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❖ Motor control & motor learning

o Definition
● MOTOR CONTROL = a study that deals w/ the understanding of the neural, physical and
behavioral aspect of the biological movement
● MOTOR LEARNING = a set of internal processes associated w/ practice or experience leading to a
relatively permanent changes in the capability of motor skills; procedural memory, automatic
▪ ***MOTOR CONTROL IS DEPENDENT ON MOTOR LEARNING

▪ Practice → skilled behavior

● **MOTOR PLAN = an idea purposeful movement and is made up of component motor programs

● MOTOR DEVELOPMENT = evolution of changes in motor behavior occurring as a result of growth,

maturation and experience.
● MOTOR SKILL: Learned → practice + feedback

● MOTOR PROGRAM = an abstract representation that when initiated, results in the production of a
coordinated movement sequence
▪ Coordinated movement sequence

● MUSCLE STRENGTH = the muscle force exerted by a muscle or a group of muscle to overcome a
resistance under a specific set of circumstances
● MUSCLE PERFORMANCE = the capacity of a muscle or a grp of mm to generate forces

● MUSCLE POWER = work produced per unit of time or the product of strength and speed

● MUSCLE ENDURANCE = the ability to sustain forces repeatedly or to generate forces over a period
o Determinants of motor learning
● PERFORMANCE = it determines the individual extent of knowledge of a specific skill

▪ How you actually do the activity

▪ Ex: graded performance during practical’s

● RETENTION = ability of an individual to perform a specific skill over a period of time after a period
of no practice
▪ Ex: buong semester yung prof mo tinuturuan ka nang maraming skills then at the end of
the exam nag bigay nang GRAND PRACTICALS
▪ application of short term memory → GOAL: LONG TERM SKILL

● ADAPTATION = ability to practice, adapt and refine the skill to changing environmental demands;
trying to be flexible with activity
▪ Ex: PT kana tinuturo mo sa pt mo yung mga natutunan mo nung college at kung paano
iapply in different environment
● RESISTANCE TO CONTEXTUAL CHANGE = ability to perform the task in varying environment

▪ Ex: teaching the pt to ambulate inside parallel bars

o Types of motor task:
● DISCRETE = has recognizable beginning and end; start → end

▪ Ex: hawakan ang kutsara

● SERIAL = series of discrete movement that are combined c particular movement; sequence of
discrete
▪ Ex: eat with your spoon → elbow flexion → sh movement

▪ First name, second name, last name

● CONTINUOUS = repetitive uninterrupted movement that as no beginning to end; no start → end

▪ Ex: running

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o Motor learning strategies

● FEEDBACK: response → during or after motor output

▪ Feedforward → before motor output

▪ Coordination: smooth controlled movement

▪ INTRINSIC

⮚ AKA inherent/ innate feedback

⮚ Occurs naturally because of movement

⮚ Comes from sensory system of individual

▪ EXTRINSIC

⮚ AKA augmented feedback

**PB Bandwidth
feedback??? Given ⮚ Signals/ cues comes from PT/examiner
only when
performance ⮚ Types of extrinsic:
deviates outside the
boundaries of error ✔ KNOWLEDGE OF PERFORMANCE
range
● Nature and quality of movement pattern base on the performance

● Naachive ba yung desired movement???

✔ KNOWLEDGE OF RESULT

● End result in relation to the goal

● Naachive ba yung goal?

● FEEDBACK SCHEDULE

▪ CONCURRENT = feedback given DURING the activity

▪ TERMINAL = feedback given AFTER the activity

▪ IMMEDIATE = feedback given DIRECTLY AFTER THE PERFORMANCE of the activity

▪ DELAYED = feedback given AFTER BRIEF DELAY; learner self ax

⮚ To allows introspection → examine of thoughts or feeling → give pt enough time to

internalize
▪ SUMMED = feedback is given AFTER A SER OR # OF TRIAL

▪ FADED = feedback given AFTER EVERY FIRST TRIAL; lesser feedback p few more trials

