L25 - INTERNAL & EXTERNAL FOCUS Flashcards
Post-injury changes:
- description of CNS input
- Description of motor control
- Disrupted CNS afferent input: loss of somatosensory signaling & increased
nociceptor activity due to pain & inflammation - Motor control adaptation: compensatory changes, including reduced ROM, mechanical instability & neuromuscular alterations like atrophy & movement
compensations
Sensory system’s role in rehab:
- sensory modalities
- post-injury adaptations
SENSORY SYSTEM’S ROLE IN REHABILITATION
- Sensory modalities: vision, vestibular, somatosensory & auditory systems contribute to mechanoreception, proprioception & kinesthesia
- Post-injury adaptations:
o Increased visual reliance
o Increased cortical involvement & cognitive processing
o Increased motor planning adaptations
Internal va external focus attention:
- definition of each
- comparison
- applications in rehab
INTERNAL VS EXTERNAL FOCUS ATTENTION
Definitions
- Internal focus = directs attention to body movements, conscious awareness of injured joint
- External focus = directs attention to desired outcome or environment
Comparison
Internal focus:
- Beneficial in early rehabilitation phases for precise control
- Can increase conscious effort & slow down automaticity
External focus:
- Promotes fluid & automatic movements
- Ideal for enhancing performance & retention
Applications in rehab
- Internal focus emphasizes awareness of injured joint & controlling movements
- External focus transitions patients to natural, goal-oriented movements
+ table
Motor learning:
- description
Influences efficiency of motor skills acquisition
Affects movement quality & performance outcomes
Impact retention & transfer of learned skills
Motor learning phases:
- name & order
- description of each
Described through 3 stages, each supported by specific brain regions:
1) Cognitive stage: learning basics with hippocampal involvement
o Hippocampus essential for memorizing steps of movement
o Role of brain: hippocampus stores memory of sequence of movements
o Instructions: use visual / verbal cues for understanding movement mechanics
o Therapist’s role: teach movement sequences & provide step-by-step guidance
2) Associative stage: refining movements using cerebellum for feedback integration
o Cerebellum integrates sensory feedback & fine-tunes movement
o Role of brain: cerebellum uses sensory input, such as proprioception & visual feedback,
to adjust & refine movement through trial-and-error
o Instructions: incorporate sensory input for corrections
o Therapist’s role: monitor & fine-tune movements via trial-and-error learning
3) Autonomous stage: automatic execution of movements guided by motor cortex
o Motor cortex ensures automatic coordination of movement with minimal conscious effort
o Role of brain: motor cortex manages smooth, automatic coordination, allowing patient to
perform movement efficiently & adapt to varied environments
o Instructions: facilitate efficient & adaptive performance
o Therapist’s role: encourage independent, smooth performance in varied environment
Constrained action hypothesis:
- description
- implications for sports
CONSTRAINED ACTION HYPOTHESIS (CAH)
- External focus reduces unnecessary muscular effort
- Leads to efficient neural adaptations & movement production
Implications for sports:
1. No significant difference in muscle onset times before take-off (inter-muscular coordination)
2. Significant difference in amount of muscular activity between focus conditions: why less external focus group? increased coordination with muscle
3. Movement production becomes more efficient with practice / external focus of attention = neural adaptations
Motor learning: elements for exercise therapy:
- name
- description of each
Implicit learning
- Implicit learning: use visual / auditory cues, promotes unconscious adjustment
- Explicit learning: step-by-step instructions, provides conscious understanding of movement mechanics & alignment
Visual external cues & modified
Visual external cues
Comparison of instructions to reduce knee valgus motion during single-leg squat with internal focus (keep knee over foot) & external focus (reach knee toward cone)
Modified visual feedback
a. Modified vision (light, blindfold)
b. Direct visual disruption (stroboscopic eyewear)
c. Visual motor training (SPARQ sensory training station, Blaze pod)
d. Indirect visual distraction (dual task)
Auditory external cues
Motor learning description
Motor learning
= process of acquiring skill by which learner, through practice & assimilation, refines & makes automatic desired movement
- Internal neurologic process resulting in ability to produce new motor task
- Set of internal processes associated with practice or experience leading to relatively permanent
changes in capability for skilled behavior
Motor control description
Motor control
= process of initiating, directing, & grading purposeful voluntary movement
Motor control & learning help therapists to understand process behind movements, motor tasks & skills.
