingMotorControl

TaskConstraintsonMovementControl

EnvironmentalConstraintsonMovementControl

THE CONTROL OF MOVEMENT: THEORIES OF MOTOR CONTROL

ValueofTheorytoPractice

ReflexTheory

HierarchicalTheory

MotorProgrammingTheories

SystemsTheory

EcologicalTheory

WhichTheoryofMotorControlIsBest?

PARALLEL DEVELOPMENT OF CLINICAL PRACTICE ANDSCIENTIFICTHEORY

Neurologic Rehabilitation: Reflex-Based Neurofacilitation

Approaches

Task-OrientedApproach

CASESTUDIES

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

2MotorLearningandRecoveryofFunction

INTRODUCTIONTOMOTORLEARNING

WHATISMOTORLEARNING?

NATUREOFMOTORLEARNING

EarlyDefinitionsofMotorLearning

BroadeningtheDefinitionofMotorLearning RelatingPerformanceandLearning FormsofLearning

Basic Forms of Long-Term Memory: Nondeclarative (Implicit) and Declarative(Explicit)

THEORIESOFMOTORLEARNING

Schmidt'sSchemaTheory

EcologicalTheory

THEORIES RELATED TO STAGES OF LEARNING

MOTORSKILLS

FittsandPosnerThree-StageModel

Bernstein's Three-Stage Approach to Motor Learning: Mastering DegreesofFreedom

Gentile'sTwo-StageModel

StagesofMotorProgramFormation

PRACTICAL APPLICATIONS OF MOTOR LEARNING

RESEARCH

PracticeLevels

Feedback

PracticeConditions

RECOVERYOFFUNCTION

ConceptsRelatedtoRecoveryofFunction

FactorsAffectingRecoveryofFunction

PreinjuryNeuroprotectiveFactors

PostinjuryFactors

SUMMARY

3PhysiologyofMotorControl

INTRODUCTIONANDOVERVIEW

MotorControlTheoriesandPhysiology

OverviewofBrainFunction

Neuron—theBasicUnitoftheCNS

SENSORY/PERCEPTUALSYSTEMS

SomatosensorySystem

VisualSystem

VestibularSystem

ACTIONSYSTEMS

MotorCortex

Higher-LevelAssociationAreas

Cerebellum

BasalGanglia

MesencephalonandBrainstem

SUMMARY

4 Physiological Basis of Motor Learning and Recovery of Function

INTRODUCTION

DefiningNeuralPlasticity

LearningandMemory

LocalizationofLearningandMemory

PLASTICITYANDLEARNING

PlasticityandNondeclarative(Implicit)FormsofLearning

ProceduralLearning(SkillsandHabits)

PlasticityandDeclarative(Explicit)FormsofLearning

TheShiftfromImplicittoExplicitKnowledge

TheShiftfromExplicittoImplicitMemory

ComplexFormsofMotorLearning

AcquisitionofSkill:TheShifttoAutomaticity

SummaryofFormsofLearning

NEURALPLASTICITYANDRECOVERYOFFUNCTION

ConceptualizingRecovery

AxonalDamage:EffectsonNeuronsandNeighboringCells

EarlyTransientEventsThatDepressBrainFunction

Axonal Regeneration: Difference in the Peripheral versus Central NervousSystems

CNSResponsetoInjury

Changes in Cortical Maps after Lesions and during Recovery of Function

StrategiestoEnhanceNeuralPlasticityandCorticalReorganization

Clinical Implications of Research on Neural Plasticity and Recovery ofFunctioninAcquiredBrainInjury

NEURAL PLASTICITY AND NEURODEGENERATIVE DISEASE

NeuralPlasticityandParkinson'sDisease

Clinical Implications of Research on Neural Plasticity and Recovery ofFunctioninPD

