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Chapter Objectives

Upon completion of this chapter, the learner should be able to:

  1. Identify elements of skilled motor control-movement and body systems responsible for motor control-movement.

  2. Describe selected impairments of motor control-movement including problems with timing, scaling, activation, and sequencing.

  3. Describe common neuromuscular disorders associated with motor control-movement impairments.

  4. Discuss the principles behind and evidence for selected therapeutic interventions for improving impaired motor control-movement.

Introduction

Martha Jones is a 75 year-old African American female who experienced a cerebrovascular accident (CVA) 3 months ago. She reports that earlier on the day of the stroke she was dizzy and numb on her left side. These symptoms progressed until she was completely paralyzed on her left side. At that time, her husband called 911, and she was transported by ambulance to the emergency department at a local hospital. Magnetic resonance imaging confirmed that she had a thrombotic clot of the middle cerebral artery in the right cerebral hemisphere.

The repertoire of everyday human movement ranges from simple reflex reactions to complex, preplanned, volitional actions. Movement characteristics, such as speed, variability, and the need for accuracy, vary as movement complexity increases. However, even simple tasks can be complicated because of the many motor and sensory parameters that must be controlled by the central nervous system (CNS). To optimize efficiency, functional movements are performed with a goal in mind. The success or failure of that movement goal is often determined by its context and the environment in which it is performed. For example, walking is a common lower extremity movement task. Walking is considered successful when one can get from one place to another in a reasonable time frame, with minimal energy costs and without tripping or falling. In most situations, the lower extremity movements involved with walking are rhythmical and do not require conscious effort to complete the task. However, walking in other situations, such as over an icy surface, may require a great deal of conscious effort.

To be optimally functional, humans are required to quickly and effectively generate movements in ways that are extremely flexible and adaptable. Motor control, as defined in Chapter 6, is the process by which the brain organizes and regulates actions of the muscular and skeletal systems, including movement and dynamic postural adjustments of a joint or body segment. Occupational therapists and physical therapists have been referred to as “applied motor control physiologists” because their professional duties are directed toward examination and intervention to restore functional movements (Brooks, 1986). Therefore, understanding how the CNS initiates and modifies functional movement is essential for their success.

Neuromuscular disorders can result in primary or secondary movement control impairments that negatively influence one’s success with functional movement. Chapter 24 discusses therapeutic interventions to address impairment of motor control-stability. In this chapter, interventions that influence the movement aspects of motor control, a frequent focus of ...

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