Slide 1. Slide 2. Slide 3. Chapter Objectives Page 45 CHAPTER 3: MOTOR LEARNING, MOTOR CONTROL, AND NEUROPLASTICITY

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1 Slide 1 CHAPTER 3: MOTOR LEARNING, MOTOR CONTROL, AND NEUROPLASTICITY PT: 151 Slide 2 Chapter Objectives Page 45 Identify differences among motor learning, motor control, neuroplasticity Differentiate between practice context and practice schedules Stages of motor learning, implications on intensity of practice and degrees of external feedback Identify differences between external and internal feedback and assignment of appropriate schedule Slide 3 Feedforward vs cognitively run programs Motor learning as a child and motor relearning of the adult with CNS dysfunction Current theories of neuroplasticity ID sensory processing, motor learning interactions and sensory input that can be used to retrain the motor system

2 Slide 4 Some Key Concepts Page Motor learning uses sensory input to give the CNS necessary info to improve motor learning and gain motor control of a task Table 3-1. Page 47 Slide 5 Some Key Concepts Page Sensory input is needed when programming changes are needed Once motor control is programmed and acecssible to the CNS sensory input is no longer needed to run that program, UNLESS changes in programming are required Slide 6 Some Key Concepts Page Motor learning is a lifelong process as long as the environment asks for change AND the CNS is plastic enough AND desires to retain control over functional movement

3 Slide 7 Central Theme Regaining movement function through therapeutic exercise has been a central theme for the field of physical therapy since the profession s beginning in respect to motor learning, motor control and neuroplasticity Slide 8 Historical Perspectives Page 48 Prior mid-20 th century theories: based on assumption that functional movement is under a rigid hierarchical control within the nervous system. During this era, treatment approaches such as proprioceptive neruomuscular facilitation (PNF), Bobath, Rood, Ayers, Johnstone, and Brunnstrom, were developed. They all had something in common: very keen observers of movement, normal and abnormal. Slide 9

4 Slide 10 Historical Perspectives Theories do change, but keen visual observations of functional movements and limitations will always remain critical skill for PT and PTA. Slide 11 Historical Perspectives Many of the previously mentioned approaches are still used and retain similar treatment applications and interventions; however the treatment rationale for each of the various approaches utilizes more current research and basic science to explain its validity. Slide 12 Motor Control page 49 Nothing happens until something moves - Albert Einstein Movement management in functional activities (page 46)

5 Slide 13 Motor Control page 49 The study of CNS regulation of the MS system and the generation of movements for attainment of tasks within the environment. 3 elements: neural circuitry, motor plan, environment Movement generation = sensorimotor loop Learning= consistency and efficiency over the control of the elements needed to generate the movement Slide 14 Motor Control pg. 49 The study of how an individual controls movement already acquired. The PTA can recognize a change in the control of a pattern or functional skill and inform PT. The patient s ability to perform a task is dependent upon his or her own inherent mechanisms, which my vary. Slide 15 Motor Control Motor control means the control an individual has, given the unique characteristics of that individual. Differences occur before injury or disease as well as following. It is up to the PT to guide the PTA s interventions in order to optimize the functional recovery of the patient.

6 Slide 16 Motor Learning The study of how individuals acquire, modify, and retain motor memory patterns so that programs can be used, reused, and modified during functional activities. Examples: rolling, head control in all planes of movement, coming to stand, toilet training, feeding, walking, running, jumping, playing group sports, mountain climbing, swimming, or any other combination of motor behaviors that synthesize to allow for success at a motor task. Slide 17 Slide 18 Motor Learning pg Principles: Learning is a process of acquiring the capability for skilled action. Learning results from experience or practice

7 Slide 19 Motor Learning learning cannot be measured directly instead, it is inferred based on behavior learning produces relatively permanent changes in behavior, thus short-term alterations are not thought of as motor learning. Slide 20 Task Analysis Slide 21 Example: Difference between short term change and motor learning You have a pt. you work with log rolling from supine to side lying. At the beginning they need both physical and verbal assist, but at the end of session they can roll independently

8 Slide 22 Difference between short term change and motor learning The next day, the pt. may not roll independently even with verbal cueing but is more quickly able to roll with assitance. This is an example of short term alteration. When the pt. can consistently roll independently over time (permanent change in behavior), then motor learning has occurred. Slide 23 Motor Learning Cont. Page 53 5 Components of motor learning Practice context Practice schedule Stage of motor learning Feedback application Type of feedback utilized Slide 24 Practice Context Pages Whole Learning Pure-part Learning Progressive/Sequential Learning Whole to Part to Whole Learning

9 Slide 25 Practice Context pg Refers to the way a therapist chooses to teach the motor activity. Whole Learning: practicing a behavior or task in its entirety. Has an end point Pure- Part Learning: Used for complex activities where the component parts are discrete motor programs in and of themselves. - i.e. when teaching and individual to stand up and then sit down in a chair. Slide 26 Practice Context pg Progressive/Sequential- Part Learning: when teaching intermediate skills and serial tasks that require many steps that must be performed in a specific sequence in order to be considered successful. Slide 27 Practice Context pg Whole to Part to Whole Learning: Most frequently used in the clinical environment. First asked to perform whole task; then clinician breaks down the task, then reconstitutes the entire program. During the initial whole task, a therapist can complete a task analysis and then work on the parts that need focusing on.

