Activity based task analysis
Is the process of breaking an activity down into its component parts to understand and evaluate the demands of a task
1. spontaneous
2. function-induced
what are 2 types of recovery of function?
Spontaneous
(occurs w/in 3-4wks) after temporary diaschisis
Denervation supersensitivity
Postsynaptic neuronal hypersensitivity, results in decreased synaptic efficiency
function-induced (use-dependent cortical reorganization)
Neural re-organization that occurs as a result of increased use of involved body segments in behaviorally relevant tasks.
-constraint induced movement therapy
-locomotor training using partial bodyweight support on a treadmill
cortical remapping
Different and under-utilized areas of the brain (i.e. cortical supplementary and association areas) can take over functions of the damaged tissue
parallel cortical maps
CNS has back-up parallel cortical maps that may become operational when the primary system breaks down
Regenerative synaptogenesis
Sprouting of the injured axons to innervate previously innervated synapses
Reactive synaptogenesis
(Collateral sprouting), refers to the reclaiming of synaptic sites of the injured axon by dendritic fibers from neighboring axons
substitution
Whole areas of the brain are capable of reprogramming
-task specific training
-motor learning strategies
What are the types of restorative interventions?
1. Emphasize early training.
2. Define the goal of task practice.
3. Determine activities to be practiced.
4. Determine the parameters of practice.
5. Utilize behavioral shaping techniques.
6. Promote problem-solving.
7. Structure the environment.
8. Esta
Task-Oriented Training Strategies Combined with Motor Learning:
Recent injury/lesions
Those who lack voluntary control
Those who lack cognition
Who is task-oriented training not meant for?
Self-care activities
Posture
Balance
Identifying fall risks
Secondary impairments prevention
What are the components of safety awareness training ?
1. efficiently
2. consistently
3. and is transferable
Motor learning strategies: A learned skill is one that can be done:
Concurrent feedback
Feedback given during task performance
Terminal feedback
Feedback given at the end of a task
Summed Feedback
Feedback is given after a set number of trials
Faded feedback
Feedback is given at first after every trial and then less frequently
Bandwidth feedback
Feedback is given only when performance is outside the given error range
Behavioral Shaping techniques
-designed to systematically progress the level of difficulty of tasks practiced
-provide immediate and explicit feedback to shape and improve performance
-Use reinforcement and reward to promote skill development
Inability to perform voluntary wrist and finger extension of the involved hand
What is one exclusion criteria for CI?
Whole part learning
-Most effective with discrete or serial motor tasks that have highly independent parts not effective for continuous mvmnts
-do the whole task then break it down into parts and then build it back up to whole
bilateral transfer
learning is promoted through practice using contralateral extremitites
Retention
The ability of the learner to demonstrate a learned skill overtime and after a period of no practice
Transfer test
An examination of performance of similar or related skills compared to a previously learned skill
Generalizability
The ability to apply a learned skill to the performance of other similar or related skills
Stage 1: Cognitive Stage
-Person experiments with strategies, keeping ones that work
-Performance is variable
-Improvements in performance are quite large
Treatment for Stage 1: Cognitive Stage
-Organize initial practice:
o Stress controlled movements
o Provide adequate breaks
o Use manual guidance as appropriate
o Break complex tasks down (part) then integrate to whole.
o Used more blocked practice at firs
-Demonstrate ideal performance of the task to establish a
reference for correctness
-Direct attention to critical task elements
-Select appropriate feedback
o High dependence on vision
o Pair intrinsic with extrinsic feedback
o Only focus on errors that b
Motor Learning Stage 2: Associative
-Spatial/Temporal become organized
-Propio increases & visual dependence decreases
-Best strategy for the task has been chosen
-Working on refining the skill
-Less variability in performance
-Improvement slower
-Verbal/cognitive aspects not as important
-May last days to months
Treatment Strategies for Stage 2: Associative?