▪ BANDWIDTH = feedback given when THE PERFORMANCE DEVIATES OUTSIDE THE

BOUNDARIES OF CORRECT PERFORMANCE
● PRACTICE TYPE

▪ PHYSICAL = performance of the task itself

▪ MENTAL = performance of the motor task is imagined or visualized **EARLY REHAB

▪ PART/WHOLE = tasks are practiced before practice of the whole task

▪ PART = breakdown to separate component ***EARLY DEMENTIA pt

▪ WHOLE = performed from beginning to end; beneficial if the pt is acquiring continuous skill

▪ TRANSFER TRAINING: gain or loss of task performance as a result of practice

⮚ Positive learning: enhances acquisition of similar or related skills

⮚ Negative learning: training experience interferes with acquisition of other skills

▪ MASSED = REST < PRACTICE “MAS PAGOD”

⮚ GOAL: For athlete pt; pts with endurance

▪ DISTRIBUTED = REST > PRACTICE “DI pagod”

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⮚ GOAL: MS pt

▪ BLOCKED = only 1 task is performed repeatedly, uninterrupted by other tasks

⮚ Pt who needs mastery

▪ RANDOM = wide variety of complex task performed RANDOMLY

● PRACTICE ORDER & ENVIRONMENT

▪ ORDER: A- SIT, B-STAND, C-WALK

⮚ BLOCK → repeated practice of tasks = AAABBBCCC

⮚ SERIAL → repeatable and predictable = ABCABCABC

⮚ RANDOM → non repeating & non predictable = ACBBCAACB

▪ ENVIRONMENT

⮚ OPEN = variable & changing

✔ MOST COMPLICATED BUT MOST BENEFICIAL

⮚ CLOSED = fixed & non-changing

✔ MOST PRACTICAL & SAFEST

● Task specific/function induced

▪ Neuroplasticity: brain formed new pathway for new knowledge

▪ Use it or lose it: gamitin mo or mawawala

▪ Repetition matters: practice para hindi mawala

▪ Salience matters: kapag important, mas maalala

▪ Use it and improve it: training for enhancement of that function

▪ Intensity matters: requires sufficient training intensity

▪ Age matters: plasticity occurs more readily in younger brains

▪ Transference: can enhance acquisition of similar behaviors

▪ Specificity: nature of training experience dictates the nature of plasticity

▪ Time matters: different forms of plasticity occur at different times

▪ Interference: plasticity can interfere with the acquisition of other behaviors

o Stages of motor learning

STAGES OF MOTOR LEARNING

COGNITIVE ASSOCIATIVE AUTONOMOUS
● What to do? ● How to do? ● How to succeed?
● Understand the task ● More consistent ● Aka AUTOMATIC STAGE
● Highly variable performance fewer/dec ● Movement are largely
performance = frequent error (+) extraneous error free
errors movements ● Low level of attention is
● Able to differentiate ● Able to detect required
correct vs incorrect safe inconsistency and able to ● At this stage pt is able to
vs unsafe correct errors perform one task while
● Highly dependent on ● Increase use of doing another task
vision proprioceptive feedback ● Perform the task in (B)
dec dependency on open & close
vision environment

❖ Stages of of motor skills:

o MOBILITY: initiation
● INFANT = random for 1st 3 mos

● ADULT = availability of ROM to assume posture and to initiate a movement

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● Ex: OKC
o STABILITY: maintaining
● Ability to maintain posture with orientation of COM over BOS & body healed steady
o CONTROLLED MOBILITY: mobility + stability
● AKA dynamic postural control; Transitional mobility

● Mobility

● Superimposed stability

● Associated w/ CKC activities

● Ex: Weight shifting

o SKILL: high coordination
● AKA combined mobility and stability

● Highest level of function

● Associated with OKC activities (distal segment is moving, while prox segment is stable)

● OKC + CKC

❖ Task specific/ function-induced strategies

o Strategies that mainly focus on the use of the affected body segment
● Advantages:

▪ Counteracts the effect of immobility

▪ Prevents learned non-used of the affected limb/segments

▪ Promote neuroplasticity
o CIMT (constraint induced movement therapy)
● It improves UE fxn CVA parts & other victims w/ CNS damage

● Three major components

▪ Repetitive, structures, practice intensive therapy in the affected arm

▪ Restraint of the less affected arm

▪ Application of a package of behavioral techniques that transfers gain from the clinical
setting to the real world
● AFFECTED HAND will be the one doing the task – shaping

