34. PEAT 1 and Other

Motor Learning

Motor Learning » Stage 1: Cognitive Stage (Beginning/Novice)

• 4 Characteristics

• Gathering Info

• Frequent Errors and Feedback

• Cannot Perform Dual Task

• Large Gains BUT Inconsistent Performance

Motor Learning » Stage 2: Associative Stage (Intermediate/Practice)

• 6 Characteristics

» Putting Actions Together «

• Practice is Critical

• Small Gains BUT Disjointed Performance

• Less Cognitive Effort

• Begin to Learn What Errors They Are Making

• Patient Reflects on Performance

Motor Learning » Stage 3: Autonomus Stage (Advanced/Fine Tuning)

• 5 Characteristics

• Accurate

• Consistent

• Efficient

• Smooth

• Recognize when skills are performed INCORRECTLY

• Motor Learning occurs as a direct result of what?

• WHO is practice important for?

• How often should feedback be given for Novice Learners?

• Practice

• Novice Learners at the Cognitive Phase

• Frequent Feedback

Cognitive Learning Phase:

• What type of practice is BEST for pts in the COGNITIVE learning phase?

  • BUT can begin ___ practice as they progress

• What should the PT allow time for in pts in the Cognitive Learning Phase?

• Blocked Practice

  • Serial Practice

• Process the Practice

Associative Learning Phase:

• ASSOCIATIVE learners are beginning to develop and hone in what?

• What type of practice are ASSOCIATIVE learners?

• What should the PT allow time for in pts in the Associative Learning Phase?

• Internal Reference of Correctness

• Transition from Serial Practice » Random Practice

• Reflect on the Performance

• What is Blocked Practice?

  • Example:

• Repetition and Practice

  • Ex: Practice STS 12x from WC

• What is Serial Practice?

  • Example:

• Practice sequence in which different skills are performed in a MIXED ORDER but FIXED FORMAT

  • Ex: Practice STS 4x from bed, 4x from WC, 4x from couch

• What is Random Practice?

  • Example:

• RP:

  • Previously constructed plans be abandoned

  • Processing facilitates learning

• Ex: Random order of transfers

• Random Practice is BEST for what 2 types of learners?

• Associative Learner » Who has developed a “Reference of Correctness”

• Autonomous Learners » Who are highly skilled/expert

• What is Mental Practice?

• What is Part Task v Whole Task Practice?

• Mental:

  • Having patient review planned movement in their heads PRIOR to completing movement

• Part v Whole:

  • Breaking up the training into portions » practice a portion of the movement

Intrinsic v Extrinsic Feedback:

• Define:

  • Intrinsic Feedback:

  • Extrinsic Feedback:

    • AKA:

    • Rate Given:

• Intrinsic:

  • Patient thinking and performing

    • Kinesthetic, Visual, Cutaneous, Vestibular, Auditory Feedback of the patient

• Extrinsic:

  • External sources that are supplemental to intrinsic feedback

    • AKA: Augmented

    • Rate:

      • Concurrently, Immediately After, or Delayed

• How much feedback should be given as learning progresses for these stages:

  • Cognitive Level:

  • Associative Feedback: (4)

• Cognitive Level:

  • Frequent Feedback

• Associative Feedback:

  • LESS OFTEN is more beneficial

  • DELAYED Feedback is more beneficial than INTERMEDIATE Feedback

  • Blocked » Random once pts has “Internal Reference of Correctness”

  • Given when patient performance falls OUTSIDE of acceptable level OR FADING feedback as pt skill level improves

Scoliosis:

• At what degree of Scoliosis curvature is a brace effective?

