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Theories of Motor Behavior

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Title: Theories of Motor Behavior


1
Theories of Motor Behavior
  • Central Nervous System
  • Sensorimotor Disorders

2
CNS Spinal Cord
  • Tracks for Sensory and Motor Impulses
  • Dorsal Ascending Sensory Tracks
  • Afferent
  • Ventral Descending Motor Tracks
  • Efferent

3
CNS Brain
  • Brain Stem
  • Postural Tone / Reflexes
  • Attention and Arousal
  • Filter
  • Reticular Activating System (RAF)
  • Reciprocal Innervation
  • Filter
  • Midbrain
  • Stability
  • Sensory info from Eyes

4
CNS Brain
  • Cerebellum (Little Brain)
  • Relay Center
  • Kinesthetic and Vestibular Input
  • Subcortical / Automatic Movements
  • Thalamus
  • Relay Station
  • Arousal

5
CNS Brain
  • Cerebrum
  • Two parts Cortex and Internal Capsule
  • Cortex Higher level Functions
  • Capsule Limbic System

6
Theories That Guide Practices
  • Maturation Theory
  • Dynamic Systems Theory
  • Hierarchical Levels of Function Theories
  • Neurodevelopmental / Neurophysiological Theory
  • Sensorimotor / Sensory Integration Theory

7
Sensory Integration
  • Understanding Theory and Practice

8
Nervous System 101
  • Central Nervous System Brain and Spinal Cord
  • Peripheral Nervous System - contains only nerves
    and connects the brain and spinal cord (CNS) to
    the rest of the body
  • Autonomic Nervous System contains Sympathetic
    and Parasympathetic Systems
  • Sympathetic Nervous System Fight or Flight
  • Parasympathetic Nervous System Rest and
    Digest
  • Neurotransmitters
  • Sympathetic response causes increase in Cortisol
  • Parasympathetic response increases Serotonin and
    Dopamine
  • Serotonin safety/satisfaction helps regulate
    input
  • Dopamine focus/attention
  • Cortisol stress chemical that uses up Serotonin
  • Lack of Serotonin impulsive behavior /
    depression
  • Release Serotonin Pressure/Vestibular
    Movement/Proprioception
  • Release Dopamine Touch/Proprioception
  • Specific movements can serve to release the
    proper neurotransmitters if there is a deficiency
    This is where intervention comes in!

9
Hierarchical Levels of Function Theory
  • Definition Development is spiral with the
    integrity of each system built on the sound
    functioning of the system immediately below it.
    The nervous system must be integrated at lower
    levels before cognitive approaches like watching
    demonstrations and listening to directions can be
    successful

10
Hierarchical Levels of Function Theory
  • Lowest part of the brain Brain Stem
  • Integration
  • Visual (vision) midbrain
  • Auditory (hearing)
  • Vestibular (balance/head movements)
  • Proprioceptive/Kinesthetic (body sense)
  • Tactile (touch)
  • Olfactory (smell) cortex
  • Gustatory (taste)

11
Highest part of the brain Cortex (Higher order
processing)
12
Introduction to Sensory Integration
  • Sensory Integration putting sensory
    information to use
  • How do we put sensory information to use?
  • Sensory Info brain stem (except?)
  • 3 choices
  • Properly working brain stem

13
Introduction to Sensory Integration
  • What types of basic sensory information do we
    get?
  • Vision
  • Auditory
  • Proprioceptive/Kinesthetic
  • Tactile
  • Vestibular

14
Introduction to Sensory Integration
  • Proprioception/Kinesthesis is information from
    the body about where the body is in space without
    vision.
  • Receptors
  • (muscle spindles, golgi tendon organs, golgi type
    receptors, ruffini endings, modified pacinian
    corpuscles, cutaneous receptors, vestibular semi
    circular canals)
  • Tactile uses the cutaneous receptors to give
    information about touch (light/deep).
  • Vestibular uses vestibular semi circular canals
    to register head movements.
  • Balance requires the integration of 3 sensory
    systems (vision, vestibular, and proprioceptive
    or somatosensory)

