Training Principles PDF

TRAINING PRINCIPLES - **List and describe 8 factors that influence neuroplasticity ** 1. Use dependent and specific - Degrade function and decrease size of cortical representations - Must activate networks during therapy - Task specific rehabilitation -- Increases these gains 2. Repe...

TRAINING PRINCIPLES - **List and describe 8 factors that influence neuroplasticity ** 1. Use dependent and specific - Degrade function and decrease size of cortical representations - Must activate networks during therapy - Task specific rehabilitation -- Increases these gains 2. Repetition and intensity  - Repetition required for the lasting neural changes must activate networks during therapy  - Greater intensity shown to induce neuroplasticity  - How many sets/reps? LOTS  3. Time sensitive  - More amenable early following injury.  4. Task performance, motivation, feedback and attention - More neuroplasticity when training relevant + important tasks - Appropriate feedback can increase therapy quality - Attention and focus during training influences the capacity to learn 5. Environment - Enhanced sensory, cognitive, motor and social stimulation facilitate increased neuroplasticity and learning - Ensure NOT competing for attention 6. Adjuvant or adjunct therapies - Priming can increase neuroplasticity - Priming can include motor imagery, mental practice, stimulation- based therapy or pharmacology 7. Patient characteristics  - Younger pepople greater/more efficient neuroplasticity than elderly - Stress can repair neuroplasticity  8. Pharmacology - GABA receptor agonists (e.g. baclofen, benzodiazepine; used for anxiety, seizures, spasticity) reduce neuroplasticity. - **Describe the 3 practice variables that influence motor skill acquisition.**  1. Task specificity → replicate the task as closely as possible using part/whole task practice.  2. Task intensity → many reps  3. Task variability → improve patients ability to perform the task in different scenarios   1. **Outline how a PT can increase the amount of repetitive task specific practice ** - Group therapy  - Independent and semi-independent supervised practice  - Training carers, nurses to practice task with patient  - Exercise booklets   - Incorporate training into daily living  b. **Outline considerations for practice specificity** - Make the task as similar to real life as possible.  - Including proprioception, attention, cognition, visual aspects that mimic the task  - Considering joint position, muscle length, closed and open chain exercises, type and velocity of contraction.  c. **Discuss when (and why) you would use exercises with low and high contextual inference  ** - Low contextual interference when a patient is less skilled at the task.  - High contextual inference when a patient has achieved basic foundational skills of the task and can apply it to different scenarios.  - **Discuss considerations for providing instructions and demonstrations to patients ** +-----------------------------------+-----------------------------------+ | **Instructions** | **Demonstrations** | +===================================+===================================+ | - Type:  | - Type  | | | | | - Sentence length, phrases, | - Unskilled by beginners  | | body language, clapping, | | | counting  | - Skilled by experts  | | | | | - Frequency:  | - Frequency  | | | | | - Attentional capacity of | - Frequently  | | the patient, | | | characteristics/interacti | - Timing | | on | | | between task and patient | - Before and during | | (previous skill | practice  | | experience) | | | | *Consideration: * | | - Timing: | | | | Demonstrations are more effective | | - Long sentence before ex  | with acquisition of a new pattern | | | of movement **rather than a** new | | - Short sentences and | parameter of a well-learned | | phrases during movement  | movement pattern | | | | | - Non-verbal during | | | movement | | +-----------------------------------+-----------------------------------+ - **Outline the different types of augmented feedback (with examples) and how these can be used in rehabilitation** - **Differentiate between knowledge of performance vs knowledge of results, Quantitative vs qualitative feedback, internal vs external focus, intrinsic vs extrinsic feedback and discuss when each could be used** +-----------------------------------+-----------------------------------+ | *Knowledge of results * | Provides information about the | | | **outcome** of performing a skill | | | or about **achieving the goal of | | | the performance** | | | | | | E.g. dynamometer, number of reps, | | | walking speed, distance walked  | +===================================+===================================+ | *Knowledge of performance* | Provides information about the | | | **movement characteristics | | | leading to a performance | | | outcome** | | | | | | E.g. force