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7.2 Motor Learning Principles & Neurodevelopmental Approaches

Key Takeaways

  • Motor learning progresses through three distinct phases defined by Fitts and Posner: Cognitive (conscious, high attentional demand, reliant on extrinsic visual feedback), Associative (refinement of motor patterns, proprioceptive integration, self-correction), and Autonomous (automatic, dual-task execution, intrinsic feedback).
  • Motor practice schedules significantly impact skill acquisition versus long-term retention: Blocked practice facilitates initial cognitive performance, whereas Random and Variable practice foster superior contextual interference, retention, and motor transfer to novel real-world environments.
  • Neurodevelopmental Treatment (NDT/Bobath) emphasizes normalizing muscle tone, inhibiting abnormal synergistic and reflex patterns, establishing symmetrical postural alignment, and utilizing proximal and distal Key Points of Control during dynamic handling.
  • Proprioceptive Neuromuscular Facilitation (PNF) employs diagonal and spiral patterns (D1 Flexion/Extension, D2 Flexion/Extension) paired with specialized neurophysiological techniques (Rhythmic Initiation, Contract-Relax, Hold-Relax, Slow Reversal, Rhythmic Stabilization) to enhance functional motor output.
  • Brunnstrom outlines 6 sequential motor recovery stages post-stroke (from Stage 1 Flaccidity to Stage 6 Isolated Movement), while the Rood Sensorimotor Approach utilizes developmental motor stages alongside specific sensory facilitation (quick stretch, tapping, vibration) and inhibitory techniques (sustained stretch, neutral warmth, slow rocking).
Last updated: August 2026

Motor Learning Principles & Neurodevelopmental Approaches

Motor rehabilitation in occupational therapy addresses sensorimotor impairments resulting from central nervous system (CNS) lesions, including Cerebrovascular Accidents (CVA), Traumatic Brain Injury (TBI), cerebral palsy, and progressive neurological conditions. Clinical practice bridges modern Motor Learning Theories—grounded in cognitive science, task dynamics, and experience-dependent neuroplasticity—with classic Neurodevelopmental Sensorimotor Approaches (NDT/Bobath, PNF, Brunnstrom, and Rood).

Certified Occupational Therapy Assistants (COTAs) utilize these frameworks to select optimal practice schedules, structure therapeutic feedback, handle tone abnormalities, and guide clients toward functional movement recovery.

1. Stages of Motor Learning & Feedback Mechanisms

Motor Learning is defined as a set of internal cognitive and neuromuscular processes associated with practice or experience leading to relatively permanent changes in the capability for producing skilled movement. Fitts and Posner established the classic three-stage model of motor skill acquisition:

+-----------------------------------------------------------------------------+
|                 FITTS & POSNER 3 STAGES OF MOTOR LEARNING                   |
|                                                                             |
|   [1. COGNITIVE STAGE]   ---> High conscious attention; "What to do?"       |
|                               Performance is erratic, inconsistent.         |
|                               Relies heavily on EXTRINSIC & VISUAL feedback.|
|                                    |                                        |
|                                    v                                        |
|   [2. ASSOCIATIVE STAGE] ---> Refining movement pattern; "How to do it?"    |
|                               Fewer errors, developing internal models.     |
|                               Proprioceptive & INTRINSIC feedback dominant. |
|                               Self-correction begins; faded extrinsic cues. |
|                                    |                                        |
|                                    v                                        |
|   [3. AUTONOMOUS STAGE]  ---> Automatic, effortless execution.              |
|                               Low attentional demand; dual-task capability. |
|                               Consistent in diverse, novel environments.    |
+-----------------------------------------------------------------------------+

Feedback Modalities in Motor Learning

Feedback provides critical sensory information that guides motor adjustments and drives synaptic plasticity:

  • Intrinsic (Internal) Feedback: Sensory information arising naturally within the client's own body during or after movement (proprioception, kinesthesia, cutaneous tactile input, vestibular sensation, visual confirmation).
  • Extrinsic (Augmented / External) Feedback: Supplemental information provided by an external source, such as the COTA's verbal cues, tactile guidance, video replay, or auditory biofeedback.
+-----------------------------------------------------------------------------+
|                EXTRINSIC FEEDBACK: KR vs. KP COMPARISON                     |
|                                                                             |
|   [KNOWLEDGE OF RESULTS (KR)]               [KNOWLEDGE OF PERFORMANCE (KP)] |
|   • Information about the OUTCOME of the    • Information about the NATURE  |
|     movement relative to the goal.            or KINEMATIC QUALITY of the   |
|   • Ex: "You dropped 2 pegs outside the       movement pattern itself.      |
|     board" or "You zipped the jacket in     • Ex: "Bend your elbow more     |
|     12 seconds."                              before reaching" or "Keep     |
|   • Best for promoting task goal awareness    your shoulder down and relaxed|
|     and self-assessment.                      while lifting the cup."       |
+-----------------------------------------------------------------------------+

