Neuroplasticity & Motor Control/Learning Flashcards
Motor Learning
-learning new strategies from moving
-permanent changes in behavior
-increases activity of thalamocortical pathways
-parallel pathways aid in efficiency and redundancy
Performance
-temporary change in motor behavior
Classical Conditioning
-1 stimulus to conditioned response
-weak stumulus and response paired with stronger stimulus
-pavlov
Operant Conditioning
-behavior to consequences
-trial and error: behavior shaped by internal throughts and motivation
-consequences: reinforcement to strengthen behavior and punishment to weaken
Implicit Procedural Learning
-skills and habits performed without attention
-must be performed by learner
-basal ganglia loops
-riding a bike
Explicit Learning
-conscious processes with end product of acquiring knowledge
-prefrontal cortex, limbic
-learning to code
Early Cognitive Phase
-high attention
-activation inc then dec in dorsolateral PFC, sensorimotor corticies, parietal and cerebellum
-sesnory feedback
-performance with rapid improvement
-lots of error
Associative Phase
-motor/sensory pathways active but less
-inc in cerebellar activity and basal ganglia
-executive function needed
-new skills, compare results
-refine skill
-slower improvements
Autonomous Stage
-primary cortex remains active but decreased
-more automatic basal ganglia
-increased accuracy, less attention
-stable performance
Degrees of Freedom
-coordination of movement
-start with a little and increase overtime as mmt becomes habitual
Movement Schema
- Initial Movement Conditions: where
- Parameters in Motor Program (KOP): how to
- Knowledge of Results: How did i do
- Sensory Consequences
Instability
-lots of instability following brain injuries
-need instability to form new patterns of stability
Gordon’s Investment Principle: Task-Oriented Theory
-plateau using old strategy
-new strategy will increase performance
Newell’s Theory of Learning
-during practice optimal strategies to solve the task
-Perception as prescriptive: understanding of goal and movements
-Perception as feedback: knowledge of performance and knowledge of results
Knowledge of Results
-extrinsic feedback about outcome
-given after pt has thought about their performance
Knowledge of Performance
-during task, analyzing performance
-movement parameters
Massed vs Distributed
Masses: same time
Distributed: spaced out (better for learning)
Constant vs variable
Constant: same circumstances
Variable: different (better for learning)
Contextual Interference
-doing something different in between breaks
Learned Non-use
-pt can use arm, they just havent learned not to use it
-from overuse of other limbs or learning compensations
Prior to Practice Considerations
Consider:
-stage of learning
-goal
-environment
-instructions
During Practice Considerations
Consider:
-task specific activity
-time allowances
-mental practice
-trial and error
Levels of Movement Analysis
Action Level: behavioral outcome; could it be done
Movement Level: movement strategy to accomplish outcome; how was it done
Neuromotor Level: underlying process contributing to movement; why was it done
Organization of Movement: Individual
-cognition
-perception
-action
Organization of Movement: Task
-mobility
-stability
-manipulation
Organization of Movement: Environment
-regulatory
-nonregulatory
Gentile’s Taxonomy
-system to classify tasks to understand demands on person
-environment
-function
Gentile’s Taxonomy: Environmental Context
-mmt matches environ features
Stationary: timing not specified
Motion:
-occurs independently of person
-must match movements of environment
-compensatte for delays
-predictions
Intertrial Variability
-changes in conditions between tasks
As movement variability decreases
-less attention paid
-pattern, schema, less late practice
-closed skill
ex: turning on the same light everyday
As movement variability increases
-more attentiveness
-new movement pattern generated
-open skill
-requires continued late practice
ex: working with a different patient each day
Gentile’s Taxonomy: Task Categories
Closed Task: stationary objects
-don’t change each trial
-least interaction with environment
Ex: pick up a phone off a desk
Variable Motionless Tasks: stationary objects
-task may vary from one attempt to next
Ex: pick up a differing cup off of a desk
Consistent Motion Tasks: motion of object remains constant
-most interactiton with environment
Ex: getting on an escalator
Open Tasks: most interaction
-most complex
Ex: running in an obstacle course
Gentile’s Taxonomy: Function of Action
Body Orientation:
-stabilizing or transporting tasks
Manipulation: usually with hands
-w/o manipulation, arms are part of postural system
Principles of Neuroplasticity
Use it or lose it
Use it and improve it
Specificity
Repetition
Intention
Salience
Time Since Onset
Age
Transference
Interference
Grading Functional Tasks: LE
-speed
-loading
-assistance
-Intensity
-error
-AD
-Cardiovascular factors
-Accuracy
Grading Functional Tasks: UE
-position of patient (describe)
-objects being manipulated (position, weight, size)
-AD
-Time
-Unilateral vs Bilateral
-Accuracy
Factors that Influence Neuroplasticity
Sleep: storage of earlier learning
-plasticity cotinues in sleep
Mood:
-Depression: reduces hippocampus, neuronal loss, decreased conentration/memory
-Stress: mild=enhances learning and memory; chronic can cause neuronal loss
Cardiorespiratory Funtion:
-decrease of dementia
-improves….everything
Predictors of Walking Recovery Post Stroke
80% walk post stroke
98% walked at 6m IF:
-(I) sitting balance in first 3 days
-LE strength of 1/5 in first 3 days
27% walked if criteria was unmet in 3 days
10% if unmet in 9 days
-Berg balance <20/56 % FIM 1 or 2= 20x more likely for only home ambulation
Predictors of UE Funcgtional Recovery Post Stroke
AROM of shoulder and middle finger predictted function at 3m
-if not at 3 months, likely wont have functional use
AVERT Study
Control= standard of care
Experimental=
-1st mobilization within 24hrs
-upright 2x/d
-BID
-14 days total
Significant Differences:
-time in PT
-time to first mobilization
-cost of care
-function
Standing Balance and Gait Study
-standing feedback traininer
-no significant differences
-ie, dont train gait using body weight supports
Gait Speed
-6th vital sign
Unlimited Household Ambulation: 0.27m/s
Limited Community Ambulation: 0.58m/s
Unlimited Community Ambulattion: 0.8m/s
Cross Commercial Street: 2 m/s
Non-stroke Community Ambulation: 1.2m/s
Neurology of Walking: Essential Neuroanatomy
-muscles and peripheral nerves
-spinal cord pattern generators
-Anteriolateral/medial SC pathways
-Medullary Reticular Formation
-Mesencephalic Locomotor Region
-Subthalamic Locomotor Regions
Neurology of Walking: Important Neuroanatomy
-sensation
-Posteriolateral SC pathways
-Pontomedullary Locomotor Strip
-Cerebellum (vermis)
-Red nucleus
-Lateral Vestibular Nuclei
-Basal Ganglia
-Limbic Cortex (hippocampus)
Function:
-timing of swing vs stance phase
-coordination
-motivation (hippocampus)
Neurology of Walking: Accessory Regions
-Motor cerebral cortex
-Pyramidal Tract
Functions:
-influence initiation, timing, transition of gait, positioning of the foot
Spinal Cord Central Patern Generators
-intrinsic circuits located in grey matter that produces and repeas a functional behavior
-switches between flexors and extensors
-can react to sensory input
-can recover and learn
Medial Medullary Reticular Formation
-final inttegrattive center for locomotion before spinal cord
-driving center for locomotion
-descends in anterolateral cord to provide drive to CPG
-treadmil training can create new CPG when forcing symmetrical mmts
Mesencephalic Locomotor Region
-region of midbrain
-when stimulated, lococmotion is initiated with speed of movement consistent
-modulates speed of walking
-involved in exploratory walking
Subthalamic Locomotor Region
-responsible for spontaneuous goal-directed locomotion
3 Key Sensory Inputs for CPG
Sretch of hip flexors:
-resets CPG
-hip ext during mid stance triggers swing from muscle spindles
-stopping extension stops walking
Unweighting of triceps surae: -initiates step
Weight Bearing to facilitate extensor tone
Lokomat
-Pt in suit that thelps them move
-max speed of 2mph
Contraint Induced Movement Therapy (CIMT)
-learned non-use
-cortical reorganization can happen with aggressive treatment
Principals:
-increased arm use
-Massed practice
-High motivational drive
- Learned non-use
- increased motivation
- Use
- Reinforcement
- More Practice
- Cortical reorg
- Reversal of Learned non-use
Candidates for CIMT
-raise arm 45deg
-extend elbow 30deg with shoulder flxed 90
-extend wrist 10-20deg , slightly extend at least 2 fingers and extend thumb 10deg**
-Stand for 2 min
-B/B continence
-understand and follow directions**
-Medically stable and highly Motivated
CIMT Protocol
Repetitive, Task-oriented training:
-shaping
-task practice
Adherence-enhancing behaviors:
-behvaior contract
-diary
-log
Constraining use of less affected:
-Mitt restraint of less involved UE
-remind Pt to use involved limb
EXCITE Trial
-stroke survivors recieving CIMT
-significant inprovements
-unmasked an ability already present
