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Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond: Summary
Neuroplasticity , a fundamental aspect of learning, refers to the nervous system’s ability to adapt and change. But contrary to popular belief, neuroplasticity leads to not only adaptive and functional changes but also maladaptive ones. In other words, learning and reinforcing bad habits or incorrect techniques also represent forms of neuroplasticity. This carries critical implications for therapy: The longer an individual practices a skill incorrectly, the more challenging it becomes to modify and instill lasting changes. This highlights the importance of early intervention to prevent the ingraining of detrimental patterns and habits. Effective rehabilitation and relearning strategies must account for these nuances to facilitate successful skill correction. It is also important to recognize that even though the brain undergoes natural changes as it ages, it remains adaptable. This adaptability may involve a broader distribution of learning across different brain areas. In essence, while the overall capacity of a specific area might decline, older adults make up for it by engaging other regions of the brain.
Reward-Based Learning • Learning what actions result in rewards • Sensory input helps determine which actions result in rewards • Cerebellum may also play a role in adapting actions to obtain rewards based on feedback • Adjustments made to actions that result in rewards to reinforce desired behaviors • Actions adjusted and refined based on immediate feedback to maximize rewards • Learners recognize when their actions result in rewards, thus reinforcing the behavior
| HEALTHCARE CONSIDERATION
The hippocampus is the part of the brain that stores long-term memories. It is closely involved with explicit learning. Individuals with damage to the hippocampus, particularly those with hypoxic brain injury or tumors that put pressure on that part of the brain, have a hard time retrieving explicit instructions and strategies. Therefore, providers must find ways to compensate for this deficit and implement alternative strategies to support learning and motor skill development.
How to Drive Neuroplasticity: The Ten Commandments 1. Use it or lose it : The brain's function may decline if it is not rehabilitated after injury. 2. Practice works : Skillful practice is essential for improving learning and recovery. 50% of practice is needed beyond mastery to ensure long-term retention of a skill. 3. Specificity: Training should align with the target skill to yield the best results. 4. Repetition : Numerous repetitions are necessary to perfect a skill and ensure long-term improvement. 5. Intensity : Effective therapy involves not just the amount of time but how that time is used. 6. Suppressed plasticity : Neuroplasticity can be diminished or suppressed at certain times, affecting the window of opportunity for learning. 7. Salience : Training must be meaningful to the patient, relying on motivation and focus for successful learning. 8. Age : The brain becomes less pliable with age, but older adults can compensate by engaging more areas of the brain. 9. Transference: Training for a specific task should translate to improvements in various areas of daily life (e.g., practice squats to improve the ability to perform a sit to stand). 10. Interference : Different types of training can either complement or counteract one another, thus affecting recovery.
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