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Neuromuscular Development/Control I > Neuroplasticity and Motor Learning > Flashcards

Neuroplasticity and Motor Learning Flashcards

1
Q

What is neuroplasticity

A
  • the nervous system is plastic or modifiable
  • ability of the brain to reorganize connections/wiring to optimize function & structure in response to internal/external stimuli
  • Brain uses similar mechanisms during development, learning/memory, in response to injury/disease and in therapy
  • Physiological basis of learning & memory and for recovery of function after injury
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2
Q

What levels can neuroplasticity occur at

A
  • Molecular
  • Cellular
  • Intercellular/synapse
  • Network
  • Systems
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3
Q

Conceptual parallels between neuroplasticity and learning

A
  • Neural modifiability: short term functional changes in efficacy of connections -> changes in synaptic efficiency -> persisting changes -> changes in synaptic connections -> long term structural changes
  • Parallel continuum of learning: short term learning/memory -> short term changes -> persisting changes -> long term changes -> long term memory
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4
Q

Common neuroplasticity concepts

A
  • Critical period/window of neuroplastic mechanisms
  • Similar critical period windows for development or for recovery after injury
  • Positive/adaptive neuroplasticity versus maladaptive neuroplasticity
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5
Q

Describe spontaneous versus activity induced neuroplasticity

A
  • Spontaneous: some processes occur independent of external factors, guided by genetic/biochemical cues, mostly lead to initial improvements in function
  • Activity induced: other processes are influenced by external input, sensory experience, motor experience, task training
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6
Q

Response of CNS to injury by changing network/circuitry and/or cortical representation

A
  • Strengthen parallel connections
  • Unmask/activate silent connections
  • Create new connections from cortex & alter cortical representation
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7
Q

Response of CNS to injury through cortical mapping following peripheral lesions

A
  • If silent/weak connections are spared (less severe injury): reactivation will occur by increasing responsiveness of existing previously masked/weak connections, cortical representation does not change much
  • If injury involves larger body parts (receiving connections from a large area of cortex; ex. extremity amputation): cortical remapping happens by expansion of neighboring cortical areas
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8
Q

Response of CNS to injury through cortical remapping following central lesions

A
  • Reorganization in the affected hemisphere: recovery of function can happen with neighboring areas taking up lost function (ex. stroke in internal capsule, recovery of hand showed extension into face area of cortex); lesion in primary motor area can also result in activation of premotor & supplementary motor area
  • Reorganization in the unaffected hemisphere (supplying uncrossed pathways): use of paretic hand activated both contralateral & ipsilateral motor areas
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9
Q

Remapping of connections come from

A
  • Adjacent areas
  • Association areas
  • Contralateral areas
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10
Q

Cortical remapping patterns associated with good or poor functional recovery

A
  • Bilateral activation was associated with poorer recovery compared to contralateral activation in case of more complete recovery
  • Best recovery happens when cortical remapping looks like original ( areas closest to injury take up lost function
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11
Q

Principles of neuroplasticity induced by activity or training

A
  • Use it or lose it
  • Use it and improve it
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12
Q

Adaptive/positive neuroplasticity associated with therapy induced recovery

A
  • In chronic stroke pts 3 wks of robot based PT pf paretic hand to improve grasp function was associated with 20 fold increase in contralateral sensorimotor cortex activation (use it or lose it); also increased laterally back towards lesioned side was associated with good functional gains
  • Principle of specificity
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13
Q

Principles of activity-dependent neuroplasticity

A
  • Use it or lose it: neural circuits not actively engaged in task performance for an extended period of time start to degrade
  • Use it and improve it: training can protect and/or improve networks that were impaired after injury
  • Specificity: plasticity is specific to training of a particular new task or relearning a lost skill due to injury (skill training will improve skills while strength training will not improve skills)
  • Intensity matters: training must be sufficiently intense to stimulate activity-dependent plasticity, needs to be progressively upgraded to match pt’s improving skills
  • Repetition matters: repetition of newly learned task is required to induce long lasting changes
  • Time matters: critical window of plasticity
  • Salience matters: need to engage attention networks for experience-dependent plasticity to reorganize brain & improve skills
  • Age matters: activity-dependent synaptic potentiation, synaptogenesis, cortical map reorganization all reduced with aging
  • Transference/generalization: neuroplasticity in one circuit can promote plasticity in other related circuits
  • Interference: plastic changes in a given circuit can impede induction of ew plasticity in same circuit ( may need to first unlearn compensatory techniques to learn the best way)
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14
Q

Which principle is supported by the OPTIMAL theory and describe the OPTIMAL theory

A
  • Salience matters
  • OPTIMAL theory attempts to enhance expectancies, support patient autonomy, & promotes external focus of attention
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15
Q

Describe motor learning

A
  • a process of acquiring new abilities for skilled action
  • cannot be measured directly but can be inferred indirectly from change in behavior/performance
  • relatively permanent change in behavior
  • theories of motor learning based ons stages of changing behavior
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16
Q

Fitts and Posner’s 3 stage model of motor learning

A
  • Cognitive stage (1st): trying out a variety of strategies, needs a lot of attention & conscious effort, makes many mistakes, improvements can be large
  • Associative stage (2nd): makes less mistakes, practices more to refine the skill, needs less attention, improvements are slower/smaller
  • Autonomous stage (3rd): performance mostly automatic, can divert attention to other tasks
17
Q