Extrinsic Feedback Scheduling & Fading

  • Continuous Feedback: Given after every single trial; accelerates initial performance during the cognitive stage but induces feedback dependency (client cannot perform without cues).
  • Faded Feedback: High frequency initially, then systematically reduced as proficiency increases; fosters internal error detection and permanent motor retention.
  • Bandwidth Feedback: Feedback provided only when the client's performance falls outside an acceptable margin of error; builds self-monitoring.
  • Summary Feedback: Feedback withheld until a set of trials (e.g., 5 reaches) is completed, summarizing overall trends.

2. Practice Conditions & Scheduling Continuum

The structure and organization of therapeutic practice directly determine whether a skill is merely performed temporarily during the clinic session (motor acquisition) or retained and transferred to the home environment (motor retention and generalization).

+-----------------------------------------------------------------------------+
|                   MOTOR PRACTICE SCHEDULING CONTINUUM                       |
|                                                                             |
|   [BLOCKED PRACTICE]  ---> [Task A - A - A] -> [Task B - B - B]             |
|                            Repetitive drill of same task. High immediate    |
|                            performance in Cognitive Stage. LOW retention.   |
|                                                                             |
|   [RANDOM PRACTICE]   ---> [Task A] -> [Task C] -> [Task B] -> [Task A]     |
|                            Unpredictable interleaving of multiple tasks.    |
|                            High Contextual Interference. SUPERIOR RETENTION.|
|                                                                             |
|   [MASSED PRACTICE]   ---> Practice time > Rest time (High fatigue risk).   |
|   [DISTRIBUTED PRAC.] ---> Rest time >= Practice time (Safe for cardiac/MS).|
|                                                                             |
|   [CONSTANT PRACTICE] ---> Single environmental condition (1 height/weight).|
|   [VARIABLE PRACTICE] ---> Varying conditions, objects, speeds (Generalize).|
+-----------------------------------------------------------------------------+

Practice Design Matrix for the COTA

Practice DimensionCondition ACondition BClinical Indications & Comparative Efficacy
Task OrganizationBlocked Practice: Practicing one motor skill repeatedly before moving to the next (e.g., 20 repetitions of scooping beans).Random Practice: Intermixing different motor skills in unpredictable order (e.g., scoop beans $\rightarrow$ pour water $\rightarrow$ reach for plate $\rightarrow$ scoop).• Blocked practice is ideal for initial skill acquisition in severe cognitive/apraxic deficits.<br>• Random practice creates contextual interference, forcing continuous motor reconstruction, resulting in superior long-term retention and real-world transfer.
Time DistributionMassed Practice: Practice time exceeds rest time (e.g., 45 minutes of continuous task practice with 2-minute rests).Distributed Practice: Rest time equals or exceeds practice time (e.g., 5 minutes practice followed by 5 minutes rest).• Massed practice is used in CIMT for high-repetition shaping.<br>• Distributed practice is mandatory for clients with MS, cardiac disease, or myasthenia gravis to prevent dangerous physiological fatigue.
Environmental ContextConstant Practice: Practicing a task under identical conditions (e.g., reaching for the same 8-oz glass on the same table).Variable Practice: Practicing the task across diverse parameters (e.g., reaching for cups of different weights, sizes, textures, and shelf heights).• Constant practice establishes basic motor schemas.<br>• Variable practice promotes motor generalizability and adaptability to novel, unstructured real-world settings.
Task ComplexityWhole Practice: Practicing an entire functional task in its complete sequence (e.g., walking, swinging a golf club).Part Practice: Breaking a complex chained task into discrete components (e.g., practicing wheelchair lock management separately from transfers).• Whole practice is essential for continuous, rhythmic, or highly coordinated tasks with tight timing.<br>• Part practice is indicated for complex, multi-step serial tasks (e.g., donning a button-down shirt).

3. Neurodevelopmental Treatment (NDT / Bobath Approach)

Developed by Berta and Karel Bobath, Neurodevelopmental Treatment (NDT) is a sensorimotor, problem-solving approach focused on the remediation of posture and movement impairments in individuals with neurological pathology (CVA, TBI, CP).

