Principles of Intervention

Use it or lose it principle of neuroplasticity

Failure to drive specific brain functions can lead to functional degradation

Use it and improve it principle of neuroplasticity

Training that drives a specific brain function can lead to enhancement of that function

Specificity principle of neuroplasticity

the nature of training experience dictates nature of plasticity

Repetition matters principle of neuroplasticity

Induction of plasticity requires sufficient repetition

Intensity matters principle of neuroplasticity

Induction of plasticity requires sufficient training intensity

Time matters principle of neuroplasticity

Different forms of plasticity occur at different times during training

Salience matters principle of neuroplasticity

The training experience must be sufficiently salient to induce plasticity

Age matters principle of neuroplasticity

Training-induced plasticity occurs more readily in younger brains

Transference principle of neuroplasticity

Plasticity from one training experience can enhance the acquisition of similar behaviors

Interference principle of neuroplasticity

Plasticity in response to one experience can interfere with the acquisition of other behaviors

What is required from the learner for motor learning?

Active participation!

What are 3 important considerations when doing motor learning?

• Behavioral state

• Engagement

• Intrinsic motivation

Why are children not considered little adults?

• Constantly learning new motor skills

• Decreased information processing capabilities

• Slower processing

• Decreased selective attention

• Need constant feedback & cuing

What does motor learning in early childhood require?

LOTS of practice

Because PTs cannot be with patients enough to facilitate the level of practice required, what is often done to keep the motor learning happening?

Teach families strategies that they can do at home

What 2 factors are most important for motor learning in children with neurologic disabilities?

• Active movement of child

• Intensive therapy

What is the “just right” challenge when trying to achieve the therapeutic effect?

• Need just right challenge to motivate child but still be achievable

• Need just right environment for child to lead

• Use play to keep them engaged

• Therapeutic use of self

Describe therapeutic use of self

• Give a different version of yourself based on the patient you are seeing

Signs of fatigue in neonates

• Crying

• Hiccups

• Tremors

• Finger splaying

• Suddenly falls asleep

• Yawning

• Looking away

• Tachypnea/ tachycardia

• Disorganized movement

Signs of fatigue in infants

• Crying

• Disengagement

• Reduced quality of movement

Signs of fatigue in toddlers

• Disengagement

• Refusal to complete task

• Reduced quality of movement

• Increased assistance needed

Signs of fatigue in preschool/school-aged children

• Disengagement

• Refusal to complete task

• Reduced quality of movement

• Increased assistance needed

• They will tell you they’re bored/tired/done

List gross motor skill interventions for children with CP

• task-specific training

• goal-directed training

• strength training

• environment enrichment

• constraint-induced movement therapy (CIMT)

• treadmill training

List flexibility & alignment interventions for children with CP

• stretching (avoid contractures)

• serial casting

• positioning

• tone management (meds)

What is serial casting?

• Use of casts to increase ROM if there are contractures present

• Measure ROM, cast, increase ROM, take off & repeat

What mobility skills are typically achieved prior to walking?

• Rolling

• crawling

• Pull to stand

• Cruising

Does a child have to meet every milestone prior to walking?

• NO

• Goal is to help them keep up with typically developing peers & their milestones

List mobility/gait interventions for children with CP

• Build standing tolerance (standing frame, knee immobilizers)

• PBWS treadmill training

• Overground ambulation

What are gait deviations caused by bony deformities?

• Internal femoral torsion (femoral IR)

• Tibial torsion (tibial ER)

• Pes planus

What are gait deviations caused by spasticity & inadequate ROM?

• Crouched gait/posture

• Forefoot IC

• PF & knee extension coupling

What are gait deviations caused by muscle weakness?

• Pelvic drop on swing side (Trendelenburg)

• Lateral trunk shift over stance side

• Crouched posture

• Limited swing-phase knee motion