15
Introduction to Sensory Integration
  • In a properly working brain, most of the sensory
    information we get from the environment is
    inhibited at the brain stem.
  • In children with sensory integration disorders,
    some sensory information is not inhibited or
    enhanced (sent up to the cortex) properly
  • visual, vestibular, tactile, proprioceptive, or
    auditory
  • When a child is not integrating one of the
    sensory information systems (e.g. vestibular),
    then they are said to have a vestibular
    integration problem. Sensory integration is a
    broad term that encompasses all of the
    aforementioned sensory systems (1-5).

16
Introduction to Sensory Integration
  • When children do not integrate properly,
    learning is compromised. Behavior may be
    compromised as well. The key is to identify
    which sensory system or systems the child is have
    difficulty with, and remediate accordingly.
  • We do not treat the symptom rather we address
    the underlying neuropathology.

17
Introduction to Sensory Integration
  • This process is called sensory integration
    therapy/training. It is based on hierarchical
    levels of function theory.
  • Remediation
  • Children with sensory disorders will typically
    display behavior that indicates a possible
    integration problem. This is called sensory
    integration dysfunction, sensory integration
    disorder, or sensory processing disorder.
  • For all practical purposes, these terms are
    synonymous.

18
Sensory Integration Dysfunction (SID/DSI)Sensory
Processing Disorder (SPD)
  • Put simply, what is sensory integration
    dysfunction?
  • It involves concepts such as modulation,
    registration, hyper/avoiding, hypo/seeking,
    integration, various sensory systems, and levels
    of severity (mild, moderate, severe)

19
Sensory Integration Dysfunction (SID/DSI)Sensory
Processing Disorder (SPD)
  • For the most functional understanding, you should
    know
  • Children will either seek (sometimes called
    aggressive) sensory input or avoid (sometimes
    called defensiveness) sensory input or not
    register sensory input (sometimes called
    under-registration)
  • Certain behaviors will be associated with the
    particular disorder/dysfunction
  • Mild disorder will typically not affect lifes
    functions
  • Severe disorder will need intervention because it
    will impact, school, social, and home life
    (pervasive).

20
What it feels like Examples
  • Visual fluorescent lights (may perceive the
    cycling of the lights feels like being in a
    strobe light similar to an old flickering light
    bulb how could a child sitting in a chair
    concentrate?)
  • Auditory vacuum cleaner or birds chirping (may
    sound like fingernails on a chalk board)
  • Gustatory strong tasting food (may taste like
    battery acid)
  • Olfactory perfume (may be like taking a deep
    breath from a bleach bottle)
  • Tactile light touch (may feel like someone is
    touching an open wound)
  • Proprioceptive coordinated movements (like a
    bull in a china shop)
  • Vestibular Stand up!

21
Food for Thought
  • All individuals need to move. The younger the
    individual, the more frequently this need to
    move is necessary.
  • Ask yourself, How long can I pay attention to
    the most incredible speaker without needing a
    break?
  • Children need breaks too. The age of the child
    is inversely proportionate to their need to have
    movement breaks.
  • What is a sensory diet?
  • Hideouts vs. Time outs

22
Sensory Integration DysfunctionActivities for
Remediation
  • Ten modalities provide sensory input that must be
    organized and processed. They include touch and
    pressure kinesthesis vestibular temperature
    pain, smell taste vision auditory and common
    chemical sense. Each modality has a special type
    of end organ (sensory receptor) that is sensitive
    to only certain stimuli, and each has a separate
    pathway from the receptor up the spinal cord to
    the brain. Most important to motor learning are
    tactile, kinesthetic, vestibular, and visual.
    When these systems exhibit delayed or abnormal
    functioning, motor development and/or learning is
    affected.