Core Philosophy & Foundational Assumptions

  • Neuroplasticity & Recovery over Compensation: Rejects compensatory one-handed techniques early in rehabilitation; strives to restore normal symmetrical movement patterns on the hemiparetic side.
  • Normalization of Muscle Tone: Abnormal muscle tone (spasticity, flaccidity) and primitive synergistic reflexes impede normal motor output. Tone must be normalized before initiating active movement.
  • Postural Control & Alignment: Normal movement requires a dynamic, stable postural base. The trunk, pelvis, and scapula must be properly aligned before distal limb movement can occur.
+-----------------------------------------------------------------------------+
|                        NDT KEY POINTS OF CONTROL                            |
|                                                                             |
|   [PROXIMAL KEY POINTS]                      [DISTAL KEY POINTS]            |
|   • Pelvis (Neutral tilt, level symmetry).   • Head and Neck.               |
|   • Shoulder Girdle & Scapula (Protraction,  • Hands and Wrists (Open web   |
|     upward rotation, depression).              space, wrist extension).     |
|   • Spine & Trunk (Elongation on weight-     • Feet and Ankles (Dorsiflexion|
|     bearing side).                             and heel strike).            |
|                                                                             |
|   *Therapist applies light manual handling at key points to guide alignment,|
|    inhibit spasticity, and facilitate active normal motor responses.*        |
+-----------------------------------------------------------------------------+

NDT Handling & Tone Normalization Strategies

  1. Scapular Mobilization & Protraction: Spasticity pulls the scapula into retraction, downward rotation, and depression. The COTA manually mobilizes the scapula into protraction and upward rotation prior to any overhead arm movement to prevent subacromial impingement.
  2. Trunk Elongation on the Weight-Bearing Side: In hemiplegia, the affected trunk is typically shortened and laterally flexed. The COTA facilitates weight-shifting onto the paretic side, actively elongating the shortened trunk musculature.
  3. Upper Extremity Weight-Bearing: Placing the hemiparetic arm in weight-bearing (shoulder extended/abducted, elbow extended, wrist extended, fingers extended with open web space) provides proprioceptive approximation that inhibits hypertonic flexor spasticity and stabilizes the shoulder.
  4. Inhibition of Associated Reactions: Prevents involuntary overflow movements (e.g., arm curling tightly into flexion when client sneezes, coughs, or exerts effort with the sound limb).

4. Proprioceptive Neuromuscular Facilitation (PNF)

Developed by Dr. Herman Kabat and physical therapists Margaret Knott and Dorothy Voss, Proprioceptive Neuromuscular Facilitation (PNF) is an active rehabilitation approach utilizing spiral and diagonal movement patterns to stimulate proprioceptive mechanisms (muscle spindles, Golgi tendon organs) and promote functional neuromuscular recovery.

PNF Diagonals for the Upper Extremity

All functional movements occur across diagonal, spiral planes combining three movement components: Flexion/Extension, Abduction/Adduction, and Internal/External Rotation.

+-----------------------------------------------------------------------------+
|                     PNF UPPER EXTREMITY DIAGONALS                           |
|                                                                             |
|   [D1 FLEXION] ---> "Eat an Apple / Brush Contralateral Ear"                |
|   • Shoulder: Flexion, Adduction, External Rotation.                        |
|   • Forearm: Supination | Wrist/Fingers: Flexion & Radial Deviation.        |
|   • Functional: Bringing spoon to mouth, brushing opposite ear.             |
|                                    ^                                        |
|                                    | (Antagonistic Diagonal Arc)            |
|                                    v                                        |
|   [D1 EXTENSION] ---> "Throw Apple Away / Push Down & Back"                 |
|   • Shoulder: Extension, Abduction, Internal Rotation.                      |
|   • Forearm: Pronation | Wrist/Fingers: Extension & Ulnar Deviation.        |
|   • Functional: Pushing car door open from inside, pushing up from chair.   |
|                                                                             |
|   =======================================================================   |
|                                                                             |
|   [D2 FLEXION] ---> "Draw Sword to Sky / Waiter Carrying Tray"              |
|   • Shoulder: Flexion, Abduction, External Rotation.                        |
|   • Forearm: Supination | Wrist/Fingers: Extension & Radial Deviation.      |
|   • Functional: Reaching into high cabinet, backhand tennis stroke.         |
|                                    ^                                        |
|                                    | (Antagonistic Diagonal Arc)            |
|                                    v                                        |
|   [D2 EXTENSION] ---> "Sheath the Sword across Opposite Hip"                |
|   • Shoulder: Extension, Adduction, Internal Rotation.                      |
|   • Forearm: Pronation | Wrist/Fingers: Flexion & Ulnar Deviation.          |
|   • Functional: Buttoning pants on contralateral side, tucking shirt in.    |
+-----------------------------------------------------------------------------+