● UNAFFECTED HAND will be fit into sling

● Type of restraint = Sling, Triangular Splint, MITT

● Patient must wear the restraint approximately 90% of waking hr

● Patient receiving CIMT program 3-9 mos. POST CVA vs 15-21 mos POST CVA
o BWSTT (body support treadmill training)
● Purpose: decrease wt bearing of pt up to 30%

● Progression: fro with BWS to w/out BWS

● Best in community ambulation

● Gait restoration after stroke

o Compensatory training approach
● Using strategies and tools that alleviate the impact of memory problems in daily life and improve
daily functioning without the expectation of improvement of memory functioning
● Bypass the deficit → Modify environment

❖ HOW TO ASSESS IF SOMEONE’S HAVING A STROKE? → BE FAST!

o Balance
o Eye
o Face

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o Arms
o Speech
o Time
❖ Cerebral blood flow rate in the human brain
o 50-55mL/100 gm of brain tissue per minute – 100% of CBF rate
o 35mL/100 gm of brain tissue per min – 40-70% of (N) CBF rate
o 10mL/ 100 gm of brain tissue per min – 20% or less of (N) CBF rate
❖ Ischemic penumbra = aka tissue at risk/salvageable tissue

❖ During Acute ischemic stroke, BP should be??? increase BP!!!

❖ Stroke pt should be referred for early rehab once medical stability is reached
o Rapid loss of mm strength → 1.5% -5-5% /day
o 40% decline in the first week
o Selective atrophy of antigravity mm
o Rapid loss of cardiovascular fitness
o Slow recovery
o Take advantage of neuroplasticity
❖ Theoretical basis
o Neurodevelopmental model
● Genetic + environmental risk → development

● Guided facilitated movement → BOBATH

● Holistic interdisciplinary

● Individualized tx programs

● Genetic and environmental risk factors act during prenatal, perinatal, and early adolescence
periods, thus altering the developmental trajectory
● Step by step learning

▪ Rehabilitation: repeating, regaining old skills

▪ Habitilization: trying to have the skills, new skill

o Reflex theory
● Reflexes as a basis for movement → actions

● Movements are controlled by stimulus & if its is combined all reflex = BEHAVIOR

● Works hand in hand with motor output & feedback

● Reflexes are combined into actions that create behavior

● Use sensory input to control motor output

● Stimulate good reflexes

● Inhibit undesirable (primitive) reflexes

● Rely heavily on Feedback

o Hierarchical theory: prevents primitive reflexes, normalizes tone and decrease spasticity
● Top down model: action starts from the highest order; voluntary movements are made by WILL;
cortical centerl controls movement
● Identify & prevent primitive reflexes

● Reduce hyperactive stretch

● Normalize tone

● Facilitate “normal” movement patterns

● Developmental Sequence

● Recapitulation

● Sensory feedback

▪ Closed loop: ongoing production of a skilled movement

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o Systems approach: systems in the body come together to make a goal directed behavior
● Goal and task directed

● Identifiable, functional tasks

● Practice under a variety of conditions

● Modify environmental contexts

❖ MOST COMMON NEUROREHABILITATION APPROACHES OF CVA Pt

BRUNNSTROM BOBATH
SYNERGY YES NO
PRIMARY PRINCIPLE Synergy are OK for ADLs Rehab strategies should promote (N)
recovery rather than compensation
GOAL To do ADL’s using synergistic pattern To do functional ADL’s through learned
postural and movement patterns
● Stereotyped and do not ● Active dynamic & functional
permit combination of mm ● Uses reflexes
● 7 stages of spasticity ● 3 stages of spasticity
❖ BRUNSTROM
o Use of tonic reflexes associated reaction and basic limb synergies
o Synergistic movement patterns: sabay sabay
o Production of motion by promoking primitive movement patterns or synergistic patterns
● Primitive: ATNR, STNR, Landau, etc.
o Uses attitudinal reflexes, associated reactions and other reflex responses
o Believes in flexion and extension synergies
o Pioneer of neurodevelopmental rehabilitation
o As long as there is movement
o Stage 3 or 4: add VOLUNTARY movement out of reflex patterns

