Principles of Neurorehabilitation and Motor Learning

Neurorehabilitation

Aims to aid recovery from nervous system injuries.

Iterative learning

Continuous improvement through repeated practice.

Motor feedback circuit

System adjusting skilled movements based on sensory input. motor cortex to cerebellum

Consolidation

Offline processing of learned motor skills after task practice. sleep may have influence. Goal and skill based

Neuroplasticity

Brain's ability to reorganize after injury.

Motor Learning Theory: Fitts and Posner model

Framework for understanding motor learning stages. It consists of three stages: cognitive, associative, and autonomous.

Retrieval

Accessing learned skills from memory. only way to observe skill acquisition

Clinical Trials

Difficult to perform in neurorehabilitation.

Control/Placebo

Lack of adequate control in studies.

Ethics

Concerns about withholding treatment from patients.

Cost

Clinical trials are extremely expensive.

Bias

Research designs may introduce bias.

Crossover Design

Participants switch groups in a study.

Neurorehabilitation Science

Understanding is crucial for evaluating interventions.

Active Participation

Engagement in activities enhances rehabilitation outcomes.

Sensory Feedback

Active movement provides different feedback than passive.

Passive Manipulation

Does not stimulate Golgi tendon organs (GTO).

Sensory Gating

Reduced perception of feedback during active movement.

CNS Activity

Differentiates between active and passive manipulation.

Renshaw Cells

Interneurons that inhibit alpha motor neurons.

Motor Plan Update

Nervous system adjusts based on discrepancies.

Task-Oriented Approach

Focus on practicing the goal actively.

Physical Aides

Reduce opportunities for practice and error correction.

Just Right Challenge

Training must be appropriately difficult for progress.

Cortical Changes

Long-term changes occur with appropriate training intensity.

High-Intensity Training

Results in better outcomes for stroke survivors.

Clinical Gains

Higher percentage of gains in high-intensity groups.

Dynamic Balance

Improved through high-intensity variable training.

Recovery Program

Six-week program by American Heart Association.

Inactivity Rate

Patients spend 48% of time inactive during rehab.

Weekend Inactivity

Inactivity rises to 98% on weekends.

Low Activity Tasks

27% of time spent on low activity tasks.

High Activity Tasks

21% of time spent on high activity tasks.

Upper Limb Treatment

Accounts for 16% of total therapy time.

Observation Duration

1941 minutes observed in stroke rehabilitation study.

Physical Activity Sessions

26-98% of sessions involve any physical activity.

Daily Training Recommendation

Train every day for optimal recovery.

Minimum Training Duration

Insufficient data for minimum training time recommendations.

General Training Duration

Aim for 30 minutes of daily training.

Session Duration

Average therapy session lasts 36 minutes.

Task Specific Movements

51% of UE interventions use task-specific movements.

Repetitions in Therapy

Average of 32 repetitions per session.

LE Interventions

84% of LE interventions focus on gait training.

Average Steps

Average steps in LE interventions is 357.

Neuroplasticity Models

Animal training models inform human neuroplasticity.

Repetition Comparison

Human studies show 10% of animal model repetitions.

Neuroprotective Exercise

High intensity exercise protects against neurotoxins.

Neurotropic Factors

Vigorous exercise increases BDNF and GDNF expression.

Training Benefits

Benefits seen only after 3 months of training.

Revolutions Required

18,000 revolutions/day needed for benefits.

Reward pathway

Neural pathways involved in reinforcing behaviors.

Mesolimbic pathway

Connects midbrain to limbic system for reward processing.

Ventral tegmental area (VTA)

Midbrain region crucial for dopamine release.

Limbic structures

Brain regions involved in emotion and motivation.

Ventral striatum

Key area for reward and motivation processing.

Nucleus accumbens

Part of the ventral striatum, linked to pleasure.

Dopaminergic neurons

Neurons that release dopamine, influencing motivation.

Motor learning

Acquisition of skills through practice and feedback.

Mesocortical dopamine pathways

Involved in cognitive aspects of reward and learning.

Long-term potentiation (LTP)

Process that strengthens synapses based on activity.

Conditions of practice

Factors affecting the effectiveness of motor learning.

Practice schedules

Timelines and methods for skill practice.

Feedback

Information provided to improve performance.

Extrinsic feedback

External information about performance quality.

Intrinsic feedback

Internal sensory information about task execution.

Knowledge of performance (KP)

Feedback on the quality of movement execution.

Knowledge of results (KR)

Feedback on the outcome of a movement.

Attention focus cueing

Directing focus to enhance motor performance.

Internal focus

Attention on body movements during performance.

External focus

Attention on the movement's effect on the environment.

Challenge Point

Optimal difficulty level for skill acquisition.

Dopamine

Neurotransmitter that enhances learning and memory.

Long-Term Potentiation (LTP)

Strengthening of synapses based on recent patterns of activity.

Aerobic Exercise

Physical activity that improves cardiovascular fitness.

Paresis

Partial loss of voluntary movement or strength.

Spasticity

Increased muscle tone leading to stiffness.

Contracture

Permanent shortening of muscles or tendons.

Robotic Arm Training

Use of robotics to assist in rehabilitation.

Active Participation

Engagement of patients in their own rehabilitation.

Just Right Challenge

Optimal difficulty level for skill acquisition.

Repetition and Intensity

Key factors in effective motor learning.

Knowledge of Results (KR)

Feedback about the outcome of a movement.

Knowledge of Performance (KP)

Feedback about the quality of a movement.

Auditory Feedback

Sound-based information to enhance motor skills.

Intrinsic Feedback

Internal sensory information from one's own body.

Extrinsic Feedback

External information provided by a coach or device.

Massed Practice

Training with little rest between repetitions.

Distributed Practice

Training with longer intervals between repetitions.

Blocked Practice

Practicing one skill repeatedly before moving to another.

Random Practice

Practicing multiple skills in a random order.

Therapist as Coach

Role of therapist in guiding patient rehabilitation.

Motivating Interfaces

Game-like elements that enhance patient engagement.

Motor Learning Potential

Capacity to acquire new motor skills through practice.

Robotic exoskeleton

Assistive device aiding upper limb movement post-stroke.

Neuroplasticity

Brain's ability to reorganize itself through learning.

Dopamine system

Neurotransmitter system regulating movement and reward.

Motor skill learning

Acquisition of coordinated movements through practice.

Traumatic brain injury

Damage to the brain from external force.

Stroke rehabilitation

Therapeutic process to recover motor functions after stroke.

Movement practice

Repetitive actions to improve motor skills.