SUMMARY

5 Constraints on Motor Control: An Overview of Neurologic Impairments

INTRODUCTION: SIGNS AND SYMPTOMS OF PATHOPHYSIOLOGYOFMOTORCONTROL

CLASSIFYING IMPAIRMENTS ASSOCIATED WITH CNS LESIONS

SignsversusSymptoms

PositiveversusNegativeSignsandSymptoms

PrimaryversusSecondaryEffects

IMPAIRMENTSINTHEACTIONSYSTEMS

MotorCortexDeficits

MotorImpairmentsAssociatedwithSubcorticalPathology

SecondaryMusculoskeletalImpairments

IMPAIRMENTSINSENSORYSYSTEMS

SomatosensoryDeficits

VisualDeficits

VestibularDeficits

PATHOLOGY OF HIGHER-ORDER ASSOCIATION

CORTICES:SPATIALANDNONSPATIALIMPAIRMENTS

RightHemisphereSpatialDeficits

RightHemisphereNonspatialDeficits

CLINICAL MANAGEMENT OF IMPAIRMENTS IN THE ACTION(MOTOR)SYSTEMS

MotorCortexandCorticospinalTractImpairments

ClinicalManagementofCerebellarandBasalGangliaImpairments

ClinicalManagementofMusculoskeletalImpairments

CLINICAL MANAGEMENT OF IMPAIRMENTS IN THE SENSORYSYSTEMS

SomatosensoryImpairments

VisualImpairments

VestibularImpairments

CLINICAL MANAGEMENT OF IMPAIRMENTS IN THE PERCEPTUALANDCOGNITIVESYSTEMS

SpatialDeficits:Hemineglect

NonspatialDeficits

SUMMARY

6AConceptualFrameworkforClinicalPractice

INTRODUCTION

COMPONENTS OF A CONCEPTUAL FRAMEWORK FOR CLINICALPRACTICE

ModelsofPractice

ModelsofFunctioningandDisability

Hypothesis-OrientedClinicalPractice

TheoriesofMotorControlandLearning

Evidence-BasedClinicalPractice

ApplyingaConceptualFrameworktoClinicalPractice

TASK-ORIENTEDAPPROACHTOEXAMINATION

ExaminationofFunctionalActivitiesandParticipation

ExaminationattheStrategyLevel

ExaminingImpairmentsofBodyStructureandFunction

TASK-ORIENTEDAPPROACHTOINTERVENTION

RecoveryversusCompensation

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

PARTII

PosturalControl

7NormalPosturalControl

INTRODUCTION

DefiningPosturalControl

ASystemsFrameworkforPosturalControl

MOTORSYSTEMSINPOSTURALCONTROL

Steady-StateBalance

ReactiveBalanceControl

Proactive(Anticipatory)BalanceControl

SENSORY/PERCEPTUAL SYSTEMS IN POSTURAL CONTROL

SensoryInputsforSteady-StateBalance

SensoryInputsforReactiveBalance

SensoryStrategiesforProactiveBalance

Clinical Applications of Research on Sensory/Perceptual Aspects of PosturalControl

COGNITIVESYSTEMSINPOSTURALCONTROL

Clinical Applications of Research on Cognitive Aspects of Postural Control

NEURAL SUBSYSTEMS CONTROLLING POSTURAL ORIENTATIONANDSTABILITY

SpinalContributions

BrainstemContributions

BasalGangliaandCerebellarContributions

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

8DevelopmentofPosturalControl

INTRODUCTION

PosturalControlandDevelopment

MotorMilestonesandEmergingPosturalControl

THEORIESOFDEVELOPINGPOSTURALCONTROL

Reflex/HierarchicalTheory

SystemsTheory

DEVELOPMENT OF POSTURAL CONTROL: A SYSTEMS

PERSPECTIVE

GeneralMovementsinInfants

EmergingHeadControl

EmergenceofIndependentSitting

TransitiontoIndependentStance

RefinementofPosturalControl

CognitiveSystemsinPosturalDevelopment

SUMMARY

9AgingandPosturalControl

INTRODUCTION

FactorsContributingtoAging

InteractionsbetweenPrimaryandSecondaryFactors

HeterogeneityofAging

BEHAVIORALINDICATORSOFINSTABILITY

DefiningFalls

RiskFactorsforFalls

AGE-RELATED CHANGES IN THE SYSTEMS OF POSTURALCONTROL

MotorSystems

ChangestoSteady-StateBalance

ChangesinReactiveBalanceControl

ChangesinAnticipatoryPosturalControl

AGINGINTHESENSORY/PERCEPTUALSYSTEMS

ChangesinIndividualSensorySystems

AdaptingSensesforPosturalControl

COGNITIVEISSUESANDPOSTURECONTROL

ACASESTUDYAPPROACHTOUNDERSTANDINGAGERELATEDPOSTURALDISORDERS

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

10AbnormalPosturalControl

INTRODUCTION

FallsinPersonswithNeurologicPathology

PROBLEMSINTHEMOTORSYSTEMS

ImpairedSteady-StateBalance

ImpairedReactiveBalance

ImpairedAnticipatoryPosturalControl

PROBLEMSINTHESENSORY/PERCEPTUALSYSTEMS

SensoryProblemsAffectingSteady-StateBalance

SensoryProblemsAffectingReactiveBalance

SensoryProblemsAffectingAnticipatoryBalance

PerceptualProblemsAffectingPosturalControl

Clinical Implications of Research on Impaired Sensation/Perceptions andPosturalControl