Stages Mm tone Movement

1 Flaccid (-)

2 Spasticity begins Minimal basic limb synergies

3 Severe and peak spasticity Voluntary control of synergy

4 Spasticity begins to decline Some/simple movement combination can be done outside synergy
pattern

5 Spasticity continues to decline More difficult movement combinations

6 Spasticity disappears Coordination and individual joint motions approaches normalcy

7 Normal motor function

❖ ASSOCIATED REACTION
o Associated reactions: resistance to the normal side → produce reaction to affected side
● Findings:

▪ UE → same side

▪ LE → opposite side
ASSOCIATED REACTION
Raimiste’s phenomenon Resisted hip ABD of the (N) side will result to involuntary hip ABD on the affected
side – same hip ABD
Sterling’s phenomenon Raimiste’s in the UE, resisted arm ABD → involuntary ABD of the affected side
(same with sh ABD)
Soques phenomenon Sh flex/ abd → passive finger ext
Goal is to open hands
Homolateral synkinesis UE abd will result to LE abd on I/L side
Affected limb synergy may mimic each other
Imitation synkinesis Mirroring movement occurring at affected side upon movement on the
unaffected sides
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Marie- foix bectherev Passive toe flex, knee and hip flex
Huntington’s phenomenon Increase spasticity (esp flexor synergy) during coughing, yawning and sneezing
Global spasticity/ La Right elbow flexion→ all other limbs flex
Syncinesie Global Ou
Spasmodic
Coordination synkinesis Flexion/ shortening synkenesia/ La syncinesie de racourcissment:
(Process of shortening):
Extensio/ lengthening synkenesia/ La Syncinesie d’ allongement
(process of lengthening)
Listing/ Pusher syndrome Leaning towards affected side

FLEXOR EXTENSOR TYPICAL UE

POSTURE

SCAPULA ELEV; RETRACT PROTRACT

SHOULDER ABER ADDIR ADDIR

ELBOW FLEX EXT FLEX

SYNERGISTIC PATTERN (Bold are strongest synergistic pattern)

FA SUPIN PRON PRON
JOINT TYPICAL FLEXOR EXTENSOR FLATS EDEMA – NOT AFFECTED
WRIST, FINGERS FLEX FLEX FLEX
MUSCLE IN SYNERGY

AXIAL Finger extensor

Head FLEXOR side

Lat. Flex to the hemiplegic EXTENSOR TYPICAL LEG POSTURE
Latissimus dorsi

Trunk Towards affected side Ankle evertors

HIP FABER EXADIR FADDIR
Pelvis Post pelvic tilting Teres major
KNEE FLEX EXT EXT
UE Serratus anterior

ANKLE
Retracted DF; INV
Retracted PF, INV
Protracted PF, INV
Scapula
Depressed Elevated Depressed
TOES EXT FLEX FLEX
Adducted ABDUCTED 90deg Adducted
Shoulder
IR ER IR

Elbow Flexed FLEXED (at acute angle Extended

Forearm Pronated Supinated Pronated

UD,
Wrist Flexed Extended
Flexed

Finger Flexed Flexed Flexed

LE

FLEXED* Extended
Adducted
Hip Abducted Adducted
IR
ER IR

Knee Extended Flexed Extended

Ankle PF Dorsiflexed Plantar flexed

Foot Inversion Inversion Inverted

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Toes Extension Flexed
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❖ SYNERGISTIC PATTERN TYPICAL

o ARM POSTURE → is the combination 1 strongest flexor synergy & 2 strongest UE extensor synergy
o DEFINIION OF TAP
● MOST VISIBLE DURING? → STANDING, SITTING & WALKING
o Speed test: to see how many components in a synergy
❖ BOBATH
o AKA NEURODEVELOPMENTAL TECHNIQUE
o Karl and Bertha Bobath
o Neurodevelopmental treatment with reflex inhibition & facilitation
o Assessment & treatment was based on the premise that the fundamental difficulty in CP is lack of
inhibition of reflex patterns of posture & movement
o Therapeutic handling
o Inhibit AbN and active movements
● Correct wrong movements → carryover of mistakes on future practices

● Do not superimpose involuntary to voluntary movement

● No associated reactions
o Incorporate the use of the (hemiplegic side in all treatment (re-establish symmetry)
o Improve functional performance of the involved side ( bimanual activities
o PROPER BED POSITIONING:
● Head: NEUTRAL

