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LEARNING OBJECTIVES
Describe a model for clinical decision making that incorporates components of normal motor control and motor learning.
Identify factors critical to motor control and describe intervention strategies designed to optimize the acquisition of motor control.
Identify factors critical to motor learning and describe intervention strategies designed to optimize motor learning.
Differentiate between recovery and compensation at the body function/structure and activity levels.
Identify key factors in recovery of function and describe intervention strategies designed to optimize recovery.
Analyze and interpret patient data, formulate goals and expected outcomes, and develop a plan of care that presents an integrated approach to treatment when presented with a clinical case study.
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Developing strategies to improve motor function (motor control and motor learning) requires a thorough understanding of the neural processes involved in learning and producing movement and the pathologies that may affect the central nervous system (CNS). In addition, knowledge of the processes of neural plasticity and recovery following CNS insult is essential. This information allows the therapist to approach clinical decision making in an organized and informed manner. Patients with disorders of the CNS frequently demonstrate altered motor function with a wide variety of impairments, activity limitations, and restrictions in the ability to participate in normal roles. Careful examination of cognitive, sensoriperceptual, motor, and learning behaviors, along with the environmental contexts in which they occur, provides an appropriate base for planning (see Chapter 5, Examination of Motor Function: Motor Control and Motor Learning). An optimal plan of care (POC) must address the individual needs of the patient. This includes minimizing or eliminating impairments, reducing activity limitations and physical disabilities, and promoting full participation in life roles to the maximum extent possible. An effective POC also enhances overall quality of life.
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Motor control has been defined as “an area of study dealing with the understanding of the neural, physical, and behavioral aspects of biological (e.g., human) movement.”1, p. 497 Information processing of human motor behavior occurs in stages (Fig. 10.1). In the initial stage, stimulus identification, relevant stimuli about current body state, movement, and environment, are identified and selected. This includes somatosensory, visual, and vestibular inputs. Meaning is attached based on past sensorimotor experiences. Perceptual and cognitive processes, including memory, attention, motivation, and emotional control, all play an integral role in ensuring the ease and accuracy of information processing during this stage. Selection of relevant sensory input is sensitive to the clarity and intensity of the stimuli received. Thus, precise and stronger stimuli result in enhanced attentional mechanisms and information processing. Processing is also influenced by stimulus pattern complexity. Complicated and novel patterns of stimuli prolong stimulus identification. An intrinsic knowledge of movement (e.g., position of limb, length of limb, distance to goal, and so forth) is a critical characteristic of motor behavior.
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