PROBLEMSINCOGNITIVESYSTEMS

BalanceandFallsSelf-Efficacy

ImpairedPosturalStabilityandDual-TaskInterference

A CASE STUDY APPROACH TO UNDERSTANDING POSTURALDYSCONTROL

Jean J and Genise T: Postural Problems following Cerebral Vascular Accident

MikeM:PosturalProblemsinParkinson'sDisease

JohnC:PosturalProblemsinCerebellarDisorders

ThomasL:PosturalProblemsinSpasticDiplegicCerebralPalsy

Malachi: Postural Problems in Severe Athetoid/Spastic Cerebral Palsy

Sue:PosturalProblemsinMultipleSclerosis

SUMMARY

PARTIII

PosturalControl

11 Clinical Management of the Patient with a Postural Control Disorder

INTRODUCTION

ConceptualFrameworkforBalanceRehabilitation

EXAMINATION

Safety—TheFirstConcern

ExaminingtheEffectofBalanceonParticipation

ExaminingBalanceinFunctionalActivities

AssessingStrategiesforBalance

ExaminationofUnderlyingImpairments

EVALUATION: INTERPRETING THE RESULTS OF THE EXAMINATION

TASK-ORIENTEDBALANCEREHABILITATION

MotorSystem

SensorySystems

CognitiveSystems

PUTTINGITALLTOGETHER

Research Evidence for a Task-Oriented Approach to Balance Rehabilitation

ImprovingParticipation—Evidence-BasedFallPrevention

SUMMARY

ANSWERSTOTHELABACTIVITIES

12ControlofNormalMobility

INTRODUCTION

MobilityintheICFFramework MOTORSYSTEMSANDGAIT

Essential Requirements of Locomotion: Progression, Postural Control,andAdaptation

CharacterizingSteady-StateGait

Adaptation of Gait: Contributions of Reactive and Proactive Balance

ControlinGait

InitiatingGait

CONTROLMECHANISMSFORGAIT

PatternGeneratorsforGait

DescendingInfluences

MusculoskeletalContributionstoGait

SENSORYSYSTEMSANDTHECONTROLOFGAIT

SomatosensorySystems

Vision

VestibularSystem

COGNITIVESYSTEMSANDGAIT

Dual-TaskPerformanceDuringSteady-StateGait

Dual-TaskPerformanceduringObstacleCrossing

STAIR-WALKING

Ascent

Descent

AdaptingStair-WalkingPatternstoChangesinSensoryCues

MOBILITYOTHERTHANGAIT

TransfersandBedMobility

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

13DevelopmentofMobility

INTRODUCTION

DEVELOPMENTOFMOTORSYSTEMSANDGAIT

DevelopmentofSteady-StateGait

DevelopmentofAdaptation

Expanding the Repertoire of Steady-State Gait Patterns: Run, Skip, Hop,andGallop

SensorySystems

CognitiveSystems

DEVELOPMENTOFOTHERMOBILITYSKILLS

DevelopmentofRolling

DevelopmentofSupinetoStand

SUMMARY

14AgingandMobility

INTRODUCTION

GaitDysfunction:AgingorPathology?

MOTORSYSTEMSANDGAIT

Age-RelatedChangesinSteady-StateGait

Age-Related Changes in Adaptation of Gait: Reactive and Proactive Balance

Age-RelatedChangesinMusculoskeletalControl

RoleofPathologyinGaitChangesinOlderAdults

AGE-RELATED CHANGES IN SENSORY SYSTEMS AND GAIT

Somatosensation

Vision

Vestibular

AGE-RELATED CHANGES IN COGNITIVE SYSTEMS ANDGAIT

Age-Related Changes in Dual-Task Performance during Steady-State Gait

Age-Related Changes in Dual-Task Performance during Obstacle Crossing

CognitiveInfluencesonGait:FearofFallinginOlderAdults

AGE-RELATEDCHANGESINOTHERMOBILITYSKILLS

GaitInitiationandBackwardGait

StairWalking

Sit-to-Stand

RisingfromaBed

SupinetoStanding

COMPARING GAIT CHARACTERISTICS OF INFANTS AND OLDER

ADULTS: TESTING THE REGRESSION HYPOTHESIS

ACASESTUDYAPPROACHTOUNDERSTANDINGAGERELATEDCHANGESINMOBILITY

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

15AbnormalMobility

INTRODUCTION

ClassificationSystems

MOTORSYSTEMSANDABNORMALGAIT

Paresis/Weakness

Spasticity

LossofSelectiveControlandtheEmergenceofAbnormalSynergies

CoordinationProblems

MusculoskeletalImpairments

Impaired Adaptation of Gait: Contributions of Impaired Reactive and ProactiveBalanceControl