● Trunk: NEUTRAL

● Scapula: PROTRACTED

● Shoulder: ABER

● Elbow: EXT

● FA: SUPINATION

● Wrist & fingers: EXTENSION

o Uses reflex inhibiting pattern, facilitation techniques for more mature postural reflexes, normalizing
abnormal tone with the use of key points of control & all day management
● PATTERNS OPPOSITE TO THE TYPICAL ABN PATTERN

● ABN TONE = ABN movement

o Key points of control
● Parts of the body that are advantageous when facilitating or inhibiting movement/ posture

▪ DISTAL: THUMB, WRIST & HAND

▪ PROXIMAL: HEAD, SH & PELVIS

o Bobath Stage of Recovery
● Stage 1: Initial flaccid stage: prepare mobility for pt

● Stage 2: Spastic stage: peak spasticity stage; stages 2-5 of Brunnstrom

▪ Goal: sit s backrest; STS c affected leg behind the good leg

▪ Weightbearing on the affected leg → to normalize tone

▪ Stance phase, circumduction gait: co-contraction of mm

● Stage 3: Stage of relative recovery:

▪ Stage 6-7 of Brunnstrom

▪ Pt is free to walk

❖ PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION

o PNF proposed by: KABAT, KNOTT & VOSS
o Neuromuscular facilitation
o Integrated approach
o Methods include diagonal movement patterns, sensory stimuli & use of special techniques

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● Use of movements to guide the body for ADLs

o IT is a positive approach
o It considers the total human being
o Provides highest functional level
o NEUROPHYSIOLOGIC BASIS:
● RESISTANCE = to add in mm cxn, motor control and motor learning

▪ To increase strength, aid motor learning

● MANUAL CONTACT = to increase power and guide motion w/ grip and pressure

● STRETCH = use of mm elongation & stretch reflex to facilitate mm cxn & dec mm fatigue

● TRACTION/ APPROXIMATION = elongation & compression of the limbs and trunk to facilitate
motion & stability
● IRRADIATION/ Overflow = use of the spread of the response to stimulation

● TIMING = promote (N) timing and inc mm cxn through (TIMING FOR EMPHASIS)

● RECIPROCAL INHIBITION:

▪ Fatigue the antagonist mm → mas makakagalaw agonist

● AUTOGENIC INHIBITION

▪ Fatigue the mm itself to move the mm → repetitive isometrics; fatigue agonist

PURPOSE TECHNIQUE DESCRIPTION

Directed to Agonist – Repeated Contractions 1 for weakness

Muscle Weakness
Combination of Eccentric ; Concentric
Isotonics

Rhythmic Initiation inc ROM, coordination

Reversal of Antagonist – Slow Reversal; Quick

muscle imbalance Reversal

Slow Reversal Hold

UPPER EX D1isometrics
with FLEXION at end D1 EXTENSION
range
SHOULDER FADER EXABIR
Stabilizing Reversal
ELBOW FLEX EXT
Rhythmic Stabilization -Trunk + Postural Stability ; PD
FA SUPINATION PRONATION
Relaxation – for Hold Relax Can be c pain/inflammation; inc ROM
WRIST
spasticity + tightness FLEX; RD EXT; UD

FINGERS Contract
FLEX Relax Resistance
EXT to antagonist + relaxation;
inc ROM; s pain
EXAMPLES EAT; DRINK SEATBELT DRIVER; ROW
Rhythmic Rotation Usually for spastic mm (trunk)
D2 FLEXION D2 EXTENSION
Slow Reversal Hold Mm imbalance, tightness c pain
SHOULDER FABER
relax EXADIR

ELBOW FLEX Stretch

Repeated EXT of Range; Through range
Beginning

FA SUPINATION PRONATION

WRIST EXT; RD FLEX; UD

FINGERS EXT FLEX

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CALLA Jr. PD; UNSHEATH SWORD SEATBELT PASSENGER
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LOWER EX D1 FLEXION D1 EXTENSION