23
Sensory Integration DysfunctionActivities for
Remediation
  • Tactile Integration
  • Probably the most fully developed resource at
    birth. The brain organizes tactile system input
    in many ways and has different locations for
    processing light touch, deep pressure, cold,
    heat, and different kinds of pain that originate
    in the skin receptor organs. Of particular
    interest

24
Tactile Integration
  • Tactile Defensiveness (avoiding) Touch (ones
    own and that of others) causes generalized
    discomfort, irritability, or temper outbursts.
  • Behaviors
  • Stiffening when tactile praise (e.g. shoulder
    touch or pat on the back is given) ducking or
    moving aside to avoid a hug or tactile praise
  • Complaining more than peers about feeling dirty
    or sweaty or hot or cold, or showing distaste
    through gesture or facial expression
  • Avoiding tight clothes, shoes, gloves, automobile
    seat belts, elevators full of people, and other
    variables that increase tactile input
  • Disliking certain food textures, unusual
    sensitivity to these
  • Complaining that peers tag too hard in games or
    push too much in lines inability to cope with
    normal roughhousing among peers
  • Note These behaviors might be specific to
    certain body parts or might occur in response to
    touch anywhere on the body.

25
Tactile Integration
  • Tactile Craving or Aggressiveness (seeking) A
    greater than average need to touch or be touched.
  • Behaviors
  • Need to touch repeatedly those surfaces and
    textures that provide soothing and comforting
    tactile experiences
  • Seem compelled to touch certain surfaces and
    textures that cause other people discomfort (nail
    biting, skin picking, skin biting)
  • Seek certain messy experiences, often for long
    durations
  • Enjoy vibration or movement that provides strong
    sensory feedback
  • Prefer extra spicy or excessively sweet foods
  • Uses mouth to explore objects (after age of 2)

26
Tactile Integration
  • Tactile Hyposensitive (under-registering) Not
    responsive to touch within the norm.
  • Behaviors
  • Seem unaware of touch unless it is very intense
  • Be unaware of messiness on face
  • Show little or no reaction to pain from scrapes,
    bruises, cuts, or shots
  • Hurt other children or pets during play, not
    comprehending the pain others feel
  • Fail to realize that they have dropped something

27
Tactile Integration Activities for Remediation
  • For tactile defensiveness (avoiding)
  • Use massage, either by hand or vibrator, to
    activate deep pressure receptors. Massage can be
    by another or by self. Encourage stroking or
    rubbing of own body parts. The back of the hands
    and forearms are the least defensive and thus
    constitute the first progression activity when
    severe tactile defensiveness is present.
  • Stroke or brush body parts with fabrics and
    brushes of different textures. Coarse or rough
    textures are more easily tolerated than smooth
    textures, so build the teaching progression from
    coarse to smooth. (Do not brush stomach, head,
    neck, face, or chest). (see Protocol)
  • Joint compressions (see Protocol)
  • Introduce weights of different textures as part
    of touch-feel-lift progressions in weight-lifting
    units. Stuffed animals are good with young
    children use hug-and-release movements as well
    as touch-and-lift.
  • Use below (seeking) activities on an as tolerable
    and increasing basis

28
Tactile Integration Activities for Remediation
  • For tactile craving (seeking) and
    under-registering
  • Can use above activities for additional tactile
    input
  • Playing in multiple textures (play dough, shaving
    cream, gak, rice, beans, bird seed, painting).
  • Conduct activities with a reach-in-grab bag or
    box that require guessing the object one is
    touching without use of sight. Have children run
    from one station to another where different
    touch-and-guess activities are done.
  • Conduct blind person bluff type games in which
    blindfolded persons tries to catch and identify
    others.
  • Squeezing a squish ball or balloon filled with
    sand (can attach to belt)

29
Proprioceptive/Kinesthetic Integration
  • Gives us information from the body about where
    the body is in space without vision. Provides
    input that helps us with perception of sensations
    from touch and movement (both external and
    internal). Of particular interest

30
Proprioceptive/Kinesthetic Integration
  • Proprioceptive Defensiveness (avoiding) resists
    input into the joints either by compression or
    traction.
  • Behaviors
  • Avoid putting weight onto their joints such as
    when standing, pushing things or jumping
  • Complain about lifting heavy things

