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Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond: Summary
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
Errorless learning is a method of minimizing errors to allow more successes during training, thereby improving self-efficiacy and enhancing learning. • Found to be less or as effective as error- based learning | HEALTHCARE CONSIDERATION One important thing to keep in mind is that motor learning is most effective when it is task specific. In practice, this means that when working on building strength in specific muscles, the ultimate objective is to ensure that those exercises directly translate to practical, real-world activities that patients perform on a daily basis.
• Older adults may have difficulty with complex tasks and cognitive overload • Tailor instructions to match their cognitive capacity • 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.
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