SENSORYSYSTEMSANDABNORMALGAIT

SomatosensoryDeficits

VisualDeficits

VestibularDeficits

PerceptualProblemsAffectingGait

COGNITIVESYSTEMSANDIMPAIREDGAIT

ImpairedDual-TaskWalking

WHAT FACTORS LIMIT PARTICIPATION IN THE MOBILITYDOMAIN?

DISORDERSOFMOBILITYOTHERTHANGAIT

GaitInitiation

StairWalking

TransfersandBedMobility

A CASE STUDY APPROACH TO UNDERSTANDING

MOBILITYDISORDERS

JeanJandGeniseT:Stroke

MikeM:Parkinson'sDisease

JohnC:DegenerativeCerebellarInjury

Sue:MultipleSclerosis

Thomas:SpasticDiplegicCerebralPalsy

SUMMARY

16 Clinical Management of the Patient with a Mobility Disorder

INTRODUCTION

ATASK-ORIENTEDAPPROACHTOEXAMINATION

Measuring Participation: Mobility Performance in Home and CommunityContexts

StandardizedMeasuresofWalkingCapacity

ExaminingtheGaitPattern

ExaminationattheImpairmentLevel

Measuring Mobility: Do We Really Need All These Tests and Measures?

TRANSITIONTOTREATMENT

SettingGoals

TASK-ORIENTED APPROACH TO LOCOMOTOR

TRAINING

InterventionsattheImpairmentLevel

InterventionattheStrategyLevel:ImprovingtheGaitPattern

TrainingAdaptation:ComplexWalkingTasks

ImprovingParticipationandReducingMobilityDisability

RETRAININGOTHERMOBILITYSKILLS

StairWalking

TransfersandBedMobility

ImportanceofVaryingTaskandEnvironmentalDemands

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

17NormalReach,Grasp,andManipulation

INTRODUCTION

MOVEMENTCONTROLPRINCIPLES

FeedforwardversusFeedbackControlofMovement

LOCATINGATARGET

Eye–Head–TrunkCoordination

InteractionsbetweenEyeMovementsandHandMovements

REACHANDGRASP

KinematicsofReachandGrasp

NEURALCONTROLOFREACHANDGRASP

SensorySystems

MotorSystems

GRASPING

ClassificationofGraspingPatterns

AnticipatoryControlofGraspingPatterns:PrecisionGripFormation

GraspandLiftTasks

COORDINATIONOFREACHANDGRASP

GENERAL PRINCIPLES OF NEURAL CONTROL OF REACHANDGRASP

InvariantFeaturesofMovement:MotorPrograms

ReactionTimesforReachandGrasp

Fitts'Law

How Does the Nervous System Plan Movements? Muscle Coordinate, Joint Angle Coordinate, and End Point Coordinate Strategies

DistanceversusLocationProgrammingTheories

INTERFERENCE BETWEEN REACHING AND THE PERFORMANCEOFSECONDARYCOGNITIVETASKS

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

18 Reach, Grasp, and Manipulation: Changes across the Life Span

INTRODUCTION

PRINCIPLES UNDERLYING THE DEVELOPMENT OF REACHINGBEHAVIORS

RoleofReflexesintheDevelopmentofReachingBehaviors

ReachingBehaviors:InnateorLearned?

LOCATINGATARGET:EYE–HEADCOORDINATION

ShiftingGaze

TrackingObjectMovements

DevelopmentofVisualPathwaysforReaching

Eye–Head–HandCoordinationDevelopment

REACHANDGRASP

MotorComponents

SensoryComponents

GraspDevelopment

When Do Children Start Using Anticipatory Control in Grasping and LiftingObjects?