HIP FADER EXABIR

KNEE FLEX EXT

ANKLE DF; INV PF; EV

TOES EXT FLEX

EXAMPLES CROSS LEG; KICK BALL INITIATE KICK

D2 FLEXION D2 EXTENSION

HIP FABIR EXADER

KNEE FLEX EXT

THRUST ANKLE DF; EV PF; INV PATTERN

TOES EXT FLEX

EXAMPLES BOWLING

Upper trunk Upper ex

Chop Flexion + rotation Bilat asymmetrical

(R) UE D2 ext
(L) D1 est

Lift Ext + rotation Bilat asymmetrical

(R) UE D2 flexion
(L) UE D1 flexion

o BILATERAL PATTERNS:
● Bilateral symmetrical (BS)

▪ Same pattern; same direction; 1 diagonal pattern

▪ D1 flex & D1 flex

● Bilateral asymmetrical (BA)

▪ Opposite pattern same direction: 2 diagonal patterns

▪ D1 flex & D2 flex

● RECIPROCAL SYMMETRICAL

▪ Same pattern; opposite direction; 1 diagonal pattern

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▪ D1 flex & D1 ext

● RECIPROCAL ASYMMETRICAL PATTERN

▪ Opposite pattern; opposite direction; 2 diagonal pattern

⮚ D1 flex & D2 ex

❖ DIRECTED TO AGONIST
o For mm weakness
● REPEATED CONTRACTION

▪ Repeated isotonic contractions from a lengthened range (enhanced by quick stretches and
adding resistance) to a range of weakness
⮚ Indication: incoordination

⮚ C/I: acute condition

● HOLD-RELAX ACTIVE MOTION (hram)

▪ Resisted isometric contraction followed by voluntary relaxation and active movement to a

new range
⮚ Indication: lack of endurance, mm balance

⮚ C/I: resisted motion that cause pain

● RHYTHMIC INITIATION

▪ Voluntary relaxation 🡪 PROM 🡪 AAROM 🡪 AROM

⮚ C/I: pain
o For mm imbalance
● SLOW REVERSAL

▪ Concentric contraction of agonist(stronger) 🡪 antagonist (weaker) against resistance

● SLOW REVERSAL HOLD

▪ Concentric contraction of agonist 🡪 antagonist against resistance 🡪 isometric contraction of

antagonist
⮚ INDICATION: DYSMETRIA

● RHYTHMIC STABILIZATION

▪ Alternating isometric contraction of agonist and antagonist against resistance

(multidirectional)
o For mm relaxation: for tightness & spasticity
● HOLD RELAX

▪ Resisted isometric contraction of antagonist 🡪 voluntary 🡪 relaxation 🡪 PROM to new range

● CONTRACT RELAX

▪ Concentric contraction of antagonist 🡪 voluntary relaxation 🡪 PROM to a new range

● SLOW REVERSAL HOLD RELAX

▪ Concentric contraction of agonist 🡪 antagonist against resistance 🡪 isometric contraction of

antagonist 🡪 voluntary relaxation
● RHYTHMIC ROTATION

▪ SLOW, repeated rotation of a limb until ROM is restricted. Can be active or passive

❖ ROOD
o Current principle
● SENSORIMOTOR STIMULATION for activation & inhibition

● Repetition of muscular response creates movement patterns

● Approximation of real-life context increases treatment effectiveness and generalizability

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● Therapist uses somatic markers to select interaction methods with clients

● Sensory-motor integration

● Sensory input = motor output

● Goals:

▪ Normalize muscle tone

▪ Tx begins at the developmental level of functioning

▪ Movement is directed towards purposeful goal

▪ Repetition is necessary for the training of responses

o Follows ONTOGENETIC PATTERN
● Total flexion or flexion withdrawal (Mobility)

● ROLL OVER (Mobility)

● PIVOT PRONE (Mobility + stability)

● NECK CO CONTRACTION (Stability)

● PRONE ON ELBOW (Stability)

● QUADRUPED (Stability + controlled mobility)

● TALL KNEELING

● HALF-KNEELING

● STANDING (Skill)

