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