EHR525 Week 4b Motor Learning in Neurorehabilitation PDF

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of th...

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice School of Allied Health, Exercise and Sports Sciences 1 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 1 EHR525 EXERCISE FOR NEUROLOGICAL & MENTAL HEALTH CONDITIONS Motor Learning Concepts in Neurorehabilitation Presenter: Jack Cannon School of Allied Health, Exercise and Sports Sciences 2 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 2 WHAT WILL WE COVER: ■ Review key motor learning concepts. ■ Applications to neurorehabilitation. School of Allied Health, Exercise and Sports Sciences 3 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 3 KEY MOTOR LEARNING CONCEPTS IN NEUROREHABILITATION ■ Meaningfulness □ Motivation/goals. ■ Timing □ Distribution and frequency of practise. ■ Repetition ■ Challenging □ Functional difficulty. ■ Task specificity □ Transfer to real life. □ Practise variability. □ Practise strategies. □ Amount of practise. School of Allied Health, Exercise and Sports Sciences 4 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 4 MEANINGFULLNESS/ MOTIVATION ■ Influences task attention and allocation of cognitive resources. ■ Motivation has a strong influence on successful rehabilitation. ■ Making the task seem important: Add meaning to exercises can serve as an intrinsic motivator and enhance performance. ■ Goal-setting: Specific goals that are adjusted during practice lead to improved learning compared to telling people to do their best. ■ Positive feedback: Can have a motivational effect that can enhance learning. Attention during exercise drives neuroplasticity School of Allied Health, Exercise and Sports Sciences 5 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 5 TIMING/ DISTRIBUTION AND FREQUENCY OF PRACTISE ■ There is weak evidence that distributed practice might be better for neurorehab than massed practice. ■ Benefits of rest periods: Frequent and longer rest periods between repetitions (distributed practice) improve learning compared to no rests (massed practice) in healthy subjects. ■ Trade-off: Massed practice enables increased amounts of training per time but higher fatigue reducing motivation and increasing the chance of injury. School of Allied Health, Exercise and Sports Sciences 6 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 6 REPETITION/ AMOUNT OF PRACTISE ■ More practise is assumed to be better than less practise. ■ Increasing the amount of task repetitions results in greater cortical changes and better functional improvement. ■ A minimal amount of repetitions might be required for recovery to take place. ■ Power law of practice: Early in practice we experience a lot of success but later in practice amount of improvement rate decreases. Practice makes perfect. School of Allied Health, Exercise and Sports Sciences 7 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 7 TASK DIFFICULTY ■ Active generation of controlled movements are necessary for effective motor learning. ■ Too much movement assistance can reduce physical effort and therefore diminish skill learning. ■ Increasing task difficulty can lead to increased effort. ■ Clients should participate as actively as possible and be cognitively challenged without being overwhelmed. School of Allied Health, Exercise and Sports Sciences 8 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 8 TASK DIFFICULTY ■ Learning is optimal when difficulty is out of “comfort zone”. overchallenge □ More complex tasks enhance shortand long-term neuronal changes. ■ Tasks should be adjusted for each client for an optimal challenge. ■ The optimal learning difficulty is not identical with the difficulty under which performance is greatest. School of Allied Health, Exercise and Sports Sciences “comfort zone” optimal learning 9 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 9 TASK SPECIFICITY ■ Clients should focus practice on activities essential in daily-life in a setting which is as realistic as possible. ■ Task oriented training improves function and changes cortical activation. ■ Practice with real objects under realistic situations significantly improves transfer of learning. School of Allied Health, Exercise and Sports Sciences 10 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 10 PRACTISE VARIABILITY ■ In general, practicing a task in variable settings or in a random order improves learning and the ability to generalise. ■ Forgetting helps remembering. ■ Motor performance and motor learning are not the same. ■ Alternating randomly between training of multiple tasks (random practice) seems to be more effective than constant practice (blocked practice) in improving motor function. School of Allied Health, Exercise and Sports Sciences 11 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 11 PRACTISE METHODS ■ Tasks should only be broken down into parts if composed of distinct subparts or if the whole task proves to be too difficult. ■ Fractionalisation: E.g. Breaking bilateral tasks into two unilateral parts. ■ Progressive part practice: E.g. Separate task into several subparts. ■ Simplification: E.g. Reducing complexity of the task or parts of it. ■ Continuous tasks such as walking and fast, discrete tasks should be learned as whole. School of Allied Health, Exercise and Sports Sciences 12 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 12 SUMMARY ■ Principles of motor learning can help drive neuroplasticity and recovery and support the development optimal training environments. ■ Motivation is very important for effective therapy and can be increased by making the training enjoyable, adequately challenging, and goal-oriented. ■ Practice should be variable and include different tasks while motor goals should be approached in small steps reinforcing client’s progress. School of Allied Health, Exercise and Sports Sciences 13 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 13