31
Proprioceptive/Kinesthetic Integration
  • Proprioceptive Craving or Aggressive (seeking)
    attempts to get needs met by seeking out
    proprioceptive input.
  • Behaviors
  • Kick heels against floor or chair
  • Bumps and crashes into objects
  • Stomp or slap feet on ground when walking
  • Wants shoelaces, hoods, and belts to be tightly
    fastened
  • Chew constantly on objects like shirt collars and
    cuffs, hood strings, pencils, toys, and gum
  • Likes to tackle people and dive into leaf piles

32
Proprioceptive Integration Activities for
Remediation
  • For proprioceptive defensiveness (avoiding)
  • Brushing follow protocol
  • Joint Compressions follow protocol

33
Proprioceptive Integration Activities for
Remediation
  • For proprioceptive craving (seeking) and
    under-registering
  • Wheelbarrow walking
  • Jumping rope
  • Trampoline jumping
  • Throwing/carrying heavy objects (bean bags)
  • Pushing/pulling weighted toys/objects
  • Hopping
  • Jumping off curbs/apparatus
  • Climbing up the down part of slide
  • Swimming
  • Raking
  • Tug of war
  • Climbing rope ladders or ladder swings
  • Smushing with cushions
  • Wearing wrist or ankle weights or weighted vest
  • Squeezing a squish ball or balloon filled with
    sand (can attach to belt)
  • Extension activities. (Activate receptors by
    changing tension). Any movement involving
    prolong contraction of extensor muscles against
    gravity (e.g. scooterboard activities done in
    prone position with head up heightens awareness
    of midline)

34
Vestibular Integration
  • The vestibular system originates in the inner ear
    area of the temporal lobe, where hair cell
    receptors take in information about the position
    of the head and all its movements, however
    subtle. This information, when interpreted and
    acted upon by other parts of the brain, helps to
    maintain static and dynamic balance. The
    vestibular system is the most important structure
    in the regulation of body postures. It prevents
    falling, keeps body parts properly aligned, and
    contributes to graceful, coordinated movement.
    Additional vestibular system functions
    gravitational security, muscle tone,
    auditory-language processing, visual-spatial
    processing, and motor planning.

35
Vestibular Integration
  • Vestibular Defensiveness (avoiding)
  • Behaviors
  • Dislikes playground activities, such as swinging,
    spinning/sliding
  • Cautious, slow moving, and sedentary, hesitating
    to take risks
  • Uncomfortable in elevators/escalators, motion
    sickness
  • Gravitational insecurity (fear of falling when no
    danger exists, fearful of heights, even slightly
    raised surfaces, become anxious when feet leave
    ground, fearful climbing stairs, feels threatened
    when head is inverted, upside down or tilted ex.
    titling head back for shampoo)
  • Easily looses balance
  • Moves in awkward, uncoordinated way
  • Hesitates or declines to join in physical
    activities
  • Has social/emotional problems

36
Vestibular Integration
  • Vestibular Craving (seeking)
  • Behaviors
  • Need to constantly move in order to function
  • Has trouble sitting still or staying in a seat
  • Repeatedly and vigorously shakes head, rocks back
    and forth, and jumps up and down
  • Craves bouncing, swinging, spinning, going upside
    down
  • Seeks out fast spinning rides/structures
  • Does not get dizzy, even after spinning rapidly
    for long periods of time
  • More than other children, crave trampolines,
    seesaws and teeter totters

37
Vestibular Integration Activities for
Remediation
  • For vestibular defensiveness (avoiding) Use
    stable surface to stand or sit on. Head should
    be aligned forward facing with shoulders
  • Slow rhythmic activities linear movement (back
    and forth)
  • Slow rocking in prone position on a Physioball
  • Brushings and Joint Compressions
  • For vestibular craving (seeking) and
    under-registering
  • Swinging
  • Prone scooter board
  • Somersaults
  • Sit and Spin
  • Trampoline
  • Going upside down
  • Rocking horse
  • Hippity Hop
  • Bouncing on a Physioball
  • Teeter totter
  • All the activities they like to do!

