Upon completion of this chapter, the learner should be able to:
Describe clinical examples of impaired motor control-stability.
Develop and implement patient-centered therapeutic interventions to improve stability aspects of motor control.
Develop and implement functional interventions that include opportunities to apply joint or segment stability in the context of essential functional activities.
Since his stroke 6 months ago, Mr. Simon has had obvious problems with his left arm and leg, particularly with stabilizing the knee joint during weightbearing. His left knee snaps back into locked extension during left midstance weight-bearing (right swing) of gait 100% of the time. Another patient, Mrs. Desonier, had a stroke that affected primarily her left upper extremity, leaving her with a dense hemiplegia with complete paralysis. She has developed major, painful left shoulder subluxation and cannot stabilize the shoulder joint because of lack of motor control of the rotator cuff muscles. Both patients demonstrate the same underlying impairment, lack of motor control-stability, but in different body joints. Once the problem has been identified, what therapeutic options are available for these patients?
As described in Chapter 6, motor control includes aspects of precise neuromotor control for both stability and movement. Motor control-stability is the aspect of motor control that allows a joint or body segment to be stable at a time when movement is not supposed to occur there (often a different part of the body is supposed to move at that same time). Such stability requires coordination between the neuromotor and the musculoskeletal systems. In this chapter, the terms “motor control-stability,” “stability motor control,” and “neuromotor stability” are used interchangeably, which implies that the instability is related to problems in the way the brain controls movement and not to disruptions of a capsule, ligament, or tendon. Impairments in joint or body segment stability due to lack of motor control can be seen in patients with a wide variety of neurological diseases across the lifespan and in most peripheral joints, the trunk, and the neck segment. The term “body segment” refers to a part of the body that may include more than one joint, such as the trunk, whereas “joint” is limited to one joint, such as the knee. Common examples of joint or body segment instability related to musculoskeletal disorders are summarized in Table 24-1.
TABLE 24-1Examples of Joint or Body Segment Instability Commonly Related to Neuromuscular Disorders ||Download (.pdf) TABLE 24-1 Examples of Joint or Body Segment Instability Commonly Related to Neuromuscular Disorders
|JOINT OR BODY SEGMENT ||EXAMPLE OF INSTABILITY |
|Shoulder ||Subluxation |
|Scapula ||Scapulothoracic winging |
|Wrist/hand ||Inability to grasp |
|Lumbopelvic area ||Trunk instability |
|Hip ||Trendelenburg |
|Knee ||Genu recurvatum or knee collapse into flexion |
|Ankle ||Footdrop or medial/lateral wobble |
THINK ABOUT IT 24.1
What functional activities and activities of daily living might ...