Select appropriate feedback
o KP, when errors consistent
o Emphasis on proprioceptive feedback (working towards more intrinsic feedback) "how did that feel?"
o Continue to provide KR (focus - functional outcome)
o Less manual facilitation during this stag
Motor Learning Stage 3: Autonomous
-Skills become more automatic with less attention required
-Learner is capable of coordinated motor patterns
-Focus now: how to succeed - should be able to function in stable and unstable environments (closed and open)
Treatment Strategies for Stage 3: Autonomous
o Stress consistency of performance in variable environments, variations
of tasks (open skills)
o High levels of practice (massed practice)
-Dual-tasks
o Vary environment
o Ready for all environments
-Focus on competitive aspects of skills ( i.e. w/c spor
immediate, continuous, then transition to delayed, variable, terminal
Feedback Schedule for Stage of Learning: Stage 1: Cognitive?
delayed, summed, fading, bandwidth, terminal
Feedback Schedule for Stage of Learning: Stage 2: Associative?
delayed, summed, fading, bandwidth, terminal
Feedback Schedule for Stage of Learning: Stage 3: Autonomous?
Massed practice
A sequence of practice and rest intervals in which the rest time is much less than the practice time
-pt must have adequate endurance, attention, concentration
Distributed practice
Spaced practice intervals in which the practice time is equal or less than the rest time
-results in the most learning per training time
-with adequate rest, performance can be improved without interfering effects of fatigue
-beneficial for low motivated,
Blocked practice
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-improved early acquisition
-better for performance bc low contextual interference
Refers to the practice sequence organization around one task performed repeatedly, uninterrupted by the practice of any other task
Random practice
Practice order is random across trials
-superior long-term retention
Serial order
123123123 "predictable and repeating order
Mental practice
Should be considered for patients easily and or unable to sustain physical practice
-alleviates anxiety
-increases the accuracy & efficiency of mvmnts
Knowledge of result (KR)
feedback on the end result
Knowledge of performance (KP)
feedback about the nature and quality
-should focus on key task elements that lead to a successful final outcome
Impairment interventions
Strength, power, endurance
Flexibility
Postural control and balance
Coordination and agility
Gait and locomotion
Aerobic capacity/endurance
Relaxation
Augmented interventions
NDT
NMES
sensory stimulation
Biofeedback
Neuromuscular electrical stimulation
(MS, GB, Chronic Fatigue Syndrome, Post-Polio)
What are CNS conditions that cause debilitating fatigue?
40-70%
moderate intensity for aerobic training is ________________ of maximal O2 ?
Progressive relaxation training
Learning to relax specific muscle groups paying to the feelings associated both with the tensed and relaxed states.
Achieve a state of deep relaxation in increasingly short periods and control excess tension in stressful situations
-16-7-4-then tension is removed
What is the purpose of progressive relaxation training?
Passive muscular relaxation
Systematic review of the skeletal muscle groups in the body
Patients identified any tension in muscle group addressed and release it
-can be taken to the workplace and take less time
-used by those with disabilities
Differential relaxation
1) isolate the task
2) reduce muscle tension to below the level the task can be done at
3) introduce the minimal amount back where the task can be completed
Muscles engage in activities needed to engage the least amount of tension necessary to produce the task
Ex: squinting while writing
PNF
Gate and locomotion
Coordination and agility can be trained by using which techniques?
Neuromuscular facilitation techniques
PNF
NDT
Patients with stroke or TBI who are early in recovery and have limited abilities are good candidates for?
** when the patient develops adequate voluntary control, these interventions are generally counterproductive and should be discontinued
NDT
This technique depends on neuro plasticity? Where normal movement patterns are stressed and compensations are avoided
Postural control
What is the key intervention focus NDT?
NDT
o Originally based on reflex and hierarchical theories
o Modern approach: uses newer motor control theories
o Depends on neuroplasticity
� Normal movement patterns stressed and compensations avoided
o Key parts of the body therapists use to control mo
-Postural control is viewed as a foundation for all skill learning
-the patient learns to control posture and movement sequence of progressively more challenging postures and activities
-uses physical handling techniques and key points of control
�Postura
Therapeutic handling. Is used to influence the quality of motor response and his matched to the patient's ability to use sensory information
What is the NDT intervention hallmark?