38
Visual Integration
  • The visual system is comprised of many
    subsystems, some reflexive and some voluntary.
    All are important in postural control and motor
    performance. The many subsystems can be
    organized into two types of vision (a) acuity
    and (b) eye coordination. Acuity refractive
    vision. Refractive problems myopia
    (nearsightedness), hyperopia (farsightedness),
    and astigmatism (blurring and distortion). Eye
    Coordination activity of the six external
    muscles of the eyeball. Binocular coordination
    both eyes working together to form a picture.
    Problems strabismus (cross eyed) and nystagmus
    (constant, involuntary movement of the eyeballs).

39
Visual Integration
  • When vision problems are suspected, an
    ophthalmologist should be consulted. Refractive
    problems are treated with prescriptive glasses or
    surgery. Strabismus can also be treated with
    surgery.
  • The best way to enhance vision for body control
    is to provide lots of practice in many and varied
    movement tasks. The breakdown in vision
    typically is not exclusively a problem of the
    eyes but rather the complex process of
    integrating inputs from several sensory
    modalities and translating them into appropriate
    motor outputs.

40
Visual Integration Activities for Remediation
  • Use suspended-ball activities in which the height
    of the ball is periodically changed so the head
    and eyes must practice accommodations
  • Do lying and locomotor activities on tables of
    different heights so that eyes look down and
    accommodate. When appropriate, switch from table
    to wide balance beams
  • Practice object handling from many positions
    midline and looking up, down, and sideways. This
    includes prone-supine-, and side-lying down on
    mats as well as on apparatus of different heights
    and tilts to give looking downward new
    perspectives
  • Practice with (a) the body stationary, (b) the
    body in locomotion, and (c) the body moved by
    external forces like swings, balance boards,
    scooterboards, merry-go-rounds, escalators,
    treadmills, and the like.

41
Deep Pressure Brushing and Joint Compression
Protocol
  • When beginning the brushing and joint
    compression protocol, please monitor the student
    for any adverse reactions up to two weeks after
    starting the protocol. Report any adverse
    reactions to your occupational therapist or
    physical therapist
  • Why Brushing stimulates the skins deep
    pressure nerves and joint nerves to help organize
    the nervous system. It appears that if the
    brushing is applied consistently over time, it
    helps reduce and at times even eliminate tactile
    defensiveness. Brushing is also used to help
    with organization and attention.
  • What Use a soft surgical scrub brush (from PDP
    products). A terry-cloth towel may be used for
    infants

42
Deep Pressure Brushing and Joint Compression
Protocol
  • How This process should take about two minutes
  • Start by brushing first the arms, hands, then the
    back, then the legs and feet
  • Use FIRM PRESSURE to brush on arms, hands, back,
    legs and feet
  • Use long, smooth strokes, typically 10 strokes
    per limb back (up down is on stroke)
  • Begin from proximal to distal (top to bottom)
    with the brush at a horizontal angle. Pressure
    should be firm enough to bend the bristles of the
    brush all the way over and all the way back
    during the opposite stroke (Do not scrub!)
  • Brushing bare skin is preferred. If brushing
    over clothing, the brush may be turned to a
    vertical angle
  • Palms and soles of feet are sometimes brushed.
    Typically when doing small areas like the hands
    and feet, go back and forth over the area 3 times
    and move on

43
Deep Pressure Brushing and Joint Compression
Protocol
  • How
  • Brushing is followed by GENTLE JOINT COMPRESSION,
    6 10x to the shoulders, elbows, wrists, hips,
    knees, ankles, and sometimes fingers and feet.
    AVOID ALL LIGHT TOUCH. No brief touch or light
    brushing is used
  • Joint compression to the shoulders, elbows and
    wrists may be substituted with pushing the palms
    of the hands together or pushing against a wall
    (wall push-up). Joint compression to the hips,
    knees, ankles and toes may be substituted with
    jumping. Be sure to have the child land flat on
    feet versus toes
  • DO NOT brush the stomach, head, neck, face or
    chest

