1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 54 Motor Function and Occupational Performance Glen Gillen

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives 1.Understand how motor function supports occupational performance throughout the life course 2.Explain how impairments related to motor function limit occupational performance across the life course 3.Compare and contrast the approaches that are used to guide the occupational therapy process related to improving occupational performance for those with motor impairments 4.Become familiar with assessments that are used to measure motor function across the life course 5.Begin to construct evidence-based intervention plans that improve occupational performance for those living with motor impairments

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Motor Function and Everyday Living Case examples: Jacob: An 8-year-old boy with a hemiparetic right upper limb secondary to cerebral palsy. Samuel: A new dad with a full thickness rotator cuff tear.

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Biomechanical Approach Based on several assumptions: –the underlying impairment is amenable to remediation; –engagement in occupation and various other therapeutic activities has the potential to remediate the underlying impairment(s); and –this remediation will result in improved occupational performance

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Approaches for Those With Decreased Motor Function –weakness; –limitations in joint range of motion; –edema; –pain –low endurance; –sensory changes, –joint instability, –poor coordination, etc.. Biomechanical Approach: Focused on remediation of impairments such as:

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Approaches for Those With Decreased Motor Function Rehabilitation Approach: includes the concepts of adaptation, compensation, and environmental modification This approach places an emphasis on the client’s strengths as opposed to their limitations. The ultimate goal is to maximize independence despite the presence of persistent impairments May be most appropriate for impairments that are permanent, when a client is not motivated for remediation, or contextual factors such as limited therapy visits.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Approaches for Those With Decreased Motor Function Task Oriented Approaches: also described as task- specific training, repetitive task practice, goal-directed training, and functional task practice, are considered the most current approach related to impaired motor function and motor control for those living with brain damage Examples include a wide range of interventions such as walking training on the ground, circuit training, sit-to-stand practice, and reaching tasks for improving balance. A major focus of task-oriented training is on arm training using functional tasks such as grasping objects,and CIMT

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Approaches for Those With Decreased Motor Function Motor Relearning Program is specific to the rehabilitation of patients following stroke. In this program, treatment is directed toward relearning of control rather than to activities incorporating exercise or to facilitation or inhibition techniques The program is based on four factors (1) elimination of unnecessary muscle activity, (2) feedback, (3) practice, and (4) the interrelationship of postural adjustment and movement

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Approaches for Those With Decreased Motor Function Occupational Therapy Task Oriented Approach: is based on current understandings of motor control, recovery and development as well as contemporary motor learning principles Assumptions: functional tasks help organize behavior, systems are heterarchically organized, occupational performance emerges from the interaction of persons and their environment, experimentation with various strategies leads to optimal solutions to motor problems, recovery is variable, and behavioral changes reflect attempts to compensate and to achieve task performance

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Motor Learning “a set of processes associated with practice or experience leading to relatively permanent changes in the capability for skilled movement” (Schmidt & Lee, 2011, p. 327) Stages: 1) Cognitive 2) Fixation 3) Autonomous

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Motor Learning Principles Classification of tasks: discrete, continuous, serial, open, closed, variable motionless, and consistent motion tasks Practice conditions: massed, distributed, blocked, random/variable, whole, and part practice Feedback: inherent/intrinsic, augmented, concurrent, terminal, immediate, delayed, knowledge of results, and knowledge of performance

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins J. Sabari, 2011

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

14. Categories of Assessment Developmental Assessments Neurological Screenings Self-Report Methods Assessments of Limb Function Assessments of Postural Control Assessments Performed in Natural Contexts

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Examples of Evidence-Based Interventions Constraint-Induced Movement Therapy Bilateral Arm Training/Bimanual Training Cognitive Strategies to Improve Performance Postural Control/Balance Interventions Physical Agent Modalities

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Conclusion Motor function and control is a multifaceted concept that relies on multiple body structures and functions, performance skills, etc. Successful rehabilitation is based on the adoption of a clear therapeutic approach or approaches; the interpretation of standardized, valid, and reliable assessments; and the adoption of evidence-based interventions