CONTEMPORARY SENSORIMOTOR APPROACHES
then train first
Motor Relearning Program (1990)
● Janet Carr and Roberta Shepard
● Contemporary approach (1990s)
● Uses dynamical systems model of motor control
● Emphasize interaction between performer and
environment
o Focuses on the environment
● Does not accept the hierarchical sequence of motor
relearning proposed by other theorists
o Not developmental
● Discourage the early use of compensatory strategies
● Most logical approach
● Clients taught to avoid abnormal compensation for
weak muscles
● Treatment techniques based on extensive study of
how normal movement occurs during functional
tasks
● Acknowledge critical role of cognition in motor
learning
● Movement patterns practiced in context of tasks,
rather than exercises
o Should be based on a certain task or context
o Mas matututo yung client
o Uses real/everyday items to practice specific
occupation
● Categories of functional daily activities –
combination of these done to carry out day to day
activities
o Upper limb function
o Orofacial function
o Sitting up over the side of the bed
o Balanced sitting
o Standing up and sitting down
o Balanced standing
o Walking
Motor Relearning Program Steps
1) Analysis of function
● Di naman pwede mag exercise or treat agad
● Substeps:
o Placing the client in optimal position to
encourage muscle activation
o Compare the client’s performance to
normal movements
▪ Is there a difference?
▪ To watch out what you are
looking for
▪ Kapag ba nag-reach ng glass
on the table, elbow lang ang
nagalaw or iba na ngayon kasi
nalapit trunk niya sa glass?
o Analyze missing components
(anatomical, biomechanical,
physiological, behavioral)
▪ Anong ROM kulang
▪ Anong muscles ang problematic
▪ Analyze pa lang ito
o Select the most essential to the activity
2) Practice of missing components and activity
● Substeps:
o Explanation and demonstration of
component
▪ Avoid abnormal movements
▪ Baka di alam ni client mali yung
ginagawa niya (ex.
nagcocompensate na pala siya)
▪ “try po iwasan na buong trunk
yung gagalaw, elbow lang po
ang dapat, tutulungan ko po
kayo” (dapat alam niya yung
dapat niyang galawin)
▪ Client should be aware of
movements (compensatory,
etc.)
o Gains visual feedback by paying
attention first to his movements
▪ Look at self in the mirror
o Verbal feedback (brief, relevant,
concise) is given before and after
performance
▪ Feedback kung nagawa ba
yung need niya gawin
o Common errors are checked
o Manual guidance or physical monitoring
is done throughout the performance
▪ Handle client para mas matuto
siya
▪ Train to what normal movement
is
3) Transference of learning
● Not only confined in the clinic/hospital, ​dapat
alam niya in diff contexts
● Substep:
o Practice under various environmental
and task conditions
▪ Matransfer in different contexts,
bahay muna, practice sa door,
cabinet door, and ref door tapos
lalabas na-door sa mall and
public restroom
Transition from Motor Control to Motor Learning
● Began in the 1990s with classic article by
Mathiowetz & Bass Haugen, and Trombly’s Slagle
Lecture
o Meron siya magagawa sa motor control na
nagain niya and maapply niya in different
contexts
o Motor control-magawa lang. SO WHAT?
o Motor learning-apply na sa envi/context
● The following introduces Trombly’s model as
changing OT’s thinking about establishing or
restoring voluntary movement
Task Focused Approach
● Occupational Functioning Model – introduced in
1995
● Goal is to develop competency and self-esteem
● Context & environment surround and permeate all
levels of the hierarchy
● When clients have mastered foundation capacities,
they move on to task-focused interventions
(individual or group)
o Same principle lang ni MRP, pero mag
application lang
o Dapat functional
o Context/envi is not separated from the
person
o Should have a holistic viewpoint
● Trombly calls this “occupation as end”
o Nagagawa niya occupation niya

Task Focused Approach Five general principles

1. Client-centered
2. Occupation-based
3. Person and environment – enablers/barriers
4. Practice and feedback – encoding
5. General treatment goals – role fulfillment,
problem-solving skills

Dynamical Systems Theory

● Applied to physical disabilities, this theory combines
reflexive and voluntary motor control
● CNS receives/interprets multiple cues from the
environment and involves multiple subsystems when
planning to reach desired goals (preferred tasks &
roles)
● Occupational performance is a product of the
interaction between the person, the task, and
multiple environmental factors
● Based on theories of motor learning and dynamical
systems theory
● Meaningful tasks are graded and sequenced
according to each client’s needs and abilities
o OTs should facilitate function
o Para di redundant with PT services, majority
unang natatanggal ay OT kesa PT
o Preparatory tasks/methods wag matagal.
Hindi lang hanggang theraputty lang ang
gagawin. To prep lang yun.
o Dapat occupations pa rin talaga. Practice
magsampay ng damit, magpintura,
magplantsa, etc.
● What could be the best strategy to use/utilize
● Each task requires experimentation using different
strategies and contexts in order for motor skills to be
learned
● Currently the preferred approach in OT for
intervention after stroke/CNS damage