10 Slide 28 Practice Context pg Summary of Practice Contexts Box 3-1 Page 55 Slide 29 Practice Schedules pp Mass Practice Distributed Practice Random Practice Slide 30 Practice Schedule pg Mass Practice: used to learn or relearn a skill that is essential for ADL s. The opportunity for a patient to repetitively practice a motor pattern or functional movement with few interruptions

11 Slide 31 Practice Schedule pg Once the skill is learned and established within CNS, no longer need to mass practice, unless external environment changes (walk on hard surface to grassy surface). Generally acute or in-patient setting 1-3 times/day Slide 32 Practice Schedule pg Distributed Practice: program is available to the patient s CNS, but impairment errors occur and practice is still needed to insure long-term motor memory. Generally used in outpt., home health settings. 2-3 times/week Slide 33 Practice Schedule pg Random Practice: task is performed indep without a scheduled frequency OR order to the practice. Patient or caregiver is responsible for performing the exercises or supervising the exercises PTA is no longer needed to assist with this practice schedule

12 Slide 34 Stages of Motor Learning - pp Stage 1: Cognitive/Acquisition Stage Stage 2: Associate/Refinement Stage Stage 3: Autonomous/Retention Stage Slide 35 Stages of Motor Learning - pg. 57 Stage 1: Cognitive Stage/Acquisition of Motor Skill The patient is learning a new skill or relearning an old one as a whole activity. (whole learning) At this stage, an individual needs to practice often and needs a lot of external feedback from the practitioner in order to be successful. Slide 36 Stages of Motor Learning pp However, allowing patient to practice and self-correct is important during this initial stage. (intrinsic feedback) Give patient time to self-correct before providing the external feedback. The environment used for practice should be consistent Type of practice: Mass Practice

13 Slide 37 Stages of Motor Learning pg. 58 Stage 2: Associative Stage/Refinement: A patient can run the program within specific environmental constraints, will have a decrease in error during the activity, and will apply less effort during performance. Slide 38 Stage 2: Associative Stage/ Refinement Cont. Usually environment is consistent, although variance in the specific components is present. Self-correction is important for refinement Slide 39 Stages of Motor Learning pg. 58 Stage 3: Autonomous/Retention The patient moves to a variety of different environments and retains control of the whole program

14 Slide 40 Stage 3: Autonomous/Retention The true hallmark of learning is the ability to retain the skill and transfer the skill into different settings. At this time, practice is usually random and part of everyday. Slide 41 Feedback- Page 59 2 Types: Intrinsic and Extrinsic Need: sensory input to have intact feedback from the CNS to the periphery Slide 42 Feedback pg. 59 Intrinsic Feedback: based upon sensory responses inherent to the patient s body as part of the desired movement itself.

15 Slide 43 Feedback pg. 59 The PT should determine whether there is conflict or loss of inherent feedback. If deficits exist, the PT should delegate the specific activities that either allow the patient to regain accurate sensory awareness during the activity or substitute another sensory system. Slide 44 Feedback pg. 59 Lack of appropriate intrinsic feedback or compensatory input systems will lead to error that is not corrected and thus, failure in obtaining functional independence. Slide 45 Feedback Extrinsic Feedback: Based upon outside source providing feedback. This type of feedback can lead to better performance during motor activity, but until the patient self-corrects using inherent feedback, independence is not obtained. (the patient will learn to rely on the external feedback)

16 Slide 46 Feedback- Extrinsic Pg types: Knowledge of performance: uses sensory system to inform the patient as to whether the quality or efficiency of the movement pattern is achieved. Knowledge of results: informs patient as to whether the task is accomplished or how close the movement comes to accomplishing the task. Slide 47 Feedback Schedules pg. 60 Schedules for external feedback: Summary feedback: provides feedback after a set number of trials of the task (ie: after every other or every third trial) Slide 48 Feedback Schedules pg. 60 Faded Feedback: initially provides feedback after every trial, then decreasing to every other trial, every third, every fourth, etc. Most effective

17 Slide 49 Feedback Schedules Cont. Delayed feedback: PTA withholds the feedback for a short time. Allows selfassessment of performance. Slide 50 Neuroplasticity pg. 61 Defined as the brain s ability to adapt and use cellular adaptations to learn new or relearn functions previously lost due to cellular death by trauma or disease at any age. Slide 51 Neuroplasticity pg. 61 Research shows that given an appropriate environment to learn in, the BRAIN CAN LEARN or RELEARN despite cellular damage. Question: When treating a patient, is it better to trigger a patient s normal walking pattern before resulting to compensatory techniques? Why?

18 Slide 52 Principles of neuroplasticity Kleim and Jones pg Use it or lose it. 2. Use it and improve it. 3. Specificity 4. Repetition and intensity matter. 5. Saliency matters.

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