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
2
Q
What levels can neuroplasticity occur at
A
- Molecular
- Cellular
- Intercellular/synapse
- Network
- Systems
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
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
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
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
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
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
9
Q
Remapping of connections come from
A
- Adjacent areas
- Association areas
- Contralateral areas
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
11
Q
Principles of neuroplasticity induced by activity or training
A
- Use it or lose it
- Use it and improve it
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
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)
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
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
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