steadiness, amount of | | | sway -- gait  | +-----------------------------------+-----------------------------------+ | *Intrinsic feedback* | Direct feedback that you get from | | | an action. A patient may | | | successfully execute a movement | | | but realize they need to improve | | | the process (through body and | | | relative to body) | +-----------------------------------+-----------------------------------+ | *Extrinsic feedback * | Feedback from a person or data | | | such as a video or balance board | | | device etc | +-----------------------------------+-----------------------------------+ | *Qualitative * | Augmented feedback that is | | | descriptive in nature and | | | indicates the quality of | | | performance i.e. "Good" "Nice" | +-----------------------------------+-----------------------------------+ | *Quantitative* | Augmented feedback that includes | | | a numerical value related to the | | | magnitude of a performance | | | characteristic i.e. Speed of a | | | baseball pitch | +-----------------------------------+-----------------------------------+ | *Internal attention focus* | Instructions that direct | | | attention to the movement | | | themselves  | | | | | | i.e. Feel the muscle contracting | | | when you perform the movement | +-----------------------------------+-----------------------------------+ | *External attention focus* | Instructions that direct | | | attention to the effect of | | | movement on environment  | | | | | | i.e. Shift your weight toward the | | | table | +-----------------------------------+-----------------------------------+ [Task intrinsic feedback: ] +-----------------------------------+-----------------------------------+ | *Vision* | - Demonstrations | | | | | | - EMG Biofeedback | | | | | | - Mirror | | | | | | - Videos (real-time and | | | playback) | | | | | | - Scales | | | | | | - Wii Fit | +===================================+===================================+ | *Auditory* | - Instructions | | | | | | - Metronome | | | | | | - Clapping | | | | | | - EMG biofeedback | | | | | | - iPhone circle timer | +-----------------------------------+-----------------------------------+ | *Proprioception and tactile* | - Manual handling/guidance | | | | | | - Lokomat | | | | | | - Taping | | | | | | - Compressive bandage | | | | | | - Orthoses | +-----------------------------------+-----------------------------------+ - **Understand the types of patients that are more suitable for EMG biofeedback over electrical stimulation** EMG biofeedback:  Must have 2-/5 MMT, assists with improving muscular contraction ES: 0-1/5 MMT , assists with movement - **Describe the different strategies to train weak muscles. ** - **Provide examples of exercises for each.** 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 - **Discuss the skill vs compensation balance** Example of training the skill: Training a stroke patient to regain ankle dorsiflexion during walking rather than using an ankle-foot orthosis (AFO). Example of using compensation: Teaching a stroke patient with severe hemiparesis to use a one-handed dressing technique. Balance:  - Train the skill as much as you can until no further improvement possible and then introduce compensation.  - May depend on:  - Severity/Prognosis of condition  - Patients goals  - **Outline the principles of skill training + compensatory movements** 1. Practice intensity: ↑ amount (\>100+ reps; \>70mins), semi-supervised/independent practice, right level of difficulty 2. Practice variability: Include active problem solving (progression via task or environment)  3. Practice specificity: Task-specific (part/whole-task)  Teach/communicate via demonstrations, instructions and feedback - **Outline factors that can increase/decrease the difficulty of training, generally.** +-----------------------+-----------------------+-----------------------+ | **Skill training -- ↑ | | | | difficulty** | | | +=======================+=======================+=======================+ | **Task factors** | **Environmental | | | | factors** | | +-----------------------+-----------------------+-----------------------+ | - ↑ reps, | - ↓ base of support | | | frequency, | | | | duration | - Softer base of | | | | support | | | - ↓manual | | | | guidance/assistan | - ↑ attentional | | | ce | demands | | | (not doing | | | | movements for | - Use of variety of | | | them) | real environments | | | | | | | - ↑ resistance | - Add extraneous | | | | conditions | | | - ↑distance/amplitu | (weather, light, | | | de, | noise) | | | speed, direction | | | | of mvmt | | | | | | | | - ↑ deg of | | | | freedom/joint | | | | involved  | | | | | | | | - Part task → whole | | | | task | | | | | | | | - Body transport + | | | | object | | | | manipulation | | | | | | | | - Add cognitive | | | | task | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+