1 / 69

Sensorimotor Learning and Severe Disability

Sensorimotor Learning and Severe Disability. Chapter 10. Introduction. Making sense of the environment Intrasensory integration - enhanced function in one sensory system Intersensory integration - enhanced interaction between two or more sensory systems

vlora
Télécharger la présentation

Sensorimotor Learning and Severe Disability

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Sensorimotor Learning and Severe Disability Chapter 10

  2. Introduction • Making sense of the environment • Intrasensory integration - enhanced function in one sensory system • Intersensory integration - enhanced interaction between two or more sensory systems • Factors affecting intrasensory and intersensory integration

  3. Organization of the Nervous System • Central nervous system – brain and spinal cord (CNS) • Peripheral nervous system – 12 pairs of cranial nerves, 12 pairs of spinal nerves and the autonomic nervous system • Neural impulses travel on dorsal and ventral tracts

  4. Parts and Functions of the Spinal Cord • Tracts carry impulses to and from the brain • Each tract carries only one kind of sensory information and has a specific destination • Sensory information - afferent - dorsal ascending sensory tracts • Motor commands - efferent - ventral descending motor tracts

  5. Parts and Functions of the Brain • Brain stem – regulates muscle and postural tone, reflexes, attention, arousal, wakefulness, and general activity • Midbrain – regulates postural reactions that enable stability and mobility in activities of daily living • Cerebellum – automatic performance of skilled movement so that conscious thought is not needed

  6. Parts and Functions of the Brain • Cerebrum • Cerebral cortex - higher level mental functions; where sensory information is processed, integrated, or organized • Internal capsule • Limbic system - regulates emotion • Basal ganglia - enable steady postures and movement without tremors • Thalamus - relay station for sensory impulses

  7. Cortical and Subcortical Disorders • Cortical disorders • Can be improved by conscious thought, practice, and determination • Responsive to ordinary teaching methods • Perceptual-motor intervention • Subcortical disorders • Do not respond to ordinary teaching methods • Sensoriomotor intervention

  8. Cortical Functions • Functions of the cerebral cortex and the cortical tracts • Performs all higher-level functions • Help regulate excitation and inhibition processes • Cortical tracts carry impulses from one part of the brain to another

  9. Subcortical Functions • Functions of all the CNS structures except the cerebral cortex and cortical tracts • Skilled movements - no conscious attention • Automatic movements like postural reactions and basic movement patterns • Common problems • Breakdown between cortical and subcortical • Problems in central processing

  10. Muscle and Postural Tone • Muscle tone – contractile tension or firmness within a muscle or group of muscles • Postural tone – mobility and stability functional capacity of the total body • Holds the body upright against the pull of gravity • Antigravity muscles

  11. Muscle Families and Actions • Extensor families – posterior surface • Flexor families – anterior surface • Adductor families – medial or inside surface and pull body parts toward or across midline • Abductor families – lateral or outside surface and pull body parts away from midline • Rotator muscle groups – inward rotators on anteromedial surface (work w/adductors) and outward rotators on posterolateral surface (work w/extensors)

  12. Reciprocal Innervation or Inhibition • Neural process that regulates muscle and postural tone • Muscles on one surface contract while muscles on the opposite surface relax • Uppermotor neurons generate excitation and inhibition impulses

  13. Muscle Tone Disorders • Hypotonia – floppiness • Hypertonia – stiffness, spasticity • Fluctuating tone – mixed cerebral palsy • Associated with both congenital and acquired conditions that cause severe damage to the motor part of the brain

  14. Assessment of Muscle Tone Disorders • Observation, palpation, or EMG • Each part of body screened separately • Scoring system • 1 point - hypotonia • 2 points - normal muscle tone • +1 point - hypertonia

  15. Hypotonia Intervention • Associated with severe disability • Delay achievement of motor milestones • Initiate little spontaneous, purposeful activity • Wheelchairs to help correct positioning and mobility • Major goal is to develop strength to use body parts in ADL

  16. Hypertonia (Spasticity) Intervention • Inhibition or relaxation techniques used to decrease spasticity • Compromises postural reactions • Stretching exercises are essential to prevent contractures • Major goal is to independently perform stretches in good alignment

  17. Sensory Input Systems • Sensory information must be organized and processed from all modalities • Touch and pressure Kinesthesis • Vestibular system Temperature • Pain Smell • Taste Vision • Audition • Common chemical sense