To identify appropriate motor learning strategy to get optimal & effective treatment results
PERFORMER & PERFORMANCE CHANGES ACROSS STAGES OF LEARNING:
- description of muscle involves
- expert vs novice
Muscle involved: number reduced & timing pattern becomes appropriate to situation
Energy use / movement efficiency
Visual attention, increasingly directed
Limb-segment coordination, from freezing to synergy
Expert vs novice:
Autonomous execution of skills
Consistency & adaptability of movement
Superior perceivers of kinesthetic information
Possess superior self-monitoring of motor skills
MASTERING MOVEMENT THROUGH VARIABILITY:
- definition
- benefits
- practical examples
- key takeaway
Learning benefits of practice variability
Definition
= practice variability defined as variety of movement & context characteristics learner experiences while
performing skill
Benefits
- Increased capability to perform practiced skill
- Ability to adapt to novel conditions that might characterize situation
Practice variability involves practicing skill in range of different contexts, conditions or environments
Helps learners generalize skills, adapt to novel situations & enhances motor learning
Practical examples:
- Gait training: practicing walking on different surfaces (smooth floor, grass, gravel, sand) to
improve adaptability
- Therapist guide patient through simple motor task (like balancing on one leg) with added
variability (use different surfaces, move arms in different ways & change focal point)
Key takeaway: practice variability leads to better generalization & adaptability in motor learning
Power of feedback:
- feedback definition
- 2 types
- practical examples
- key takeaway
POWER OF FEEDBACK: How to give it right
Feedback = information given to learner about performance, and it’s crucial for error correction & motor skill acquisition
2 types of feedback:
- Knowledge of results (KR)
- Knowledge of performance (KP)
Practical Examples:
Mirror Therapy: Patients view their reflection to self-assess movement quality.
Gait Retraining: Use video feedback to show patients how their walking pattern can be improved.
The “therapist” guides the “patient” through a simple exercise (like a squat) and provides feedback on
performance (KP) and results (KR).
Key Takeaway: Well-timed, specific feedback improves motor performance and accelerates
Learning
Simplifying complex tasks:
- description
- practical examples
- key takeaways
BREAK IT DOWN: SIMPLIFYING COMPLEXT TASKS
Task simplification involves breaking down complex movement into smaller, more manageable components
It builds confidence & allows patient to focus on mastering each part before combining them
Practical examples:
Walking rehabilitation: start with weight shifts, then assisted stepping & finally walking
Key takeaway: breaking down tasks builds patient confidence, reduces cognitive load & enhances motor learning
Motivation trough reinforcement:
- description
- practical examples
- key takeaways
MOTIVATION THROUGH REINFORCEMENT
Positive reinforcement: providing rewards or praise to increase likelihood of repeating good behavior
Negative reinforcement: removing aversive stimulus when correct action performed. Reinforcement builds motivation & strengthens motor learning
Practical examples:
Verbal praise: great job keeping your balance on one foot
Process tracking: use charts or apps to track patient progress, providing sense of accomplishment
Token systems: for pediatric patients, reward stickers for successful repetitions of exercise
Therapist selects task & uses positive (verbal praise) / negative (remove aid) reinforcement to encourage success
Key takeaway: reinforcement motivates patients, builds confidence & encourages sustained effort & practice
Repetition: pathway to mastery:
- key concepts
- practical examples
- key takeaway
REPETITION: PATHWAY TO MASTERY
Key concepts:
- Repetition essential for creating motor memory & reinforcing neural pathways
- High-repetition, task-specific practice fundamental for rehabilitation
Practical examples:
Gait training: patients repeat step patterns over & over to re-establish gait mechanics
Tasks for stroke patients: repeated reaching toward different targets builds shoulder & arm coordination
Therapist selects motor task & tracks how repetition affects improvement
Key takeaway: repetition strengthens motor pathways & builds muscle memory required for skill retention
