Types of movement
Movement can generally be divided into three main categories: reflexive movement, random movement and rhythmic.
(I) Reflexive movement
Reflexive movement is the simplest and most basic movement, usually caused by specific sensory stimuli, and the resulting movement has a stereotyped trajectory. The most important feature of reflexive movement is that it is not controlled by will. When a specific stimulus appears, the reflex occurs “automatically” and its strength varies according to the size of the stimulus and cannot be changed at will. Ma Xiaolei, Department of Rehabilitation Medicine, Henan Provincial People’s Hospital
(B) Random movement
Random movement is usually a movement directed to a certain goal in order to achieve a certain purpose, either in response to a sensory stimulus or due to subjective will. In contrast to reflexive movements, the direction, trajectory, speed, and duration of such movements can be chosen at will and can be changed at will during the execution of the movement. The vast majority of complex random movements require repeated practice to perfect and mastery.
(C) rhythmic movement
Rhythmic movement between the reflexive movement and random movement, for example: breathing, chewing, walking, etc.. These movements can start or end at will, and once started, they no longer require conscious participation and can be repeated automatically. Most of these movements can be regulated by sensory information during performance.
Basic motor components
The “components” of motor relearning originally referred to visible joint movements, and the “basic components” listed for each task are in fact these movements. Thus, these basic components form the baseline for normal patient performance. A “component” can be a group of muscles (e.g., quadriceps) or a spatial-temporal relationship between muscles in a particular concerted movement
Motor skills (dexterity)
Movement is divided into low-level and high-level movements
Low-level movement is the movement that you are born with, such as visceral movement, eye movement, and limb movement, while high-level movement is a complex process that is not innate, but acquired through learning, such as dressing, writing, walking, and various sports.
The motor skills we are talking about are advanced movements, acquired through acquired learning, motor skills are formed through practice, control of the execution of the movement, the way of action required by the law; should be able to make the activity more effective and better organized; motor skills are created through the functional synergy of the components of the movement composition, when these motor components are linked in the appropriate spatio-temporal sequence, it completes the controlled motor operations (certain components are called biomechanical elements); characterized by the ability to demonstrate rapid, precise, fluid and skillful movement, which is repeated, systematic practice and becomes automatic, and thus becomes proficient.
Classification of motor skills
There are various ways of classifying motor skills; one is to classify them into 3 types of movement: separate movement, series of movement, and continuous movement according to the process of movement.
Another classification method is to describe the skills according to the predictability of the environment, divided into closed skill movement and open skill movement.
1.Discrete movement
There is a clear beginning and end, and the movement can be relatively quick, such as putting the hand to the mouth, or it can take a longer time, such as sitting at a table and writing. Regardless of the above, the completion of the movement is certain. Separate movement often represents a functional movement component, and therefore, can be seen as a movement-oriented movement.
2.Serial motion (serial task)
A series of separate movements is required to achieve a certain result, therefore, it is characterized by an increase in the difficulty and complexity of the movement. For example, brushing the teeth, this functional activity requires opening the toothpaste cap, squeezing the toothpaste onto the toothbrush, and then putting the toothbrush into the mouth to brush the teeth. The functional outcome of this sequential activity is brushing the teeth and, therefore, can be seen as an action-oriented activity. The sequence of actions in the sequence of movements is the key to the success of the functional outcome.
3.Continuous movement
It is a movement that does not have a clear beginning and end. Movement continues to occur until the action stops, and is therefore the opposite of detached movement. For example, walking, bicycling, pushing a wheelchair. These activities require different levels of skill to complete, but do not represent a movement broken down into several small motor components (as in detached movement). Sequential movements often require interaction with the environment to achieve certain outcomes and are therefore considered more complex than sequential movements.
Closed skill movement (closed skill)
is a movement that is accomplished in a predictable environment. Because the environment is relatively stable and unchanging, the skill of the movement is more habitual in character and the skill to be developed by the individual is what can repeat the movement.
Open skill movement (open skill)
In contrast to closed skill movement, the environment in open skill movement changes frequently, which requires the individual to respond to the changing environment. The individual must develop skills in the process of completing the movement and have the ability to anticipate or adjust the movement under different conditions. The ability to quickly adapt to environmental changes is necessary for the formation of open-ended skills.
Open and closed skill movements represent a continuum of movement. Because function must adapt to changes in the environment, functional skill movement has more of the nature of open skill movement in this continuum.
Motor Learning Stages
The process by which more mature learners acquire motor skills can be summarized in the following 3 stages.
(i) Cognitive stage
(ii) Connective stage
(iii) Autonomy stage
Human biomechanics
Kinematics —- is used to describe movement itself without regard to forces
— Linear and angular shifts
— linear and angular velocities
–Linear and angular acceleration
–paths, trajectories of body parts
Kinetics —- refers to the activity that we can observe caused by endogenous and exogenous forces
— Ground reaction forces
— moments of the joints
–Mechanical forces
–Energy
Electromyography —- has a quantitative understanding of the mechanics of muscles
Four steps of the motor relearning program
The sequential arrangement of the parts is irrelevant and has no coherent meaning with each other. The therapist selects the most suitable part to start the training according to the specific problems present in the patient, and each part is divided into four steps.
