OTAP 2124:
OCCUPATIONAL THERAPY APPLIED TO PEDIATRIC
MOTOR CONTROL
LEARNING OUTCOME 01 Describe motor
control/ learning
theories and
motor control 02 Discuss
challenges for occupational
children with therapy motor
movement learning 03 Perform skills in
dysfunction strategies motor learning
strategies and
motor control
intervention
LO1:Describe motor control/ learning
theories and motor control challenges for
children with movement dysfunction
Motor Control??
How body directs environment
How musculoskeletal system interacts to
carry out movements
How CNS organizes movement
How we quantify movement and
nature of movement
Motor Learning??
Strategies and techniques to
teach others to move
Process, conditions and rate
in which a person learns
motor skills
DYNAMIC PERSON
Cognitive
SYSTEM Musculoskeletal
Sensory
THEORY Perceptual
Social-emotional
ENVIRONMENT
Movement derives Contexts
Physical
TASK
from variety of Nature of task Terrain, light, novelty
Goals Social
sources Rules Familiar/ unfamiliar
Object properties Expectations
Type Cultural
Within natural & Size Values, beliefs
Shape Virtual
meaningful contexts Texture Temporal
Personal
PRINCIPLES OF
DYNAMIC SYSTEM THEORY
Motor performance Dysfunction Modify and adapt
Adapatable + Movement pattern the requirement and
Flexible system unmet environmental affordance of task
& task demands
Motor actions: Result of New movement
1. Order perturbation pattern= Change in
parameters = Shifting to new control parameter
2. Control behavioral pattern
parameters
GIBSON’S ECOLOGICAL THEORY
ECOLOGICAL (1969)
THEORY • Ability to control
Utilizes functional Agency through own action
approach
• Predictive component of
Examines the purpose Prospectivity actions
of perception in every
day activities
• Transfer strategies/
Flexibility skills to another context
PRINCIPLES OF
ECOLOGICAL THEORY
Goals are motivated
Children are and motor actions Motor actions are
sensitive to and are geared to guided by
perceive information serves these goals perception-action
information
Interaction involves
active perception: Use exploratory
1. Exploratoray movements to seek
action information to plan
2. Performatory motor actions
action
FACTORS INFLUENCING???
Cognition Perception
• Attention
• Motivation
PERSON • Body schema
• Body awareness
• Problem-solving • Body image
• Self-efficacy
Musculoskeletal Social-emotional
• Muscle tone • Positive feelings
• Strength • Negative emotions
• Posture.
• Symmetrical
• Muscular structure
Sensory
Body schema Body awareness Body image
BODY SCHEMA
CONCEPT OF
Internal External
Reflective self-awareness
Laterality
Sensory dominance
Body part identification
Right-left discrimination Directionality
Spatial orientation of body
Body to objects
Objects to objects
FACTORS INFLUENCING???
Nature Objects
• Simple TASK • Size
• Complex (OCCUPATION) • Shape
• Open task • Weight
• Closed task • Texture
• Sensory aspects
Goals Rules
FACTORS INFLUENCING???
Physical ENVIRONMENT Social
Cultural Virtual
Temporal Personal
MOTOR CONTROL CHALLENGES
• Typical muscle tone
• Impaired muscle activation
• Impaired timing, sequencing & scaling of forces in motor execution
• Excessive overflow of intralimb & interlimb contractions
• Insufficient force generation
• Impaired anticipatory postural control
• Dissociated movement
• Sensory processing impairment
• Secondary impairment in neuromuscular & musculoskeletal systems
MOTOR CONTROL CHALLENGES
Timing & sequencing
deficits
Movement not smooth, coordinated
and interfere with everyday
Poor postural
functioning (Meunks et al.,
control
2018)
SI dysfunction & Difficulty with
DCD flexible movement
Slow reaction time
response
Interfere accuracy and quality of
movements e.g. child with
Difficulty to carry handwriting problems(Zwicker et
Need to correct/ Difficulty with
out effective, timely al., 2018)
repeat motor actions sensory perceptual
& accurate motor
to accomplish task function
actions
MOTOR CONTROL CHALLENGES
Poor integration of
information for motor
planning
ASD
Increase variability in in
sensory input & motor output
MOTOR CONTROL CHALLENGES
• Down syndrome.