Bernstein’s 3 stage model of motor learning - mastering the degrees of freedom

A
  • Novice, advanced, and expert stages (same as Fitts and Posner’s stages)
    -Talks about releasing degrees of freedom at different joints with higher stages
  • Releasing degrees of freedom allows for more efficient & flexible movements according to task & environment demands
18
Q

Clinical application of Bernstein’s 3 stage model of motor learning

A
  • Need to provide external support during early stages of learning to constrain degrees of freedom, support can be gradually released with improved performance
19
Q

Essential requirements for motor learning

A
  • Acquisition of skill: successful performance of skill
  • Retention of skill: successful demonstration of skill at a later time without practice during the intervening period
  • Transfer of skill: successful application of the rules of movement of the skill to a related skill in a different environment
20
Q

When has a patient learned a skill

A
  • a patient is said to have truly learnt a skill only if transfer or at least retention is demonstrated
  • need to complete retention or transfer tests to assess motor learning
21
Q

Important ingredients to promote motor learning

A
  • Practice: from principles of neuroplasticity (intensity & repetition matters); perfect practice makes perfect; practice patterns
  • Feedback: feedback patterns = what type of feedback to provide, how often, timing
  • Design treatment sessions with appropriate practice & feedback patterns for optimal motor learning
22
Q

Practice types

A
  • Massed
  • Distributed
  • Constant: good for acquisition of skill
  • Variable: good for retention and transfer of skills
  • Random
  • Blocked
  • Whole: for continuous movement
  • Part: for movements that can be broken into parts
  • Mental
23
Q

Massed versus distributed practice

A
  • Massed: all practice trials at once, amount of practice time is greater than amount of rest, may lead to fatigue
  • Distributed: divide reps into smaller chunks, amount of rest between trials is equal or greater than the amount of time for the time
24
Q

Is massed or distributed practice better

A
  • no evidence that one is consistently better but need to consider the patient’s impairments like strength, cognitive status, attention span, etc.
25
Q

Constant versus variable practice

A
  • Constant: practice of given task under constant/unchanging conditions, may improve acquisition of skill (use it to improve it)
  • Variable: practice of a given task under variable conditions, better for retention & transfer of skill (transference principle)
26
Q

Blocked versus serial versus random practice (ways to increase variable practice)

A
  • Blocked: practice a single type task before going to the nest type (10 A’s, 10 B’s, 10 C’s)
  • Serial: ABC, ABC, ABC, and so on
  • Random: practicing different types in random order (A, C, B, A, A, C, B, B, and so on)
27
Q

Is blocked, serial, or random practice better for true motor learning

A
  • Random variable practice is best for motor learning (true motor learning)
28
Q

When is random practice useful

A
  • in random practice initial performance is worse during acquisition stage but performance later is better
  • Patient needs good cognitive abilities to benefit from random practice, not good for patients with cognitive impairment & might be hard to motivate patient since little initial success
29
Q

Knowledge of results versus performance

A
  • Knowledge of results: terminal feedback about the outcome of a movement in terms of achieving goal (telling the patient good job you did the task that was asked)
  • Knowledge of performance: feedback relating to the movement quality/pattern used to achieve the goal (patient could have been faster, used more of their arms, directed toward of the patient completed the task, more qualitative)
30
Q

Whole versus part practice

A
  • Whole: practice the entire task together
  • Part: practice of an individual impaired component(s) of a task from movement analysis of tasks, ultimately needs to practice the whole task to improve function
31
Q

General guideline for whole versus part practice

A
  • perform whole task for continuous tasks, & part practice followed by whole task for tasks that can be broken down into natural components
  • breaking down linked components artificially might not be helpful or might even hinder learning
32
Q

Describe mental practice

A
  • performance of skill in one’s imagination without physical action can produce positive effects on performance
  • Trigger of neural circuits responsible for motor planning during mental practice (SMA test activated during mental practice - motor control physiology class)
  • Can help with motor learning when physical practice is not yet possible
33
Q

What kind of feedback is most effective for retention and transfer of skills

A
  • Knowledge pf results is more effective than knowledge of performance
34
Q

Types of feedback

A
  • constant
  • intermittent
  • bandwidth
  • fading
35
Q

Describe constraint induced movement therapy

A
  • Strongest research support
  • Involves high intensity treatment daily for several hrs for 2-3 wks, after constraining the unaffected limb
  • UE must retain some voluntary function on which to build
  • Showed best results in subactue/chronic stroke (3-21 mo post stroke)
  • Should not be considered for use with patients before 4 wks post stroke
36
Q

Describe body weight supported treadmill training (BW-STT)

A
  • Improved gait speed and balance comparable to traditional over-ground gait training
  • Due to unweighting, BW-STT can provide a higher reps/volumes of training than over-ground training, so is more likely to induce neuroplasticity
37
Q

Describe high intensity gait training (HIGT)

A
  • Purpose is to improve locomotion function (walking speed and distance)
  • Gait training at moderate to high intensity (65-85% HRmax/60-80% HRR) or based on RPE scale of 14-17
  • Based on research using individuals who were able to walk w/o substantial assistance , may not apply to individuals with limited ambulatory function
38
Q

Other interventions that have shown good motor learning of skills

A
  • Mirror therapy with hemiparetic UE: patient moves the less affected UE while watching it move in mirror as though it were the more affected UE
  • Bilateral arm training: performance of tasks with symmetrical patterns
  • Mental practice

Neuromuscular Development/Control I (22 decks)

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