6- Stroke Research and Motor Learning Flashcards
What are some predictors of poor functional recovery when it comes to stroke?
- extent and depth of the stroke
- previous stroke
- older age
- incontinence
- visuo-spatial deficits (esp neglect)
- poor sensation
- delay in hospital admission 1st in 6th months
What are some factors that DON’T predict functional recovery?
- hemisphere affected
- severity of hemiparesis at admission
- gender
Most motor recovery occurs within the 1st ___ post CVA
6 months
What does severe spasticity and flaccidity affect?
Poorer ambulation recovery
What is the most important muscle for functional ambulation?
Rectus femoris
When is hand motor recovery poor?
- initial complete paralysis at onset
- no measurable grip strength at 1 month
_____% of pts with some function in 1st month have good motor recovery (Esp finger extension)
70%
When does rehab work best for stroke?
Better the earlier it starts, the more intense it is, the more task specific it is, when delivered by multidiscipinary teams, and with the engagement and motivation of the patient
What is evidence based in the evaluation of stroke?
standardized tools and regular reassessment
What is evidence based in the treatment of stroke?
Using theoretical concepts that are supported by a body of research to guide treatment
Using treatment strategies that are based on best available evidence and are cost effective
What is compensation?
uses remaining circuitry to utilize other muscle groups/synergies and motor plans (like using an intact UE to compensate for hemiplegic one)
What is rehabilitation?
recovery of lost function using neuroplastic mechanisms and redundancy built into brain circuitry (CIMT and BWSTT brain scans)
What are the 10 factors neuroplasticity depends on, according to Kleim?
- Use it or lose it
- Use it and improve it
- Specificty
- Repetition
- Intensity
- Time
- Salience
- Age
- Transference
- Interference
What is a task-oriented concept of motor control?
movement is organized around tasks, not reflexes
What is the concept of motor control centered about interaction with the environment?
environment dictates how we respond and move
What does the concept of motor learning entail?
- practice makes perfect
- variety is the spice of life
- goal driven (meaningful tasks the patient is motivated to complete)
What is the concept of the therapist as a collaborator?
- adapt to the environment to allow for motor learning and function
- teacher vs. handling specialist
What is explicit learning?
can verbalize the steps, centered in language centers and prefrontal lobes
(example- manual on how to program a remote)
What is implicit learning?
unconscious learning of an action, various centers all over the brain?
(example-learning to ride a bike)
What type of learning is planning movements and strategy correction?
Explicit
What type of learning is executing movements and in-task adjustments?
Implicit
Task-specific training takes advantage of 2 types of recovery in stroke rehab:
Compensation
Recovery of lost function (neuroplasticity and redundancy)
Why must practice be beyond the acquisition of a skill?
For long-term potentiation
What does distributed practice mean? Why is it important?
learning is better when you give rest breaks in between bouts
- allows patients to think about and consolidate learning
- allows patients to strategize next attempt
What is variable practice?
changing it up instead of practicing the same thing over and over (blocked practice)
What is contextual interference?
random sequencing that forces the patient to think about each attempt as a new challenge, instead of relying on rote memorization of a task
What is internal feedback?
provided by sensory feedback mechanisms
What is external feedback?
provided by the therapist visually, audibly, physically
Which type of feedback is faster and more accurate?
Internal
Is delayed or immediate feedback better? why?
delayed is better than immediate because it allows us to give a rest after a task before giving feedback and ask patient to predict how they did before offering knowledge of results (leads to better performance and retention)
What is even better than delayed or immediate feedback? what is it?
Summary feedback is even better. Waiting until after several attempts before giving an overall estimation of performance
What is bandwidth feedback?
allowing a certain level of error before offering feedback (# of mistakes, distance outside parameters)
When it comes to feedback…
less is more!
More cards
More cards