By Boot et al. (2012)
Poor timing
Decrease strength
Decrease postural control
Delayed visual orientation
MOTOR CONTROL CHALLENGES
Postural control
Neuromuscular & Motor deficits
difficulties
sensory impairments
CP child
Interfere voluntary
muscle control
Abnormal muscle
tone & spasticity
Impaired muscle
coactivation, causing
coordination
challenge
Motor planning
Sensory impairments
challenge
LO2: Discuss occupational therapy motor
learning strategies
KEYWORDS
Neurodevelopmental Approach Meaning,whole-task training,
(handling, qualities of touch, part-task training, variability
preparation,
facilitation and inhibition
CIMT (Constraint Induced
Movement Therapy
Transfer of learning &
Practice levels (massed
practice, distributed practice
and random practice)
Positioning & adaptive
equipment
NEURODEVELOPMENTAL APPROACH
• Margaret Rood proposed the use of sensory stimulation to
facilitate muscles for movement
Brushing, stroking, joint compression, tapping, proprioceptive
pressure
• Activities such as slow rocking & sustain pressure used to
inhibit muscle tone
• Used other senses (e.g. visual and auditory) to stimulate
responds
MEANING, WHOLE-TASK TRAINING,
PART-TASK TRAINING & VARIABILITY
• Meaning:
OT viewed essential of meaningfulness in activities
More motivated to engage in difficult motor skills when child find
it as:
Participate for longer periods; perform more repetitions; with
better quality of movement
Can be determine through semistructured interviews
Pediatric Volitional Questionnaire, Test of Playfulness, COSA
MEANING, WHOLE-TASK TRAINING, PART-TASK
TRAINING & VARIABILITY
• Whole-task training:
Facilitate multiple systems and interactions
Performed more efficiently with better coordination
than only part of movement (Emanuel et al., 2008)
More brain activation (Klinberg et al, 2013)
Goal of intervention: To promote variability &
flexibility in movement through whole training
MEANING, WHOLE-TASK TRAINING, PART-TASK
TRAINING & VARIABILITY
• Part-task training:
To enhance learning that require multiple difficult
task
Shaping child’s ability to perform a task
Usually starts with learning the final step of task
MEANING, WHOLE-TASK TRAINING, PART-TASK
TRAINING & VARIABILITY
• Variability:
Inherent in activity as well as within and between systems
Movement in variety of context + need of child to adapt to
environmental changes
Expectation of interventions:
Perform movements in variety of ways vs repeat & learning one
pattern of movement
Requires problem solve & self-corect
TRANSFER OF LEARNING &
PRACTICE LEVELS
• Generalization; apply learning to new
situations
• Goal of intervention:
Transfer learning performed in the clinic/
intervention setting to natural context
• Best able to transfer motor skills
Practice in ‘real world’ situation (natural
context)
• OT recognizes motor skills with similar
components more likely to transfer
TRANSFER OF LEARNING &
PRACTICE LEVELS
Massed Practice Distributed Variable/ Random
(blocked) Practice Practice
• Rest>Trial time • Repeat same
• Period perform> patterns, but
Rest period make small
• When child begin changes as
to learn necessary
• Increase
adaptation &
generalization
CONSTRAINT-INDUCED MOVEMENT THERAPY (CIMT)
• Unilateral motor weakness
• 3 elements:
1. Restraint stronger unaffected UE
2. Task-oriented mass practice of specific motor
activities
3. Shaping of more mature movement
• For at least 2 consecutive weeks by a professional
(Kolobe et al., 2014)
POSITIONING & ADAPTIVE EQUIPMENT
Improving balance
Secondary
Primary Components: Components:
1. Body movement 1. Position of body
2. Use of vision 2. Internal base of
3. External base of support
support 3. Elevation
POSITIONING & ADAPTIVE EQUIPMENT
Improving balance
(Primary components)
1. Body movement 2. Use of vision
Maintain balance in When visual information is 3. External base of support
static/ dynamic available Structure of environment
E.g. E.g. in variety ways to
Sitting in one position Balance with vision & challenge balance
(static) vision occluded E.g.
Sitting on unstable Varying kind of distortion Wide to narrow
surface such as on gym of visual information Stable to unstable
ball with playing (e.g. wearing googles, Flat to tilted or inclined
catch/throw ball blocking
POSITIONING & ADAPTIVE EQUIPMENT
Improving balance
(Secondary components)
1. Position of body
Alignment of different 2. Internal base of support
3. Elevation
parts of body Modifications in the
Element of height is
E.g. internal BOS that
added
upright position challenging balance
E.g.
trunk flexed forward E.g.
balancing on large, very
arm extended in front balance on 1 foot, knee
stable box of different
hands on hips and a hand or one foot
height
arms overhead and a knee
any combination
LO3: Perform skills in motor learning
strategies and motor control intervention
INTERVENTIONS
• Head and trunk control
• Righting reactions
• Equilibrium reactions
• Protective reactions
INTERVENTIONS
• Head control stimulation
Put the child in prone position on wedges.
Stimulate the posterior part of neck.
At the same time, use rattles as stimulation for the child to lift
his/her head up.
INTERVENTIONS
• Trunk control stimulation
Put the child in sitting position. Provide support or corner chair if
needed.
Stimulate the child to sit in upright position. Hold his/her back/hip
to support if needed.
Use toys to encourage him/her to play in sitting position
INTERVENTIONS
• Balance reaction
Put the child on gym ball in sitting position.
Roll the ball to left and right to stimulate the righting and
equilibrium reaction.
Put the child on gym ball in prone position.
Provide support by holding his/her leg or buttock.
Push him/her forward and backward and sideways to stimulate the
protective reaction.
CONCLUSION
• Motor control is essential in occupational participation
of child
• Multiple systems interact to influence movement
• Engaging children in whole, meaningful tasks in a
supportive natural environment promotes brain
plasticity
REFERNCES
• Case-Smith, J., & O'Brien, J. C. (2020). Occupational therapy for children and
adolescents. Elsevier
• Levin, M. F., & Demers, M. (2021). Motor learning in neurological rehabilitation.
Disability and rehabilitation, 43(24), 3445-3453.
• Muenks, K., Wigfield, A., & Eccles, J. S. (2018). I can do this! The development and
calibration of children’s expectations for success and competence beliefs. Developmental
Review, 48, 24-39.
• Sadowska, M., Sarecka-Hujar, B., & Kopyta, I. (2020). Cerebral Palsy: Current Opinions
on Definition, Epidemiology, Risk Factors, Classification and Treatment Options.
Neuropsychiatric disease and treatment, 16, 1505–1518
• Zwicker, J. G., Suto, M., Harris, S. R., Vlasakova, N., & Missiuna, C. (2018).
Developmental coordination disorder is more than a motor problem: Children describe the
impact of daily struggles on their quality of life. British journal of occupational therapy,
81(2), 65-73.