1.Analysis Assignment
Using the basic components as a model or framework for analysis, observe, compare and analyze the kinematic, kinetic, neurological and muscular aspects to find out the missing components and the problems.
2. Exercise the lost components (decomposed exercises or partial exercises)
Aiming at the lost motor components of the patient, the lost motor functions are restored through concise explanations and instructions, repeated exercises, and with verbal and visual feedback and manual guidance.
3.Practice work (overall practice or functional, task-oriented training)
Combining the acquired motor components with normal functional activities, the abnormalities are constantly corrected in different environments to gradually normalize them.
4.Transfer of training
Practice the acquired motor functions in a real-life environment to become continuously proficient.
Motor relearning training guidance
— Soft tissue stretching
–Induced muscle activity (decomposition of the lost components of the exercise)
–holistic exercises (practice work)
–Muscle training (intensive training)
–Optimizing technique (increasing skill, difficulty, flexibility, complexity)
Upper limb function basically consists of two groups of activities: reaching objects and manipulation (grasping, releasing, manipulating)
–grasping and releasing different objects
–Arms grasp and release different objects in different positions on the body
–Moving objects from one place to another
–Turning objects within the hand
-Use various tools for specific purposes
–Reaching in different directions
–Hands operate simultaneously
Basic components of the upper limb and hand
Although the function of the upper limb is complex, it is still possible to identify its basic motor components
components, i.e., when they are activated, they can perform many different activities.
First, the patient activates these basic components, and then in specific synergistic movements required for specific operations
and other musculo-articular combinations.
Combining with other muscles and joints in specific synergistic movements.
Basic components of the shoulder and arm
Motor relearning places more emphasis on functional, task-oriented exercises, and integration with the environment.
Normal function of the upper limbs (arm and hand)
The main function of the arm is to place the hand in the proper position for manipulation and the main components are.
–shoulder abduction
–Forward flexion of the shoulder joint
–posterior extension of the shoulder joint
-Elbow flexion and extension
–Concomitant shoulder girdle motion and glenoid o joint rotation
Basic components of hand function
The main function of the hand is to grasp, release and manipulate objects for certain purposes.
1, Flexion lateral deviation with wrist extension
2.Extension and flexion of the wrist while holding an object
3.Palmar abduction and rotation of the carpometacarpal joint of the thumb
4.Flexion of each finger combined with rotation of the thumb
5.Metacarpophalangeal joint flexion and extension when the interphalangeal joint is slightly flexed
6.Forearm rotation forward and backward when holding an object in the hand
Analysis of upper extremity function
Common problems and typical adaptive movement patterns
1. The upper part of the body is flexed at the hip instead of the shoulder joint when reaching for an object within the length of the upper limb. (This movement decreases as shoulder flexion improves.)
2.When reaching objects forward: shoulder girdle lift, lateral spinal flexion, shoulder abduction with elbow flexion, shoulder internal rotation and forearm rotation forward.
3.When releasing the object: extension of the fingers with wrist flexion due to contracture of the long finger flexors and weak wrist extension muscles, the thumb is extended at the wrist
The thumb extends at the metacarpophalangeal joint instead of abducting at the carpometacarpal joint. As in the above figure.
4, Pre-grip: In order to grip, the hand is over-extended to compensate for potential inaccuracies.
5, Grasp: flexor force is excessive to compensate for poor control. Below
6, Habitual use of the healthy limb when active movement is possible, resulting in “learned disuse”.
7, Habitual posture of the affected limb causes adaptive soft tissue length-related changes, including loss of muscle extensibility and increased stiffness.
8, Joint pain and stiffness.
9, Other problems. As shown.
–Positioning the hand on a wall or table or sitting on a bed for brief or continuous unassisted stretching (long finger flexors, wrist flexors, thumb adductors)
–Place the forearm on the table and press the palmar side of the thumb at the carpometacarpal joint to stretch (forearm rotators)
–Sitting or supine hand behind the head, seated upper extremity on the table, short or continuous stretching. (glenohumeral adductors and internal rotators)
–Special splint (continuous stretching of thumb adductors, finger pads)
–Continuous stretching of the anterior rotators of the forearm
Evoked muscle activity
1.Electrical stimulation
2.myoelectric biofeedback
3.Promotional techniques
4.Imagery training
5.Active training to induce muscle activity
Active training to induce shoulder and elbow muscle activity
Evoking wrist and hand muscle activity
-Training wrist extension
-Training posterior rotation
-Training thumb abduction and rotation (opposite palm)
-Training flexor side and ulnar side of the hand relative to each other (opposite finger)
Reaching objects and balance training
Plyometric training
-Progressive resistance method
–stretch band
–Hand grasping of heavy objects for manipulation
Strength training does not increase spasticity
Manipulation and dexterity training
to increase speed and accuracy and improve motor skills
Bimanual training
Two-handed training should be started once the patient has the ability to control simple activities with the affected limb.