  18. Tactile Integration • Most fully developed resource at birth • Light touch, deep pressure, cold, heat, pain • Tactile integration disorders • Tactile defensiveness • Tactile craving or aggressiveness • Body image and object awareness problems related to body boundaries

  19. Assessment of Tactile Integration Problems • Tactile Defensiveness • Tactile Craving • Body Image and Object Awareness • Various problems

  20. Activities for Intervention • Pairing touch with reward and gradually increasing the amount of touch • Pairing not touching with reward • Using rewards for improved awareness • Generalization • Various activities

  21. Kinesthetic Integration • Muscle sense system • Contributes to movement awareness and coordination of body parts • Movement awareness problems with concepts of time, space, force, and flow • Receptors in every muscle, tendon, and joint • Noncortical kinesthetic integration • Cortical kinesthetic integration

  22. Assessment of Kinesthetic Integration Problems • Observation in four areas before language • Reflex integration • Postural reaction emergence • Motor milestone achievement • Unsolicited, spontaneous imitations of movement • Observation after language • Imitate body movements on command • Do a movement, feel it kinesthetically, and then repeat it exactly after a period of time

  23. Activities for Intervention • Repetition of movement • Movement targeted toward stationary points • Movement targeted toward moving object • Assisted and coactive movement • Extension activities • Movement exploration approaches • Minimize other input systems

  24. Vestibular Integration • Helps to maintain static and dynamic balance • Equilibrium – biomechanical term denoting equal forces acting upon an object • Balance – the control processes that maintain body parts in the specific alignments necessary to achieve different kinds of mobility and stability • Vestibular, kinesthetic, tactile, and visual systems interact with environmental variables to enable balance • Vestibular apparatus

  25. Assessment of Vestibular Integration • Challenges that cause momentary losses of balance - use of various playground apparatus • Natural activities that change head position • Vestibular activities spinning activities and nystagmus • Variety of activities that integrate tactile, kinesthetic, vestibular, and visual systems

  26. Visual Integration • Various subsystems • Two types of vision • Refractive vision (acuity) • Orthoptic vision (eye coordination)

  27. Refractive Vision (Acuity) • Visual acuity, the product of light rays bending and reaching the receptor cells (rods and cones) of the retina • Problems include myopia, hyperopia and astigmatism

  28. Orthoptic Vision (Eye Coordination) • Six external muscles of the eyeball control movement • Binocular coordination – ability of two eyes to work in unison and fuse separate images into one, closely linked with balance and postural reactions • Depth perception - deriving meaning from visual space-time relationships • Problems include developmental delays in binocular coordination and depth perception, strabismus, and nystagmus

  29. Assessment of Visual Integration • Observe students performing skills that require hand-eye and foot-eye coordination • Ophthalmologist – eye specialist • Refractive problems – treated by prescriptive glasses or surgery • Ophthalmic problems – some can be corrected with surgery, others may be associated with higher levels of visual processing

  30. Activities for Intervention • Practice in many and varied movements • Complex process of integrating inputs and translating them into appropriate motor outputs • Variety of activites for intervention

  31. Infant and Pathological Reflexes • Emphasis on pathological reflex-activity in adapted physical activity • Postures and patterns similar to those of infants are demonstrated by individuals with severe CP and TBI • Clumsiness or DCD is associated with failure to totally integrate reflexes

  32. Infant Reflexes and Stereotypies • Involuntary, predictable muscle and postural tone shifts that are age-specific and important to typical development between birth and 9 months of age • Reflexes are building blocks for developing sensorimotor system - integrated about 9 months • Stereotypies are rhythmical movements of body parts that are performed over and over for no apparent reason - integrated about 12 months

  33. Age-Appropriate Integration of Reflexes and Stereotypies • Integration - neural process of layering over, inhibiting, or suppressing reflexes and stereotypies • Occurs in various degrees - fatigue and stress conditions may cause breakdowns • Abnormal reflex activity is recognizable in clumsy movements

  34. Pathological Reflexes • Reflexes that are not integrated at the developmentally appropriate times • Involuntary shifts of muscle tone, interfere with smooth, coordinated movement • Abnormal retention of reflexes contributes to the clumsiness associated with cerebral palsy