Specific PNF Neuromuscular Techniques

PNF TechniqueExecution & Biomechanical MechanismPrimary Clinical GoalsClinical Indications
Rhythmic InitiationSequential progression: Passive $\rightarrow$ Active-Assisted $\rightarrow$ Active Resisted $\rightarrow$ Independent Active movement through the diagonal pattern.• Overcome bradykinesia, rigidity, or motor apraxia.<br>• Teach the rhythm and trajectory of movement.• Parkinson's disease (severe rigidity, hesitation).<br>• Acute stroke / flaccidity.<br>• Traumatic brain injury apraxia.
Contract-Relax (CR)Passive stretch to limitation $\rightarrow$ active concentric/isotonic contraction of the antagonist (tight muscle) against resistance $\rightarrow$ relaxation $\rightarrow$ passive stretch into agonist pattern.• Increase passive range of motion.<br>• Utilizes autogenic inhibition (GTO firing relaxes tight muscle).• Soft tissue joint contractures.<br>• Tight hamstring or pectoral musculature restricting ROM.
Hold-Relax (HR)Passive stretch to limitation $\rightarrow$ active ISOMETRIC contraction of the antagonist against unyielding resistance $\rightarrow$ relaxation $\rightarrow$ active or passive movement into new range.• Increase pain-free passive ROM.<br>• Autogenic inhibition without joint movement.• Joint stiffness accompanied by acute pain or muscle guarding.
Slow Reversal (Dynamic Reversals)Alternating concentric isotonic contractions of the agonist pattern immediately followed by the antagonist pattern against manual resistance without relaxation between turns.• Improve reciprocal muscular coordination.<br>• Increase dynamic active endurance.<br>• Promote smooth reversal of direction.• Ataxia, general deconditioning, muscle weakness in antagonistic pairs.
Rhythmic StabilizationAlternating isometric contractions against multi-directional manual resistance applied simultaneously to opposing muscle groups around a joint.• Develop joint co-contraction, stability, and postural core balance.<br>• Alleviate joint pain.• Unstable shoulder subluxation.<br>• Weak trunk and seated balance.<br>• Hypermobile joints.

5. Brunnstrom 6 Recovery Stages of Hemiplegia

Signe Brunnstrom formulated an evolutionary neurodevelopmental framework describing the predictable, stereotyped sequence of motor recovery in adults following stroke. Brunnstrom recognized that damaged higher cortical centers release primitive spinal and brainstem reflexes, resulting in stereotypical synergistic mass movement patterns.

+-----------------------------------------------------------------------------+
|                  BRUNNSTROM 6 STAGES OF MOTOR RECOVERY                      |
|                                                                             |
|   [STAGE 1: FLACCIDITY]     ---> Complete absence of tone or movement.      |
|                                                                             |
|   [STAGE 2: SYNERGIES EMERGE]---> Weak associated reactions; spasticity     |
|                                  begins to appear.                          |
|                                                                             |
|   [STAGE 3: SYNERGY DOMINANCE]-> Voluntary movement within synergy;         |
|                                  SPASTICITY REACHES ITS PEAK.               |
|                                                                             |
|   [STAGE 4: SPHERES OF SYNERGY]-> Spasticity declines; initial voluntary    |
|                                  movement combinations OUTSIDE synergy.     |
|                                                                             |
|   [STAGE 5: COMPLEX COMBINATIONS]> Synergies lose dominance; isolated joint  |
|                                  movements performed with extended arm.     |
|                                                                             |
|   [STAGE 6: ISOLATED MOVEMENT] -> Spasticity disappears; coordinated,       |
|                                  near-normal individual joint control.      |
+-----------------------------------------------------------------------------+

Stereotypical Synergy Patterns in Hemiplegia

  • Upper Extremity Flexor Synergy (Dominant in UE): Scapular retraction/elevation, Shoulder abduction & external rotation, Elbow flexion (strongest component), Forearm supination, Wrist and finger flexion.
  • Upper Extremity Extensor Synergy: Scapular protraction/depression, Shoulder adduction & internal rotation (strongest), Elbow extension, Forearm pronation, Wrist flexion/extension, Finger flexion.

