brain behavior mechanisms Flashcards
What are some outcomes of ACL reconstruction?
- 1in 3 patients fail to return to sport after ACLR
- Increased levels of injury-related fear
- individuals with fear of reinjury were 13X more likely to suffer a second ACL tear withing 24 months of Return to sport
What do we know about injury-related fear and reaction time?
- increased levels of injury-related fear have been associated w/ slower lower extremity reaction time
- Slower reaction time is associated with musculoskeletal injury-risk
- Neuropsychological response to injury!
What is the negative response in the fear-avoidance model?
after injury –> pain response –> catastrophizing –> fear of pain (increased arousal) –> Defense mechanisms (avoidance or using body part and escape- avoidance of sport all together) –> pain anxiety (prevention motivation, increased arousal, and hypervigilance) –> disuse of the injured body part, disability, and depression –> reinjury
What is the better response in the fear avoidance model?
injury –> pain experience –> low fear –> confrontation –> recovery
What is neuropsychology?
a branch of psychology concerned with how the brain interacts with the rest of the nervous system influences a person’s cognitions and behaviors
What is neuroplasticity?
general ability of nervous system to continuously change and adapt in a context-dependent manner throughout life
- injury changed brain chemistry
What happens in the brain during an injury?
the prefrontal cortex (what to do in a situation, thinking and logic) –> hippocampus (regulates memory and emotions) –> amygdala (turns on fight or flight and stores memory events)
What is the role of the thalamus in injury?
- receives all sensory input from brian stem
- sends input to subcortical and cortical structures
- Direct link to amygdala
What is the role of the amygdala in injury?
- responsible for emotional responses and learning
- connects to the hypothalamus
- leads to fear expression
What is the role of the hypothalamus in injury?
- responsible for threat assessment
- links nervous and endocrine system
- facilitates the release of cortisol
What is the role of the hippocampus in injury?
- processing and storage of memory
- holds spatial memory (what we know of environment and surroundings)
- initiates and processes fear response
What is the role of the prefrontal cortex in injury?
- associated with the production of emotions
- associated with motivation and executive functions
- ## can STOP fear response (active coping)
Can fear be adaptive?
yes, you can eventually reduce or eliminate the fear response
- exposure
- prefrontal cortex (changing thought process changes memories about the situation which will then change amygdala response)
Steps for musculoskeletal rehab
Plan - start with a clinical exam. Develop a plan together so the athlete knows what to expect and they can make unique goals to aid in motivation (creating a plan reduces fear response)
Train - should reflect what the patient needs to do to be successful. mediates disappointment when relearning movement patterns
Retention - schedule the patient follow-up to determine if the effects are sustained
Re-check - repeat clinical assessment and adjust if needed (check on movement and also injury-related fear)
What is the goal of rehab?
change in sensory input to have a desired motor output
- Rehab = adaptive neuroplasticity
Adaptive plasticity model?
we can relearn how we associate sensory responses to mediate that fear of reinjury
Advantageous neuroplasticity v. maladaptive neuroplasticity?
Maladaptive = leads to chronic pain
Advantageous = if we teach athletes to reframe their minds they will experience no pain
How do we optimize rehab?
motor learning - A complex process in response to practice or experiencing a novel task (or skill) resulting in relatively permanent changes in the CNS, allowing for the production of that task
What are the constraints of motor learning?
- Individual – Heredity, past experiences, individual characteristics, psychosocial
- Task – Demands, rules, difficulty
- Environmental – Physical, sociocultural, feedback
What is the cognitive phase of motor learning theory?
trying to put all of your deliberate attention into one thing
- cannot attend to external events
what is fixation in the motor learning theory?
successful performance replication – closed skills
what is Diversification in the motor learning theory?
success in the technique – open skills
What is the associative phase in motor learning theory?
reallocation of attentional resources
What is the autonomous phase in motor learning?
proprioception and all skills are learned
- free to focus on external factors
What is involved in sensory neuroplasticity?
- afferent input disrupted
- somatosensory processing altered
What is involved in proprioreception?
- inhibited joint position and motor detection
- depressed somatosensory contribution to motor control
What is involved in motor neuroplasticity?
- efferent output altered
- motor processing requires more planning and visual feedback
What is involved in postural control?
decreased stability without visual feedback
what is involved in movement control?
Visual feedback reliance to maintain neuromuscular control
Role of injury psychology in rehab?
- Psychology of injury is not just addressing emotional responses after injury
- Attention is KING for neuroplasticity
- Skill acquisition is not only important to understand for participation in sports, but also for REHAB!
Concepts for quiz
- know how the brain interconnects and how they all respond to fear
- know how motor learning is used to modify those fear responses
- not so concerned with physiological
