50 Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond: Summary 50
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 therapy 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.
CASE STUDY 2: INTENSITY
Russ, a 58-year-old diabetic, recently experienced a hemorrhagic stroke. Over the past few weeks, Russ has shown remarkable progress in his recovery. However, while he can now walk aided by a quad cane, he faces persistent challenges, particularly in lifting his left foot when stepping and in dealing with dynamic tasks such as altering his gait speed and direction.
Russ’s rehabilitation program starts with a 15-minute session on the step machine, aiming to achieve a target max heart rate of 50% to 60%, which significantly contributes to enhancing his cardiovascular health and overall physical endurance. Additionally, Russ engages in task practice, which accounts for about a third of recovery after a stroke; gait training; and balance exercises to enhance his stability and reduce the risk of falls . Finally, Russ participates in strength-training exercises aimed at bolstering his overall strength. One key challenge that needs to be addressed is the intensity of Russ’s training regimen. The existing program may not provide sufficient challenge in terms of strength training and aerobic exercise intensity, which play important roles in achieving substantial recovery following a stroke. However, it can be difficult to balance the benefits versus the deleterious effects of fatigue in learning. It’s essential to make adjustments to build up the training intensity, particularly by introducing high-intensity strength training and aerobic exercises to achieve better results and expedite Russ’s recovery.
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