Motor control : Translating researching into clinical practice

Fifth Edition

Motor Control

TRANSLATING RESEARCH INTO

CLINICAL PRACTICE

Anne Shumway-Cook, PT, PhD, FAPTA

Emeritus Professor

Division of Physical Therapy

Department of Rehabilitation Medicine

University of Washington

Seattle, Washington

Marjorie H. Woollacott, PhD

Emeritus Professor

Department of Human Physiology

Institute of Neuroscience

University of Oregon

Eugene, Oregon

Acquisitions Editor: Michael Nobel

Product Development Editor: Linda G. Francis

Editorial Assistant: Tish Rogers

Production Project Manager: Bridgett Dougherty

Design Coordinator: Joan Wendt

Product Manager: Laura S. Horowitz

Manufacturing Coordinator: Margie Orzech

Marketing Manager: Shauna Kelley

Prepress Vendor: SPi Global

Fifth Edition

Copyright © 2017 Wolters Kluwer

Copyright © 2011, 2007, 2001, 1995 Lippincott Williams & Wilkins

All rights reserved. This book is protected by copyright. No part of this book may be reproduced or

transmitted in any form or by any means, including as photocopies or scanned-in or other electronic

copies, or utilized by any information storage and retrieval system without written permission from the

copyright owner, except for brief quotations embodied in critical articles and reviews.

To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street,

Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products

and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data

Shumway-Cook, Anne, 1947- , author.

Motor control : translating research into clinical practice / Anne Shumway-Cook, Marjorie

Woollacott. — Fifth edition.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4963-0263-2

I. Woollacott, Marjorie H., 1946- , author. II. Title.

[DNLM: 1. Motor Skills—physiology. 2. Movement—physiology. 3. Movement Disorders—

therapy. 4. Physical Therapy Modalities. 5. Posture—physiology.WE 103]

QP301

612'.04—dc23

2015035145

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,

including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals'

examination of each patient and consideration of, among other things, age, weight, gender, current or

prior medical conditions, medication history, laboratory data and other factors unique to the patient.

The publisher does not provide medical advice or guidance and this work is merely a reference tool.

Healthcare professionals, and not the publisher, are solely responsible for the use of this work including

all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional

verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and

treatment options should be made and healthcare professionals should consult a variety of sources.

When prescribing medication, healthcare professionals are advised to consult the product information

sheet (the manufacturer's package insert) accompanying each drug to verify, among other things,

conditions of use, warnings and side effects and identify any changes in dosage schedule or

contraindications, particularly if the medication to be administered is new, infrequently used or has a

narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is

assumed by the publisher for any injury and/or damage to persons or property, as a matter of products

liability, negligence law or otherwise, or from any reference to or use by any person of this work.

LWW.com

Not authorised for sale in United States, Canada, Australia, New Zealand, Puerto Rico, and U.S.

Virgin Islands.

Acquisitions Editor: Michael Nobel

Product Development Editor: Linda G. Francis

Editorial Assistant: Tish Rogers

Production Project Manager: Bridgett Dougherty

Design Coordinator: Joan Wendt

Product Manager: Laura S. Horowitz

Manufacturing Coordinator: Margie Orzech

Marketing Manager: Shauna Kelley

Prepress Vendor: SPi Global

Fifth Edition

Copyright © 2017 Wolters Kluwer

Copyright © 2011, 2007, 2001, 1995 Lippincott Williams & Wilkins.

All rights reserved. This book is protected by copyright. No part of this book may be reproduced or

transmitted in any form or by any means, including as photocopies or scanned-in or other electronic

copies, or utilized by any information storage and retrieval system without written permission from the

copyright owner, except for brief quotations embodied in critical articles and reviews.

To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street,

Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products

and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data

Shumway-Cook, Anne, 1947- , author.

Motor control : translating research into clinical practice / Anne Shumway-Cook, Marjorie

Woollacott. — Fifth edition.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4963-0263-2

I. Woollacott, Marjorie H., 1946- , author. II. Title.

[DNLM: 1. Motor Skills–physiology. 2. Movement–physiology. 3. Movement Disorders–therapy. 4.

Physical Therapy Modalities. 5. Posture–physiology. WE 103] QP301

612'.04–dc23

2015035145

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,

including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals'

examination of each patient and consideration of, among other things, age, weight, gender, current or

prior medical conditions, medication history, laboratory data and other factors unique to the patient.

The publisher does not provide medical advice or guidance and this work is merely a reference tool.

Healthcare professionals, and not the publisher, are solely responsible for the use of this work including

all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional

verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and

treatment options should be made and healthcare professionals should consult a variety of sources.