Neuromuscular Facilitation (NMF)
-Facilitation, activation, or inhibition of muscle contraction and motor responses.
Resistance
Tapping
Joint approximation
Vibration
Quick stretch
Prolonged stretch
Joint traction
facilitation
enhanced capacity to initiate a movement response through increased neuronal activity
activation
actual production of a movement response through altered synaptic potential
1. Techniques are additive
A. Spatial Summation
B. Temporal summation
2. Response is dependent on the patient; choose wisely and watch carefully.
3. These techniques are used as a bridge to voluntary movement
Guidelines important for neuromuscular facilitation
Sensory Stimulation (SS):
Purpose:
1. improve attention and arousal
2. enhance sensory selection and discrimination
Maintained pressure
Light touch
Prolonged cooling
Rapid vestibular stimulation
Slow, repetitive stroking
Neutral warmth
Slow vestibular stimulation
1. Appropriate stimulation intensity is required
2. Sensory receptors adapt over time
3. Careful on face, palms of hands, soles of feet
4. Maintain focus on sensory-deficient limbs (despite patient's lack of interest in moving it)
5. Can also attempt to r
Guidelines important for sensory stimulation:
Biofeedback
-It provides and accurate indication of electrical activity associated with muscular effort (not force of effort)
-Most beneficial to patients with weak muscles (MMT 1-3)
NMES
Electrodes are placed directly over muscles to stimulate
them
-Can help with: reduce tone, re-educate muscle, improve ROM, decrease edema, treat disuse atrophy
-NMES and FES
Compensatory interventions
Substitution training
Assistive devices
Supported devices
quick stretch
Activates muscle spindles sensitive to velocity and length changes. has both segmental (SC) and suprasegmental (CNS higher centers) effects.
-more effective when applied in a lengthened range
-can use tapping w/ this
prolonged stretch
-applied at max available range
-activates muscle spindles, GT organs,
-segmental and suprasegmental
-inhibits muscle contraction and tone due to stretch-protection reflex
-casting .......
-more effective in extensor muscles
**to maintain effects follow w
resistance
-activates muscle spindles & GT organs
-segmental and suprasegmental
-peripheral reflex effects: facilitates agonists, inhibits antagonists, facilitates synergists
-GT organs via autogenic inhibtion
-carefully grade for optimal function
joint approximation
-activates joint receptors (static type 1)
-segmental and suprasegmental
-facilitates postural extensors
-enhances joint awareness
inhibitory pressure
-deep, maintain pressure applied across the longitudinal axis of tendons, prolonged positioning in extreme lengthened range
-dampens muscle tone
-
vibration
100-200Hz to facilitate muscle contaction
maintained pressure
-firm manual pressure to midline of back
-has a calming effect, generalized inhibition, decreased fight or flight, desensitizes skin
-used in patients with agitation and high arousal (TBI)
-hypersensitivity pt's
slow, repetitive stroking
-Applied to midline back
-Calming effect, generalized inhibition, decreased fight or flight
light touch
brisk, quick stroking
-facilitates muscle, can elicit protection/ flexor withdrawal response
-used initially to mobilize pt's w/ low lvls of response (TBI)
neutral warmth
-Retention of body heat through body wraps
-Calming effect, generalized inhibition, decreased fight or flight
-used in patients with high arousal or increased sympathetic activity
prolonged cooling
-decreases neural and muscle spindle firing
-Provides inhibition of muscles and painful muscle spasm
-Decreases metabolic rate of tissues
slow vestibular stim
-Constant repetitive rocking
-calming effect, generalized inhibition, decreased fight or flight response
-useful with patients who are hypertonic, hyperactive, or who demonstrate high arousal or tactile defensiveness
rapid vestibular stim
-Rapid movements, fast spinning in a chair
-heightens postural responses, movements
-used with patients who have hypotonia (down syndrome), patients with sensory integrative dysfunction, patients w/ bradykinesia (PD)