Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond: Summary 50
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. Considerations for older adults: • Older adults may find it more challenging to consolidate learning • The dopaminergic system, which is crucial for neuroplasticity, slows down with age • Sleep quality significantly affects learning, especially during stage 2 sleep • Focus on simple, positive feedback and instruction • The medial temporal lobe may compensate for implicit learning deficits in older adults So how do we design an optimal training setup for our patients to learn in the best possible way? Challenging and learning from midrange errors, intensity, and practice all play a role. Let's look at some case studies. • Older adults may have difficulty with complex tasks and cognitive overload • Tailor instructions to match their cognitive capacity
CASE STUDY 1: ERROR AND CHALLENGE
Yerling is a 77-year-old man with Parkinson disease who recently had surgery for a hip fracture. He can walk fairly well with a walker but struggles with balance when turning, standing from a chair, or sitting down. He’s been doing physical therapy, but his progress has been slow, and he seems unenthusiastic about it, likely due to his condition. To help Yerling improve and stay motivated, it’s important to adjust his therapy.
One way to do this is by considering the challenge point theory, which suggests that people learn best when the challenge matches their skill level. In Yerling’s case, the therapy should be more tailored to his specific issues with balance and mobility. The therapist should increase the level of challenge as he gets better, making sure he learns from his mistakes. Motivation is critical in rehabilitation, so the therapist should strike a balance between making the ther- apy challenging enough to engage Yerling and allowing him to learn from errors. If Yerling’s errors are too small to notice or too big to handle, the therapist can increase the challenge or make the errors more obvious. This will help Yerling become more aware of his mistakes and encourage him to improve.
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