AdaptationofGripForces

LearningtoReachforandGraspMovingObjects(Catching)

CognitiveComponents

THE ROLE OF EXPERIENCE IN THE DEVELOPMENT OF EYE–HANDCOORDINATION

REACTIONTIMEREACHINGTASKS

Fitts'Law

CHANGESINOLDERADULTS

Reaching:ChangeswithAge

Grasping:ChangeswithAge

Reach–GraspAdaptation:ChangeswithAge

Compensation and Reversibility of Decrements in Reaching Performance

ACASESTUDYAPPROACHTOUNDERSTANDINGAGERELATED CHANGES IN REACH, GRASP, AND MANIPULATION

SUMMARY

ANSWERS

TOLABACTIVITYASSIGNMENTS

19AbnormalReach,Grasp,andManipulation

INTRODUCTION

TARGETLOCATIONPROBLEMS

VisualDeficitsandObjectLocalization

PROBLEMSWITHEYE−HEAD−HANDCOORDINATION

PROBLEMSWITHREACHANDGRASP

ImpairmentsofReach

ProblemswithGrasp

PROBLEMSWITHIN-HANDMANIPULATION

ProblemswithRelease

INTERLIMBCOUPLINGANDBIMANUALTASKS

ReachandGraspintheIpsilesionalNonhemipareticLimb

APRAXIA

A CASE STUDY APPROACH TO UNDERSTANDING UPPER-EXTREMITYDISORDERS

Jean J and Genise T: Reach-and-Grasp Problems Following CerebrovascularAccident

MikeM:Reach-and-GraspProblemsinParkinson'sDisease

JohnC:Reach-and-GraspProblemsFollowingCerebellarPathology

Thomas:Reach-and-GraspProblemsinCerebralPalsy

Malachi: Reach-and-Grasp Problems in Severe Dystonic/Spastic

CerebralPalsy

Sue:Reach-and-GraspProblemsinMultipleSclerosis

SUMMARY

20 Clinical Management of the Patient with Reach, Grasp, and ManipulationDisorders

INTRODUCTION

EXAMINATION

ExaminingtheEffectofPrehensiononParticipation

ExaminingPrehensioninFunctionalActivities

ExaminationofUnderlyingImpairments

EVALUATION: INTERPRETING THE RESULTS OF THE EXAMINATION

Long-TermGoals

Short-TermGoals

Patient-IdentifiedGoals

TASK-ORIENTEDREHABILITATIONOFPREHENSION

InterventionforUnderlyingImpairments

InterventionforSensorimotorStrategies

InterventionsattheFunctionalLevel

ImprovingParticipation

SUMMARY

ANSWERSTOLABACTIVITYASSIGNMENTS

References

Index

PARTI

TheoreticalFramework

Movement is essential to our ability to walk, run, and play; to seek out and eat the food that nourishes us; to communicate with friends and family; and to earn our living—in essence to survive.

CHAPTER1

MotorControl:IssuesandTheories

LearningObjectives

Followingcompletionofthischapter,thereaderwillbeableto:

1. Define motor control, and discuss its relevance to the clinical treatmentofpatientswithmovementpathology.

2. Discuss how factors related to the individual, the task, and the environmentaffecttheorganizationandcontrolofmovement.

3. Define what is meant by a theory of motor control and describe the valueoftheorytoclinicalpractice.

4. Compare and contrast the following theories of motor control: reflex, hierarchical, motor programming, systems, and ecological, including the individuals associated with each theory, critical elements used to explain the control of normal movement, limitations, and clinical applications.

5. Discuss the relationship between theories of motor control and the parallel development of clinical methods related to neurologic rehabilitation.

6. Compare and contrast the neurofacilitation approaches to the taskoriented approach with respect to assumptions underlying normal and abnormal movement control, recovery of function, and clinical practicesrelatedtoassessmentandtreatment.

INTRODUCTION

WhatIsMotorControl?

Movement is a critical aspect of life. It is essential to our ability to walk, run, and play; to seek out and eat the food that nourishes us; to communicate with friends and family; and to earn our living—in essence to survive. The field of motor control is directed at studying the nature of movement and how movement is controlled. Motor control is defined as the ability to regulate or direct the mechanisms essential to movement. It addresses questions such as how does the central nervous system (CNS) organize the many individual muscles and joints into coordinated functional movements? How is sensory information from the environment and the body used to select and control movement? How do our perceptions of ourselves, the tasks we perform, and the environment in which we are moving influence our movement behavior? Whatisthebestwaytostudymovement,andhowcanmovementproblemsbe quantifiedinpatientswithmotorcontrolproblems?