Evidence-Based Intervention to Improve Motor Control Flashcards
challenging the system with the potential to heal is known as
neural adaptation
what are the 3 degrees of recovery following CNS injury
spontaneous
function-induced recovery
compensation
what are the 3 stages of motor learning
cognitive
associative
autonomous
list sources of intrinsic feedback
proprioception, visual, vestibular, cutaneous
list sources of extrinsic/augmented feedback
visual, auditory and manual cues, biofeedback, force plates, virtual reality
what type of practice is best for motor learning
random
changes that occur from the natural repair process shortly after injury - body heals itself
spontaneous recovery
CNS modified itself due to changes in activity and environment that promote restoration of ability to move in the same or similar manner as before the injury (use dependent cortical reorganization)
function-induced recovery
development of new patterns of movement results from adaptation by remaining strategies or body segments
compensation
what is super important when dosing patients to promote recovery
doing lots of reps
describe constraint induced movement therapy
Uninvolved limb is restrained for 90% of waking hours which forces use of involved limb
Based on the theory that concentrated and repetitive practice of the involved UE shapes motor behavior
constraint induced movement therapy (CIMT)
Process of decreasing a pt’s body weight by a given percentage using support harnesses and counter balancing system often used in combination with overground gait training or treadmill training
body weight support treadmill training (BWSTT)
what type of practice is BWSTT
masses practice
what is the minimum number of steps/session for BWSTT
3000 steps/session
new CPG recommends high intensity gait training for what patients
CVA, TBI, iSCI > 6 months
BWSTT advantages
- Produces an enriched environment that promotes brain plasticity
- Decreased energy expenditure
- Highly repetitive
- Decreases anxiety/fear of falling
- Allows quantitative documentation of improvement
- “Hands free” intervention for PT
- PT must assure that pt is experiencing quality reps, not just quantity → but it is okay if it looks ugly/wonky to begin
BWSTT disadvantages
- Harness discomfort/appearance
- False sense of proximal stability → the harness provides stability even if pt has weak trunk control
- Augmented proprioception may delay motor learning
- Increased HR reported with high levels of support
- Treadmill limitations - must go below .5 mph
- Intervention parameters not clear to produce significant better outcomes
- Manpower involved
- Inconsistent research regarding efficacy
what type of recovery techniques is the exoskeleton
compensatory
advantages of exoskeleton
- Computer controlled “suit” activated by minimal muscle cx or electrode to facilitate gait
- Can be used in rehab to facilitate upright, walking patterning, endurance, preventing falls, functional tasks
- Can be long term solution for certain pts mobility needs
Some use FES to facilitate muscle cx - With SCI → helps increase bone mineral density due to being upright
what types of populations is the exoskeleton commonly used for
CVA, SCI, MS
disadvantages of exoskeleton
- Bulky, heaving, extremely costly → not covered by insurance
- Limited gait speed and use in all environments
- Changes from functional induced recovery strategy in early stages to compensation in long term
- Can only be used in certain pts (SCI level, spasticity, cognitive ability)
- Compensatory, NOT restorative
An immersive, interactive experience that occurs in real time and is created by a computer interface
augmented reality (VR)
augmented reality (VR) advantages
- Allow experiential learning in a safe, but challenging environment
- Allows ability to control environment completely
- Allows objectively scoring the response to the stimulus
- Encourages early training in complex environments which may improve outcomes for rehab
- Encourages self learning
- Encouraging results to improve plasticity in new CPG for locomotion
disadvantages of VR
- Cost - some systems take up multiple rooms and require multiple staff to operate
- Additional research required on proper dosing and scope of use
- Fear of technology
what types of interventions do impairment specific interventions focus on
improving strength/power/muscle endurance, aerobic training, improve flexibility through ROM exercises/passive stretching/facilitated stretching, spasticity management/serial casting, activities to improve postural control and balance, strategies to reduce fall risks, interventions to improve coordination and agility, gait training/WC mobility, relaxation training
Use task analysis to determine extent to which impairments contribute to functional limitations, Prioritize interventions to improve performance
impairment specific interventions
should you do strength training on a pt with spasticity
yes - will NOT increase spasticity
strength training principles
- higher load/resistance offers better improvements in strength
- > 70% 1 RM, multiple reps/sets
aerobic training principles
Moderate intensity: 40-70% max O2 consumption, 64-77% HR max
3-5 days/week for 20-30 minutes or multiple 10 minute session
how to stretch a pt with spasticity
Use firm, constant pressure over bony or non-spastic arears when stretching or ranging a person with spasticity - avoid direct pressure over spastic mm - use rotation to elongate out of shortened range - maintain stretch positions for 10 minutes
what is the foundation for skilled learning in NDT
postural control
what do you need first, proximal or distal stability
proximal
Structured application of sensory stimuli to improve arousal and attention and to improve sensory function in persons with altered responses
senstory stimulation tecnhiques
what brace can be used to decrease knee hyperextension
Swedish knee brace