When prescribing medication, healthcare professionals are advised to consult the product information

sheet (the manufacturer's package insert) accompanying each drug to verify, among other things,

conditions of use, warnings and side effects and identify any changes in dosage schedule or

contraindications, particularly if the medication to be administered is new, infrequently used or has a

narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is

assumed by the publisher for any injury and/or damage to persons or property, as a matter of products

liability, negligence law or otherwise, or from any reference to or use by any person of this work.

LWW.com

It is with great love and gratitude that we dedicate this book to the

many people, including professional colleagues and patients, who

have contributed to the development of the ideas presented here.

We also gratefully acknowledge the divine source of our

enthusiasm, wisdom, and joy. The sweet mix of inspiration and

ef ort involved in the creation of this book was truly a delight.

PREFACE

In recent years, there has been a growing emphasis on evidence-based clinical

practice, which is characterized by the integration of the best available

research with expert clinical judgement and patient preferences regarding

assessment and treatment of motor control problems. However, the

integration of research into clinical practice is easier said than done. The

explosion of new research in the field of neuroscience and motor control has

created an ever-widening gap between research and clinical practice. This

book is dedicated to reducing this gap by reviewing current research in the

area of motor control and exploring the translation of this research into best

clinical practices.

AN OVERVIEW OF THE FIFTH

EDITION

The overall framework of the fifth edition has not changed and contains four

parts. Part I, the Theoretical Framework, reviews current theories of motor

control, motor learning, and recovery of function after neurological insult.

The clinical implications of various theories of motor control are discussed,

as are the physiological basis of motor control and motor learning. This

section also includes a suggested conceptual framework for clinical practice

(Chapter 6) and a chapter on the pathophysiology of sensory, motor, and

cognitive impairments affecting motor control. The first section is the

foundation for the major thrust of the book, which addresses motor control

issues as they relate to the control of posture and balance (Part II), mobility

(Part III), and upper-extremity function (Part IV).

The chapters in each of these sections follow a standard format:

The first chapter in each section discusses issues related to normal

control processes.

The second and third chapters describe development and age-related

issues, respectively.

The fourth chapter presents research on abnormal function

The final chapter in each section discusses clinical strategies related to

assessment and treatment of problems in each of the three functional

areas and reviews the underlying research that supports these strategies.

This book will be of use in several ways. First, we envision it as a textbook

used in both undergraduate and graduate courses on normal motor control,

motor development across the life span, and rehabilitation in the area of

physical and occupational therapy, as well as kinesiology and exercise

science. We also envision that the book will assist clinicians in staying

connected to some of the research that serves as the foundation for evidence￾based clinical practice. A strength of Motor Control: Translating Research

into Clinical Practice is its summary of a broad range of research papers and

the translation of this research into clinical practice. However, reading

summaries cannot replace the insights that are gained by delving into the

original research papers. A book by its very nature summarizes only research

available before its publication; therefore, it is critical that clinicians and

students alike continue to read emerging research.

CHANGES TO THE FIFTH

EDITION

This fifth edition of Motor Control includes updated research and significant

revisions to the three key areas: postural control, mobility, and upper

extremity function. In order to emphasize essential knowledge, more detailed

information has been removed from the main text and placed into Extended

Knowledge boxes. Laboratory activities have been expanded, and the

Answer Keys are at the end of each chapter. Several Case Studies with

associated videos have been added, including a person with moderately

severe relapsing remitting multiple sclerosis, a child with severe cerebral

palsy, and a longitudinal case study examining recovery from an acute stroke,

with examinations at 4 days, 1 month, and 6 months poststroke. Two

treatment videos have been developed including treatment of motor control

problems in a woman who is 1 month poststroke, and assessment and

treatment of segmental trunk control in a child with severe cerebral palsy.

ONLINE RESOURCES FOR

STUDENTS AND FACULTY

Videos associated with the case studies, and referred to throughout the text,

may be found at thePoint.lww.com. These are intended to be used along with

the book and are available to both students and faculty.

Teaching materials available to faculty only are the following:

An image bank

PowerPoint slides

Test generator

Links to journal articles

Additional case studies with student exercises

For more information, please visit the text's companion Web site

(http://thepoint.lww.com/) or contact your local representative.

A FINAL NOTE

Motor Control: Translating Research into Clinical Practice, Fifth Edition,

seeks to provide a framework that will enable the clinician to incorporate

current theory and research on motor control into clinical practice. More

importantly, it is our hope that the book will serve as a springboard for

developing new, more effective approaches to examining and treating

patients with motor dyscontrol.

Anne Shumway-Cook

Marjorie H. Woollacott