● WALKING
o FACILITATORY & INHIBITORY
FACILITATORY INHIBITORY
Heavy joint compression LIGHT JOINT COMPRESSION
Pressure on MM BELLY SLOW STROKING – for opisthotonic posture
Quick stretch SLOW ROLLING
A-icing NEUTRAL WARMTH – how to address baby c colic
C-icing FAST ICING susig question
Vibration Proprioceptive
Light moving touch - Prolonged stimuli
Fast brushing - Jt distraction
Tapping - Tendon pressure
Resistance - Vestibular (slow rocking)
Proprioceptive MAINTAINED STRETCH
- Fast swaying DEEP TENDON PRESSURE
- Bouncing SLOW MAINTAINED ICING - SLOW ICING
- Quick stretch
- Heavy joint compression
❖ OTHER NEUROREHABILITATION APPROACHES
o DOMAN DELECATO
● Glenn Doman and Carl Delacato

● Follows basic beliefs of Fay but recommends the additional methods such as:

▪ Periods on inhalation of Co2 from a breathing sack

▪ Hanging a patient upside down & whirled around

▪ Restriction of fluid intake

▪ Development of cerebral hemisphere dominance

● To stimulate VESTIBULAR APPARATUS

● “DELICADO”
o TEMPLE FAY
● ONTOGENETIC Development of a man is a recapitulation of PHYLOGENETIC DEVELOPMENT:

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▪ Prone lying

▪ Homolateral stage

▪ Contralateral stage

▪ On hands and knees

▪ Walking pattern

● Progressive movements patterns

● In general, suggested building up motion from

▪ Reptilian squirming → amphibian creeping → mammalian reciprocal → primate erect

walking
● Eight ontogenetic motor stages:

▪ Stage 1: prone lying head & trunk rotation from side to side

▪ Stage 2: homolateral stage

▪ Stage 3: contralateral stage

▪ Stage 4: On hands and knees

▪ Stage 5: Walking pattern

● Theory of recapitulation of species:

▪ Human development mimics animal evolution

▪ Fish > reptiles> amphibians> mammals > man

o PHELP
● An orthopedic surgeon from Baltimore

● Encourages PT, OT, and SP to from themselves into CP habilitation team

● Focuses of 4 main points

▪ Braces & calipers: used to correct deformities & to obtain upright posture in athetoid type

▪ Muscle education: muscle antagonistic to spastic muscles are activated

● 15 modalities:

▪ Massage

▪ PROM

▪ AAROM

▪ AROM

▪ Resisted motion

▪ Conditioned motion

▪ Confused/ synergistic motion

▪ Combined motion

▪ Relaxation techniques

▪ Movement from relaxation

▪ Reciprocation

▪ Rest

▪ Balance

▪ RGR

▪ ADL skills

o AYRES

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● Sensory integration for those with sensory problems

● Approach/ theory

● We have 8 primary senses:

▪ Smell

▪ Sight

▪ Touch

▪ Hearing

▪ Taste

▪ Proprioception

▪ Vestibular

▪ introspection

● Associate > action

● Different from Roods

▪ Sensory input

▪ Motor input

▪ Gamma efferent activity

o VACLAV VOJTA
● Reflex creeping and other reflex reactions

● A neurologist in Czechoslovakia advocated the works of Fay & Kabat

● Main features:

▪ Use reflex reaping, rolling, sensory

● Use proprioceptive trigger points on trunk and extremities to initiate reflex movement which
produces:
▪ Reflex rolling

▪ Resistance

▪ Reflex creeping

▪ Sensory stimulation:

⮚ Touch

⮚ Pressure

⮚ Stretch

⮚ Mm action

● Reflex Locomotive Patterns & positions

▪ Reflex creeping: prone

▪ Reflex crawling: prone

▪ Reflex rolling: sidelying

▪ Seen in Eclectic technique, for pediatric patients

o CARR & SHEPHERD
● Motor relearning program MRP

● If you want to do an action, tuturo mo na agad

● Goal directed

▪ Supporter of bobath

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⮚ Discourage compensatory movement

⮚ Use of affected side to carry out movement

▪ Momentum

▪ Sit to stand activity

▪ PT will give downward pressure on the WB leg to facilitate quads cxn

▪ How to assess if pt is giving equal WB on (B) feet

o PETO
● AN ALL-DAY PROGRAMME

● rhythmic intension = verbalization of task

o Deaver
● Extensive use of bracing to promote ADL

● Bed & W/c mobility & activities

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