  35. Reflexes Important in Physical Education REFLEX AVG. AGEMUSCLE TONE WATCH Tonic labyrinthine-prone 0-4 mon. Flexion Total body Tonic labyrinthine-supine 0-4 mon. Extension Total body Asymmetrical tonic neck 0-4 mon. Flex-Ext Arms Symmetrical tonic neck 6-8 mon. Flex-Ext Arms-Legs Moro 0-4 mon. Extension Arms-Hands Hand grasp 0-4 mon. Flexion Hands-Arms Foot grasp 0-9 mon. Flexion Toes, feet Extensor thrust 0-3 mon. Extension Legs Crossed extension 0-3 mon. Flex-Ext Legs Positive supporting-legs 3-8 mon. Extension Legs-trunk

  36. Assessment Criteria for Physical Education Reflexes • Examine various aspects for each reflex • Tonic labyrinthine-prone reflex • Tonic labyrinthine-supine reflex • Asymmetrical tonic neck reflex • Symmetrical tonic neck reflex • Moro reflex • Hand grasp reflex • Foot grasp reflex • Extensor thrust reflex

  37. Reflex Integration in Teaching • Explain movement errors in spite of corrective feedback • Student cannot override reflex patterns • Visual and auditory instructions alone are not effective

  38. Principles of Reflex Integration • Maximize tactile, kinesthetic and vestibular input • Use total body movement patterns and games that inhibit reflexes • Increase practice time and time-on-task for correctly executed patterns • Intensify individual assistance so that patterns are performed correctly and pay particular attention to head position

  39. Four Most Troublesome Reflexes • Reflexes initiated by head movements • Cannot move head without associated movements or muscle tone changes • TLR-prone - emphasize extension • TLR-supine - emphasize flexion • ATNR - emphasize head turn • STNR - emphasize head up or down

  40. Overflow (Associated Movements) • Common indicator of clumsiness • Undesired reflex responses of body parts that should remain stationary • Caused by poorly integrated reflexes • Occur in childhood and generally disappear by adolescence • Many repetitions of correct movement

  41. Postural Reactions • Automatic responses to sensory input that act to keep body parts in alignment, maintain equilibrium, and prevent injury • Some replace reflexes and others emerge to perform unique functions • Generally appear between 2 and 18 months • Generally persist throughout life

  42. Assessment of Postural Reactions • Righting reactions - adjustments of the head or trunk • Parachute reactions - protective extension movements of the limbs • Equilibrium reactions - total body reponses • Assessment is completed by holding, tilting, and/or positioning child in specific ways

  43. Righting Reactions • Automatic postural responses elicited by sensory input that signals that the head or trunk is not in midline • Head-in-space or Labyrinthine • Optical or visual • Landau reaction or body-in-sagittal plane righting • Body derotative (segmental rolling) • Body rotative (rise to stand)

  44. Parachute or Propping Reactions • Protective extension movements of the limbs used to break or prevent a fall • Elicited by vestibular input, which signals a change in the movement of the head • Downward parachute • Sideward parachute • Forward parachute • Backward parachute

  45. Equilibrium or Tilting Reactions • Total body responses that prevent falls • Appear between 5 and 18 months and remain throughout the lifespan • Initiated primarily by vestibular input • Assessment focuses on curve of the spine and position of the limbs • Absence or immaturity result in balance problems • Standing equilibrium involves stepping reactions

  46. Activities for Intervention • Numerous trails to perform the same task over and over again • Positions used in testing are also used for intervention • Variety of apparatus and environments should be used to promote generalization

  47. Overall Assessment Approach: Milani-Comparetti • Nonambulatory or ambulatory conditions • Protocol is easy to use and takes about 5 minutes • Developed for ages birth to 2 years, but frequently used with individuals of all age groups with severe body control problems • Scores on spontaneous behavior and evoked responses are recorded

  48. Spontaneous Behaviors on the MC • Motor tasks in nine broad areas • Head control - four head positions • Body control - three body postures • Active movement - two active movement sequences

  49. Evoked Responses • Five early reflexes • Hand grasp reflex • Asymmetrical tonic neck reflex • Moro reflex • Symmetrical tonic neck reflex • Foot grasp reflex • Three types of postural reactions • Righting • Parachute • Tilting or equilibrium

  50. Pedagogy in Relation to Reflexes and Reactions • Physical education for young students with abnormal reflexes and balance problems is guided by the neurophysiological treatment approach of Bobath • Inhibition or suppression of abnormal reflex activity • Facilitation of righting, parachute, and equilibrium reactions in their proper developmental sequence

More Related