44
Deep Pressure Brushing and Joint Compression
Protocol
  • When Brushing has an effect on the nervous
    system for 90 minutes to 2 hours. Often times it
    is used the first thing in the morning, before
    school, before a specific concentrated task and
    before going out to stimulating environments.
    Brushing and joint compressions can be repeated
    every two hours.
  • PRECAUTIONS
  • Skip over any sores, cuts, rashes, etc.
  • Never brush the stomach, head, neck, face and
    chest
  • Report any unexpected responses
  • Consider joint problems with the joint
    compressions
  • NEVER BRUSH A CHILD UNDER 2 MONTHS OF AGE

45
Mirror Neuron Systems
  • New Research

46
Mirror Neuron Systems
  • Specific subsets of neurons (called Mirror
    Neurons) are activated when an individual
    performs certain actions
  • These same neurons activate when the individual
    observes others performing the same movements
  • Implication mirror neurons provide a direct
    internal experience and therefore understanding,
    of another persons act, intention or emotion
    (Rizzolatti, et al., 2006 pg. 58)
  • Intention of an action is significant factor in
    which mirror neurons (specific to different areas
    of the brain) are fired
  • Mirror neurons respond strongly to the intention
    of an act
  • Ex. Monkeys action of grasping depending on
    final goal, mirror neurons fire differently (more
    strongly to understood goal)

47
Mirror Neuron Systems
  • Emotions
  • Disgust
  • Ex. when observing disgust on the face of someone
    else mirror neurons in the anterior insula are
    activated
  • The observer and the observed share a neural
    mechanism that enable a form of direct
    experiential understanding
  • This may represent a physical neural mechanism
    for empathy that permits the understanding of
    emotions in others
  • Pain
  • Ex. When feeling pain or witnessing pain in
    others, the anterior insula and anterior cingular
    cortex mirror neurons activate
  • This may provide a neural basis for interpersonal
    relationships on which more complex social
    behaviors are built allowing us to empathize
    with others

48
Autism and Mirror Neuron Systems
  • Mirror neurons may be involved in empathy and the
    perception of another individuals intentions
  • Mirror neurons are involved in the interpretation
    of complex intentions
  • Inferior Frontal Gyrus (movement guidance and
    assessment of intentions of others)
  • Mirror neurons allow our brain to mentally
    simulate others actions
  • Individuals with Autism have dysfunctional mirror
    neuron systems
  • Mu WAVE suppression on EEG in premotor cortex

49
Autism and Mirror Neuron Systems
  • Characteristics of Autism that may be explained
    by dysfunction in the mirror neuron system
  • Characteristics
  • Deficit in ability to construct a theory of
    other minds (Frith Baron Cohen) Empathy
  • Difficulty imitating others
  • Dysfunction in mirror neurons of the Anterior
    Cingulate Cortex (regulation of empathy and other
    emotions)
  • Difficulty interpreting metaphors
  • Requires cross domain mapping (Angular Gyrus)
  • Bouba / Kiki Test

50
Autism and Mirror Neuron Systems
51
Autism and Mirror Neuron Systems
  • The limbic system triggers the autonomic nervous
    system preparing the body for action
  • Ex. Fear heart rate increases and body sweats
  • The ANS arousal in turn provides the brain with
    feedback amplifying the emotional response thus
    creating an emotional map of the emotional
    significance of the individuals environment
    (Salience Landscape Theory Ramachandran
    Oberman, 2006)
  • Individuals with autism may have a distorted
    salience landscape
  • Distorted perceptions of emotional significance
    may explain
  • Inappropriate social responses to events
  • Intense preoccupation with ex. train schedules
  • Looking away during normal conversation to reduce
    stress
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