• 25-45 degrees

Heart Murmurs:

• Murmur =

• Sounds occurring between S1 and S2 =

• Sounds occurring between S2 and S1 =

Correct: 1

• Murmur = Turbulent blood flow within heart or great vessels

• Sounds occurring between S1 and S2 = Systolic Murmurs

• Sounds occurring between S2 and S1 = Diastolic Murmur

Ankle Sprain Grades:

• Grades 1-3:

Ankle Brachial Index (Ankle SBP / Arm SBP)

• Purpose:

  • To distinguish…

• Compares…

• Uses Doppler at what 2 arteries?

• Purpose:

  • To distinguish LE Neurogenic vs Vascular Claudication Pain

• Compares:

  • Ratios of SBP of Arms and Legs

    • L Leg Systolic / Highest Brachial BP

    • R Leg Systolic / Highest Brachial BP

• Doppler:

  • Posterior Tibial Artery

  • Dorsalis Pedis Artery

Myositis Ossificans:

• Widespread ossification of __ __.

• Episodes of _ and _ _ _.

• Tissues can __

• How can Myositis Ossificans occur? (3)

• 3 MC sites

• Tx: (2)

• Connective Tissue

• Eposides of Fever or Soft Tissue Inflammation

• Harden

• How:

  • Often in Early Childhood or after trauma

  • Maybe from massage or STM TOO EARLY in rehab

  • Lack of RICE after injury

• Muscles:

  • Quads

  • Brachialis

  • Deltoid

• Tx:

  • Ice in fully stretched positions

  • STOP MASSAGING AND USING HEAT

Metabolic Equivalent:

• 1 MET =

• Convenient Method for standardizing…

  • Light Intensity:

  • Moderate Intensity:

  • Vigorous Intensity:

• 1 MET = Relative Oxygen Consumption at REST

• Standardizing » Intensity of Activities

  • Light Intensity: 1.6-2.9 METS

  • Moderate Intensity: 3.0-5.9 METS

    • Walk, Run, LE/Arm Cycling (~3.5)

  • Vigorous Intensity: ≥ 6.0 METS

Tethered Dura:

• Define:

• Can Cause:

• Define:

  • Abnormal fixation of the SC/Dura

• Causes:

  • Traction and Neurological Symptoms ESPECIALLy c Movement or Growth

Idiopathic Pulmonary Arterial Hypertension (IPAH):

• Prevalence:

• Describe:

• IPAH can lead to:

• RARE

• Define:

  • Progressive disease where there is abnormally high BP in Pulmonary Artery c no identifiable cause

• Lead to:

  • R Heart Failure

Idiopathic Pulmonary Arterial Hypertension (IPAH):

• Physiology: (4)

• Pulmonary Artery becomes narrowed, thickened, or stiff

• Increase Pulmonary Vascular Resistance (Afterload)

• R Ventricle has to work harder to push blood to lungs

• Overtime » R Ventricle Hypertrophy » R HF

Define:

• Nociplastic Pain:

• Nociceptive Pain:

• Neurogenic Pain:

• Psychogenic Pain:

Correct: 3

• Nociplastic Pain:

  • Associated c symptoms that do not have clear anatomical correlate, is widespread, and/or not consistent

• Nociceptive Pain:

  • Pain resting from stimulation of nociceptors

  • Often with a clear stimulus-respose relationship between movement and symptoms

• Neurogenic Pain:

  • Pain that arises from injury, dysfunction, or disease of the nervous system

• Psychogenic Pain:

  • Pain where psychological factors are the primary cause

T4 Syndrome:

• T4 actually means:

• Describe:

• Presentation:

• T4 = T2-T7

• Describe:

  • Symptom complex especially Upper T/S

  • Unknown Cause

• Presentation:

  • Hand or Hands always affected

  • Glove like distribution of parethesias

  • Dull aching or pressure in or around the head

  • No changes in reflex or myotomes

• CRPS:

  • Common S/S:

  • In final stage, affected limb is…

Correct: 4

CRPS:

• Common S/S:

  • Burning or Aching Pain

  • ANS Dysfunction

  • Edema

  • Movement Disorder

• Affected Limb = Cooler