5. Innovations in motor rehabilitation

Question 1

What is proprioception?

Answer 1

Awareness of the position/movements of you own body.

Question 2

Which 2 acquisition phenomena are there?

Answer 2

1. Sequence learning = the acquisition of new movement patterns through long-term practice
2. (Sensori)motor adaptation = the ability to adjust our movements to changing internal or environmental demands

Question 3

Sequence learning has 3 stages, which?

Answer 3

1. Early/cognitive phase (acquisition): involves declarative learning –> people often engage in self-talk to remind themselves of what they have to do.
2. Associative phase (consolidation): detect and eliminate errors, starting to link individual components of movements together (smoothness).
3. Autonomous phase (retention): performance becomes automatic, skill has developed –> working memory can be used for other purposes.

Question 4

What are 3 examples of (sensori)motor adaptation?

Answer 4

1. Visual displacement: shifting the visual field with goggles.
2. External forces: when you push right, but it goes left –> adaptation.
3. Split-belt traitmail: can be used for gait rehabilitation in stroke patients –> when someone adapts, that’s a good indication that rehabilitation may help.

Question 5

What is neuroplasticity neutrality?

Answer 5

The fact that the brain is capable of strenghtenen, weakenen, and forming neural connection, but that learning of the wrong thing also can lead to more of the wrong thing.

Question 6

An effective innovative intervention that allows for motor skill acquisition through neuroplasticity needs to include… (5x)

Answer 6

1. Practice: repetitive and varied practice of meaningful tasks
2. Level of difficulty: adjusting to the patients skill level (staircase procedure)
3. Problem solving/error-correction: cognitive and executive mechanisms should be engaged by the task
4. Motivation: gamified and VR approached are more fun (this affects motivation)
5. Feedback quality/frequency: feedback should be used to stimulate wanted, and discourage unwanted movement, matching the relevant sensory modality of the task

Question 7

Individual differences in what domains can be used as predictors of adaptability of motor memory? (4x)

Answer 7

1. Visual field dependence: people who learn faster usually rely less on visual information, so this tells us that visual reliance may predict how someone will adapt.
2. Visuospatial working memory: better vWM performance is associated with faster manual adaptation training, so WM might be another predictor.
3. Structural brain changes: patients with greater grey matter increases in the PMC after initial training also show a faster rate of adaptation on that same task.
4. Functional brain changes: some areas are associated with faster adaptation, others with better memory of adaptation strategies when tested in a follow-up trial.

Question 8

Innovative alternatives for the assessment of motor issues for the following domains:

1. Tremor/fine motor skills
2. Reaction time and medication
3. Freezing of gait
4. Remote assessment

Answer 8

1. Tremor/fine motor skills: with the Archimedes spiral drawing test –> when done on a tablet, this allows for much broader investigation and quantification of performance (time, speed, length of spiral, deviation from template, etc.).
2. Reaction time and medication: often assessed with key press tasks, however, mouse movements may better distinguish between planning (= better of meds) and actual execution (= better on meds) –> since initiation is more cognitive and execution is more motor.
3. Freezing of gait: hard to assess, because it doesn’t always happen during a clinician visit, but Interactive WalkWay can project stepping stones and stop bars on the floor –> this doesn’t evoke freezing of gait, but the outcomes can differentiate freezers from non-freezers.
4. Remote assessment: online assessments of motor symptoms can be done with a smartphone video, whenever symptoms are experienced. The interpretation is objective (done by algorithm) and there is a strong correlation between this tool and clinical evaluations (strong convergent validity).

Question 9

Name some assistive technology for movement for the following domains:

1. Walking
2. Eating
3. Writing

Answer 9

1. Walking: external cues can be very helpful
   - Laser shoes
   - Vibrating socks
   - Holocue (MR goggles)
2. Eating: Liftware spoon –> counter vibrations to stabilize the hand
3. Writing: ARC pen –> has a high-frequency vibration to help patients increasing their size of writing (micrographia)