Brunnstrom Stage Breakdown & COTA Intervention Protocols

Brunnstrom StageClinical Presentation & Motor CapabilitiesTone / Spasticity LevelTarget COTA Interventions & Therapeutic Goal
Stage 1Flaccidity; zero voluntary movement or reflexive response in affected limb.Flaccid (Hypotonic).• Bed positioning to prevent subluxation and contractures.<br>• PROM within pain-free limits.<br>• Elicit primitive reflexes / associated reactions (e.g., Raimiste's phenomenon, yawning).
Stage 2Synergies begin to develop; minimal voluntary finger flexion; movement occurs primarily as weak associated reactions.Spasticity begins to develop.• Facilitate emerging synergies through sensory input (tapping, vibration).<br>• Encourage active-assisted initiation of mass flexor synergy during functional tasks.
Stage 3Voluntary initiation and control of mass synergies; client can flex elbow fully in synergy; cannot isolate single joints.Peak Spasticity (Severe hypertonicity).• Utilize voluntary synergy functionally (e.g., using flexor synergy to hold an object against chest while sound arm works).<br>• Begin introducing transitional movements to prepare for Stage 4.
Stage 4Spasticity begins to decline; client can perform first isolated movements outside synergy:<br>1. Placing hand behind lumbar spine.<br>2. Elevating arm forward to $90^\circ$ with elbow extended.<br>3. Forearm pronation/supination with elbow flexed at $90^\circ$.Spasticity declining.• Practice isolated non-synergistic movements (reaching forward to $90^\circ$).<br>• Break flexor synergy by combining shoulder flexion with elbow extension and forearm pronation.
Stage 5Synergies lose dominance; spasticity is minimal; client performs complex movement combinations:<br>1. Elevating arm overhead to $180^\circ$ with elbow straight.<br>2. Shoulder abduction to $90^\circ$ with elbow straight.<br>3. Pronation/supination with elbow fully extended.Spasticity minimal.• Advanced functional task practice (reaching into high cabinets).<br>• Emphasize movement speed, dexterity, and fine motor coordination.
Stage 6Spasticity is completely absent; isolated joint control is present; individual finger movements and coordinated motor tasks performed near normal speed.Normal tone.• Rapid alternating movement drills (diadochokinesia).<br>• High-level manual dexterity tasks (typing, pegboards, musical instruments).

6. The Rood Sensorimotor Approach

Developed by Margaret Rood, the Rood Sensorimotor Approach is predicated on the principle that motor output is intimately linked to sensory input. Rood proposed that applying specific cutaneous, proprioceptive, and vestibular sensory stimuli can either facilitate (activate) or inhibit (dampen) skeletal muscle tone to guide the client through the developmental sequence of motor control.

Rood's Four Stages of Motor Control

  1. Mobility (Reciprocal Innervation): Reflexive, phasic movement where agonists contract while antagonists relax to produce motion (e.g., flailing arms, flexor withdrawal).
  2. Stability (Co-Contraction): Simultaneous isometric contraction of agonists and antagonists around a joint to hold a static weight-bearing posture (e.g., holding prone-on-elbows, quadruped, standing).
  3. Controlled Mobility (Mobility Superimposed on Stability): Proximal body segments move over a distal weight-bearing fixed segment (e.g., weight-shifting side-to-side in quadruped or standing, rocking on hands and knees).
  4. Skill (Heavy Work Superimposed on Distal Freedom): The proximal trunk and girdle stabilize firmly, allowing the distal extremity to move freely in space for fine manipulation and tool use (e.g., reaching, writing, kicking a ball).
+-----------------------------------------------------------------------------+
|              ROOD SENSORY FACILITATION vs. INHIBITION MATRIX                |
|                                                                             |
|   [FACILITATION: TO INCREASE LOW TONE / HYPOTONIA]                          |
|   • Fast Brushing: Cutaneous battery-powered brush over dermatome.          |
|   • Light Touch: Rapid light stroking over fingertips/palms.                |
|   • Quick Stretch: Rapid low-amplitude stretch activating Ia spindle fibers.|
|   • Tapping: Rapid manual tapping over muscle belly or tendon.              |
|   • High-Frequency Vibration: 100–200 Hz vibrator over muscle belly.         |
|   • Joint Approximation / Compression: Heavy compressive force down axis.   |
|   • A-Icing: Quick sensory ice swipes (activates autonomic C fibers).       |
|                                                                             |
|   [INHIBITION: TO DECREASE SPASTICITY / HYPERTONIA]                         |
|   • Sustained Gentle Stretch: Slow prolonged hold activating GTO Ib fibers. |
|   • Neutral Warmth: Cotton blanket/towel wrap for 10–20 minutes.             |
|   • Slow Rhythmic Rocking: Gentle, low-frequency vestibular stimulation.    |
|   • Slow Rolling: Rhythmic side-to-side trunk rolling in sidelying.         |
|   • Prolonged Manual Tendon Pressure: Firm direct pressure over insertion.  |
|   • Light Joint Distraction: Gentle traction across joint surfaces.         |
+-----------------------------------------------------------------------------+

