Neuroplasticity and Strategies to Improve Motor Function

Question 1

Define neuroplasticity

Answer 1

• the brain’s ability to reorganize itself by forming new neural connections
• both structure and function

Question 2

How does neuroplasticity occur

Answer 2

• in response to training and practice and to compensate for injury or disease

Question 3

What are the 4 ways the brain changes through neuroplasticity?

Answer 3

1) neurogenesis: continuous generation of new neurons in certain brain regions
2) new synapses: new skills and experiences create new neural connections
3) strengthened synapses: repetitions and practice strengthens neural connections
4) weakened synapses: connections in the brain that aren’t used become weak

Question 4

What changes must take place in order for neuroplasticity to occur?

Answer 4

1) dendritic spines
2) properties of membranes and ion channels
3) hormonal activity
4) microglia activity
5) DNA regulation and Transcription
6) neurotransmitters

Question 5

What are the 4 criteria to promote neuroplasticity?

Answer 5

1) Repetition
2) Neuroadaptive
3) Attentionally engaging
4) Rewarding: engaging the dopaminergic reward system and noradrenergic novelty detection system

Question 6

What is Task-Specific Intervention?

Answer 6

• requires extensive practice of a specific task
• emphasizes a functional mobility task
• PRACTICE
• adapt the treatment by changing the task and environmental conditions
• PRACTICE
• vary the level of difficulty and progressed

Question 7

Example of task specific training

Answer 7

Sit to stand
- surface height: start with higher height and gradually lower
- sitting surface: chair, bed, toilet, couch, foam, BOSU, Swiss ball, rolling stool
- standing surface: foam, BOSU, unilateral, stool
- stand to sit (eccentric control)
- sit <> stand with resistance: manual resistance, T-band
- transfer circle: sit <> stand while moving from chair to chair toward the involved side (vary sitting/standing surfaces)
- sit to walk

Question 8

What is motor control?

Answer 8

• defined as the ability to regulate the mechanisms essential to movement

Question 9

Define motor skill

Answer 9

• motor skills that require body, head and limb movements to achieve a goal
• assumes both CONTROL, COORDINATION AND A GOAL

Question 10

Define performance

Answer 10

behavioral act of executing a skill at a specific time and in a specific situation

Question 11

What is motor learning

Answer 11

the the acquisition of skills necessary to plan and execute a desired movement pattern for a given task

Question 12

What is the difference between open and closed loop mechanisms?

Answer 12

• open loop mechanism: does not use feedback, control center provides all the information for effectors to carry out movement
  
  • does not use feedback to continue and terminate movement
• closed loop mechanism: uses feedback, control center issues information to effectors sufficient only to initiate movement
  
  • relies on feedback to continue and terminate movement

Question 13

What are Fitt’s and Posner’s Stages of Learning

Answer 13

1) Cognitive Stage “What to do”
- understanding task and developing strategies
- large amount of attention
2) Associative Stage “how to do”
- selected the best strategy for the task and refines skill
- some attention still required
3) Autonomous Stage “how to succeed”
- automaticity in the skill
- low degree of attention required

Question 14

What is the PT’s role to increase motor function?

Answer 14

1) determine the patient’s strengths and limitations
2) develop a collaborative POC that includes goals and outcomes that match the patient’s unique needs

Question 15

What is the first level of neurorehabilitation interventions?

Answer 15

First level: top to bottom
- starts with restorative interventions that are designed to promote and restore optimal functional capacity

Question 16

Define the Second Level of neurorehabilitation interventions

Answer 16

Second Level: functional training (activity-based, task-oriented intervention) - uses normal patterns to accomplish the task and motor learning strategies

Question 17

Define the Final Level of neurorehabilitation interventions

Answer 17

Final Level: compensatory interventions in the presence of severe impairment designed to promote optimal function using altered movement patterns and strategies using all body segments

Question 18

What are the 4 motor learning variables?

Answer 18

1) Practice and repetition
2) Performance feedback
3) Generalizability and variability
4) Diverse activities in varied contexts

Question 19

Explain practice and repetition for motor learning

Answer 19

• practice is the most important variable in motor learning
• WHAT and how a task is practiced is more important than simple repetition

Question 20

What are the types of Practice and Practice Parameters?

Answer 20

1) Massed vs. distributed practice
2) constant vs. variable practice
3) blocked vs random - contextual interference
4) whole vs part training
5) guidance vs discovery learning
6) transfer of learning (new task or to new environment)
7) mental practice

Question 21

Define blocked practice vs random practice

Answer 21

• blocked practice is practicing a skill repetitively during a session
• random practice is practicing various skills rather than concentrating on the acquisition of a single skill during a practice session

Question 22

What are the types of performance feedback?

Answer 22

1) intrinsic/extrinsic
2) knowledge of results: information about the outcome of movement
3) knowledge of performance: information about the characteristics (parameters) of movement (PM)

Question 23

What will help facilitate motor learning in terms of performance feedback?

Answer 23

• when the pt problem solves not and doesn’t just repeats the solutions
• too much feedback may change performance during the session, but may not create true learning and carryover

Question 24

What are the 7 types of external feedback?

Answer 24

1) demonstration
2) visual feedback
3) tactile feedback
4) verbal feedback
5) auditory feedback
6) biofeedback
7) neurofeedback

Question 25

How can you promote motor learning through generalizability and variability?

Answer 25

1) different settings (e.g. gym, room, home)
2) different surfaces (e.g gait, carpet, tile, mats, uneven ground, curbs, ramps, stairs, etc.)
3) different assist (e.g. nurse, family, PT)
4) different time of the day

Question 26

How to promote motor learning through diverse activities in varied contexts?

Answer 26

• blocked vs random practice
  
  • multiple activities in multiple different ways
• task changing weight, object, position, surface, location. etc.
• varied environments (decreased lighting, inclement weather)

Question 27

Transcranial Megnetic Stimulation (TMS)

Answer 27

• the electromagnetic coil is held against the head and short electromagnetic pulses which causes depolarization or hyperpolarization of the neurons in the brain are administered through the coil
• the magnetic pulse passes through the skull, ad causes small electrical currents that stimulate nerve cells in the targeted brain region

Question 28

Forced Use

Answer 28

• interventions are designed to “force” the patient to use the affected extremity
  
  • may use immobilization of the unaffected extremity
  • force of treatment is to strongly encourage the use of the affected extremity

Question 29

Constraint Induced Movement Therapy (CIMT)

Answer 29

• Intense practice using involved UE
• Use of a “constraint” for the uninvolved UE
• Use of the involved UE for all activities throughout the day

Question 30

Virtual Reality and Game Systems

Answer 30

• allows patients to perform movements in a simulated environment and receive feedback on the effects of those movements
• use of various gaming systems and multiple games to advance activities
• generally used for UE mobility, LE weight bearing, sitting balance, and standing balance

Question 31

Body weight support treadmill training

Answer 31

• body weight support
  
  • harness/overhead counterweight system
  • provides support for excessive weakness
• motorized treadmill training
  
  • increases number of steps person is able to take (task practice)
• manual assistance given to generate normal stepping kinematics
• robotic gait training

Question 32

robotic assisted BWSTT

Answer 32

• the Lokomat is a body weight support treadmill system with a computer-driven walking orthosis, which is fastened to a patient’ trunk and LE’s, and passively guides them through a symmetrical gait pattern

Question 33

wearable robotics

Answer 33

• battery-powered and rechargeable, wearable exoskeletons
• allows people with paralysis to stand and walk
• use gesture-based human-machine interface
  
  • sensors observe gestures made to determine the intentions and then acts accordingly