STROKE

Question 1

Strategies to train weak muscles (<2/5)

Answer 1

Strategies to train weak muscles: Grade 0-2
Grade 0-1 /5: ES
Grade 2-/5: EMG biofeedback
Reduce friction → socks, skateboard, slidesheet
Eliminate gravity → change position
Shorten lever
Provide manual guidance
Reduce degrees of freedom
Mental practice

Question 2

List and describe 8 factors that influence neuroplasticity
(URTTEAPP)

Answer 2

1. Use-dependent and specific
2. Repetition and intensity
3. Time-sensitive
4. Task performance, motivation, feedback and attention
5. Environmental features
6. Adjuvant or adjunct therapies
7. Patient characteristics
8. Pharmacology

Question 3

What are the 3 practice variables that influence motor skill acquisition?

Answer 3

1. Practice intensity (high reps)
2. Practice specificity (whole/part task)
3. Practice variability (less then progress)

Question 4

what is meant by practice intensity for stroke patients

Answer 4

neuroplasticity can take days, weeks, months..
Lots of reps are required for motor skill acquisition.

Question 5

What strategies can you use to increase the amount of practice for practice intensity?

Answer 5

group therapy
training partner
incorporate training into daily living
exercise booklets
independent and semi-independent supervised practice.

Question 6

What is meant by practice specificity in motor skill acquisition?

Answer 6

Movements should be similar and in the correct context while the skill is being practiced.
Use whole and part task practice to best replicate the skill that is being practiced.

Question 7

what is meant by practice variability in motor skill acquisition?

Answer 7

The variability in movement and context characteristics the learner experiences when practicing a skill.

Question 8

How can we make a skill more specific?

Answer 8

Senses: vision, proprioception (walk on uneven terrain), attentional (count steps out loud) and cognitive (multi-tasking)

Muscles: joint angle, muscle length, type and velocity of contraction, open or closed chain

Environment specific: objects, equipment, active, static.

Question 9

How can we make a skill more variable?

Answer 9

Additional tasks/ skills/actions
Intertrial variability
Contextual interference (sequencing, i.e. low = blocks of the same skill practice, high = random order of trials between task variations)

WALKING example:
- Change the surface, alter the speed, change the environment (inside v outside), include obstacles, change footwear, add dual task.

Question 10

Outline factors that increase the difficulty of training

Answer 10

Task:
- increase reps, frequency, duration.
- increase resistance
- reduce manual guidance
- increase speed, distance, amplitude
- progress from part to whole task
- add a cognitive task

Environmental:
- reduce base of support
- change support i.e. soft chair
- increase attentional demands
- change the environment
- perform in a loud/busy space

Question 11

What are important considerations when providing instructions to patients?

Answer 11

Timing (before, during or after)
Type (sentence length)
Frequency (attentional capacity of the patient)

Question 12

difference between knowledge of results and knowledge of performance?

Answer 12

Knowledge of results provides info about the outcome of a result
Knowledge of performance gives feedback on the process of performing a skill

Question 13

how can qualitative feedback be helpful in rehab

Answer 13

can provide improvements in technique

Question 14

In what scenario would you prefer intrinsic feedback over extrinsic feedback?

Answer 14

when patients are skilled enough to evaluate their own performance