— Two-handed exercise activities can regain chronological coordination between the hands of both upper extremities
— Two-handed exercises can practice clumsy inflexibility when using the healthy hand (due to brain injury affecting the ipsilateral pathway)
–Bicycle-like exercises for the upper limbs
–Pushing the wall
–Pushing water from water bottle to cup to bottle
–From glass bottle to glass bottle
–folding towels
–Winding a crank pin
–Changing coins to the other hand
–Tap on keyboard
–Take a newspaper and turn the pages
–Reaching a box in the cupboard
–Walking with a two-handed tray or glass
Exercise requirements
–Training in meaningful activities of sufficient intensity
–Concrete work activity training rather than abstract and empty training
–Repetition
Balance
The concept of balance
–Ability to maintain posture (static balance)
–the ability to automatically adjust posture regardless of the activity or task in which one is involved (self-dynamic balance)
–the ability to react quickly and appropriately when subjected to external forces (expected or unanticipated by oneself) (other dynamic balance)
Balance is idiosyncratic
–Related to the environment and the task
Factors that influence balance
–Muscle tone –Muscle strength –Sensation
-Integration of the brain -Skeletal muscle system -Interactive innervation
Seated balance body alignment : –
–Feet and knees a few centimeters apart
–Equal weight distribution
–Flexion of both hips, shoulders directly above both hips
–Trunk extension
–Balancing the head on the horizontal shoulders
Competencies that should be present in seated balance (essential components)
–Prepared postural adjustment
–Continuous postural adjustment during movement
Standing balance Essential components of alignment.
–Feet a few inches apart
–Hips in front of the ankle
–Shoulders square to hips
–Head balanced on the horizontal shoulder
–Torso upright
Abilities to have
–Preparatory postural adjustments
–Continuous postural adjustments
Balance common temporal and spatial adaptations
Change in support surface (sitting, standing, walking and other activities)
–Wide support surface (as shown)
-Inappropriate strides
–Non-exertion of the affected leg (as shown)
Restriction of body movement
–Stiffening of the body as the body changes alignment (as shown)
–slow movement
–Shifts in body segment alignment to avoid large shifts in weight (postural alignment)
Inadequate) (as shown)
-Standing forward, reaching sideways, reaching sideways in a seated position, standing, and not stepping when necessary
–Support with hands
–Grabbing support, grasping
Training instruction
Soft tissue stretching
–Gastrocnemius, Flounder, Hip flexors
Evoked muscle contraction
–Hip alignment training
–Evoked quadriceps contraction
–Induced active foot dorsiflexion
Practice sitting balance
1.Help to sit up from the bedside
2.Motion of head and trunk
–sitting position (training as shown)
3.Reaching for objects movement
–sitting position (training as shown)
4.Optimization skills
–Increase the moving distance
–Change the speed
–move direction
–reduce leg support
–Increase the weight of the object, volume to engage both upper limbs
–Increase the external time limit. Such as catching or slapping a ball
Standing balance
Importance of early standing
–Prevent or reduce unilateral spatial neglect
–Enhance spatial position awareness and kinesthetic awareness
–Reducing spasticity
–Preventing contractures
–Improve level of alertness
–Increases active awareness and self-confidence
–Aids bladder control
Practice standing balance
1. Head and body movements
–Standing position, the patient stands with weight on both feet and extends the hip joints
–Standing position, feet a few centimeters apart, head looking up, left, right and back
2.Reaching for objects training
–Standing, forward, lateral (bilateral), backward, reaching exercises
3.One-legged support
–Healthy side of the limb to take a step forward
–Affected side of the limb to take a step forward
–Practice reaching objects
4.Lateral walking
5.Pick up objects
6.Optimization techniques
(1) Reaching and picking up objects practice
Environment
–Change the support surface (width, front and back, height), stand on one foot
–Distance and proximity of objects
Task aspects
–The weight of the object, the change of volume, two-handed, etc.
–Different speeds
–Unpredictable occurrences
(2) Stride training
–Shifting of weight on both sides (front and back, left and right)
–Moving up high steps
–step to the mark on the ground
–Place the affected foot on the ball
(3) Increase the activities that require quick reaction time
–catching the ball, tapping the ball, throwing the ball
(4) Introduce complexity and non-inevitability into the environment
–Crossing obstacles of different sizes
–Complex terrain and roads
Plyometric exercises
–Stepping exercises
Stepping up: in front and to the side. Stepping down: performed under suspension weight reduction if necessary
–heel lift and drop
–Unweighted exercises
motomed exercises, quadriceps trainer