[!CAUTION] Rood Cutaneous Facilitation Warnings: Fast brushing and A-icing stimulate sympathetic autonomic nervous system pathways. They are strictly contraindicated over the posterior primary rami along the spine in clients with seizure disorders, cardiac dysrhythmias, or autonomic dysreflexia.

7. Clinical Scenario: Post-Stroke Neurodevelopmental Intervention

Clinical Case Vignette: A 58-year-old client who sustained a left MCA stroke 3 weeks ago presents with right hemiplegia. Assessment reveals Brunnstrom Stage 3 motor recovery in the right upper extremity (peak flexor synergy: elbow flexed tightly at $110^\circ$, forearm pronated, wrist and fingers clenched into fist; unable to extend fingers or reach forward voluntarily). The client demonstrates moderate shoulder subluxation (2-finger breadth gap).

COTA Treatment Plan & Session Protocol:

  1. Preparation & Tone Inhibition (NDT & Rood):
    • The COTA positions the client seated upright with symmetrical pelvic weight-bearing.
    • The COTA applies sustained gentle manual pressure over the right biceps tendon insertion and uses neutral warmth (warm towel wrap) around the arm for 10 minutes to inhibit hypertonic flexor spasticity.
    • The COTA manually mobilizes the right scapula into protraction and upward rotation, then positions the arm in upper extremity weight-bearing on the tabletop with the wrist in extension and fingers flattened on Dycem (providing axial joint approximation to reduce subluxation and inhibit flexor tone).
  2. Transitional Movement Training (Brunnstrom Stage 3 to 4):
    • The COTA guides the client through reaching forward to touch a target placed at waist height, encouraging active elbow extension while inhibiting shoulder elevation.
  3. PNF Diagonal Movement:
    • The COTA initiates PNF D2 Extension ("sheath the sword") using Rhythmic Initiation (Passive $\rightarrow$ Active-Assisted) to guide the hand from high left shoulder down across to the right hip.
  4. Motor Learning Practice: The client completes 15 repetitions of forward reaches to pick up a plastic cup using a random practice schedule interspersed with wiping the table, receiving summary Knowledge of Performance feedback every 5 trials.
Test Your Knowledge

A COTA is working with a client who sustained a stroke 4 weeks ago. During the evaluation, the client is able to initiate voluntary movement of the affected arm, but all movements occur exclusively in a rigid mass flexor synergy pattern (shoulder abduction, scapular retraction, full elbow flexion, forearm supination, and clenched wrist/finger flexion). Spasticity is at its peak, and the client cannot perform isolated joint movements. What Brunnstrom stage of motor recovery does this client exhibit?

A
B
C
D
Test Your Knowledge

A client with severe biceps brachii hypertonicity and flexor spasticity following a traumatic brain injury is unable to extend the elbow to reach for grooming items. Applying the neurodevelopmental and sensorimotor principles of the Rood Approach, which sensory technique should the COTA apply to inhibit the spastic biceps?

A
B
C
D
Test Your Knowledge

A COTA is utilizing Proprioceptive Neuromuscular Facilitation (PNF) patterns to retrain upper extremity functional movement in a client recovering from a stroke. The COTA instructs the client to start with their hand near the contralateral ear and move their arm down and outward across the body to push open a heavy car door. Which PNF diagonal pattern is being utilized?

A
B
C
D
Test Your Knowledge

A client learning to utilize an adaptive button hook is in the Cognitive Stage of motor learning. According to motor learning principles, which combination of practice organization and extrinsic feedback should the COTA implement to optimize initial skill acquisition?

A
B
C
D
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7.3 Task-Oriented Training, CIMT & Bilateral Integration

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