Implementing Neuroscience Principles to Support Habilitation and ...

TABLE 8-6
Functions of the Major Nuclei of the Thalamus
Thalamic Nucleus Cortical Connection Function Supported
Anterior limbic system emotional tone
Dorsomedial prefrontal lobe judgementlreasoning
Centromedian reticular system generalized arousal
Intralaminar
Midline
Ventral Anterior
Ventral Lateral
Pulvinar
Ventrobasal Complex
*VP Lateral
*VP Medial
*VP Inferior
Lateral Geniculate Body
Medial Geniculate Body
posterior frontal lobe
association areas
parietal lobe
occipital lobe
temporal lobe
motor functions
higher cognitive thought
sensory mapping (i.e.,
somatosensory,
somatosensory.
vestibular)
visual system functions
auditory system functions
are all indications of a loss of the balance of power in the basal
ganglia and associated structures. These clinical signs can be
disruptive to functional performance by interrupting ongoing
activity, or making it hard to engage in the activity at all.
Many believe it is erroneous to consider the function of
the sensory and motor systems separately, and thus refer to
these networks as the sensorimotor system (e.g., Moore,
1980; Dunn, 1991 a; Kandel, Schwartz & Jessell, 1991 ). The
CNS receives information from the sensory organs, processes
the sensory information, creates possible responses, filters
them through the internal motor circuitry, and produces a
motor response, which is executed by the motor neurons and
musculoskeletal system. The motor systems cannot operate
without sensory information, either during the current event
requiring a response, or from memories of prior events which
helped to construct maps of the body and the environment.
Thalamic Integration
The thalamus is an integrating structure that sits in the
center of the brain (Figure 8-1 1). It is a critical structure
because every single stimulus that goes to and from the
brain (except olfaction) must travel through the thalamus.
This gives the thalamus a big responsibility, that of organizing
input and output so that it serves an optimal purpose in
helping the organism to respond properly. Table 8-6 contains
a summary of the major nuclei of the thalamus, their system
connections and the general function each nucleus supports.
Motor Control
Motor control is the ability to manage one's body for
movement (Dunn, 199 1 b), but is different from praxis (see
cognitive section below). We use movement schema that we
have created from experience or practice to make our movements
more efficient. The motor cortex supports the sequencing,
timing and maintenance of control over movements; all
the motor centers of the brain rely on sensory information to
activate the desired movements. There are several questions
that therapists can ask themselves to identify motor control
iswes that may be interfering with performance (Dunn,
1991 c): Table 8-7 contains these questions.
Principles for Designing Therapeutic
Interventions Based on Motor System
Functions
The EHP framework outlines five intervention approaches
that can be used to provide therapeutic supports. The five
interventions acknowledge the ways that therapists can
address not only person-related variables, but also task and
context variables that can affect performance.
Estublish/restore interventions address person variables; the
therapist identifies the person's skills and abilities, and
designs interventions to improve them. When therapists