[Abstract] Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study.

Abstract

Purpose: The goal of this study was to examine which motor learning options are applied by experienced physiotherapists in neurological rehabilitation, and how they choose between the different options.

Methods: A descriptive qualitative approach was used. A purposive sample of five expert physiotherapists from the neurological ward of a rehabilitation center participated. Data were collected using nine videotaped therapy situations. During retrospective think-aloud interviews, the physiotherapists were instructed to constantly “think aloud” while they were watching their own videos.

Results: Five “operators” were identified: “act”, “know”, “observe”, “assess” and “argue”. The “act” operator consisted of 34 motor learning options, which were clustered into “instruction”, “feedback” and “organization”. The “know”, “observe”, “assess” and “argue” operators explained how therapists chose one of these options. The four operators seem to be interrelated and together lead to a decision to apply a particular motor learning option.

Conclusions: Results show that the participating physiotherapists used a great variety of motor learning options in their treatment sessions. Further, the decision-making process with regard to these motor learning options was identified. Results may support future intervention studies that match the content and process of therapy in daily practice. The study should be repeated with other physiotherapists.

• Implications for Rehabilitation

• The study provided insight into the way experienced therapist handle the great variety of possible motor learning options, including concrete ideas on how to operationalize these options in specific situations.

• Despite differences in patients’ abilities, it seems that therapists use the same underlying clinical reasoning process when choosing a particular motor learning option.

• Participating physiotherapists used more than the in guidelines suggested motor learning options and considered more than the suggested factors, hence adding practice based options of motor learning to the recommended ones in the guidelines.

• A think-aloud approach can be considered for peer-to-peer and student coaching to enhance discussion on the motor learning options applied and the underlying choices and to encourage research by practicing clinicians.

 

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Source: Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study – Disability and Rehabilitation –

[ARTICLE] Revisiting the neurofunctional approach: Conceptualizing the core components for the rehabilitation of everyday living skills. – Full Text HTML

ABSTRACT

Background: Introduced in the 1980s, the neurofunctional approach (NFA) is one of the few interventions designed primarily for clients with severe deficits following traumatic brain injury (TBI). Specifically the NFA was intended for those individuals who were limited in their ability to solve novel problems or generalize skills from one setting to another and whose lack of insight limited their engagement in the rehabilitative process.

Description of the approach: The NFA is a client-centred, goal-driven approach that incorporates the principles of skill learning and promotes the development of routines and competencies in practical activities required for everyday living. Programmes based on the NFA are developed specifically to meet each client’s unique needs, using a range of evidence-based interventions.

Recent evidence: Recently the NFA has been found to be more effective than cognitive-retraining for some individuals with moderate-to-severe TBI who have deficits in activities of daily living. This paper aims to define the core features of the NFA, outline the theoretical basis on which it is founded and consider implications of the findings for rehabilitation after TBI in general. The NFA is highly relevant for clients living in the community who require a case manager to direct an integrated, rehabilitation programme or provide structured input for the long-term maintenance of skills.

Continue –>  Revisiting the neurofunctional approach: Conceptualizing the core components for the rehabilitation of everyday living skills, Brain Injury, Informa Healthcare.

[ARTICLE] Spaced Noninvasive Brain Stimulation

Abstract

Neuroplasticity is critical for learning, memory, and recovery of lost function following neurological damage. Noninvasive brain stimulation (NIBS) techniques can induce neuroplastic changes in the human cortex that are behaviorally relevant, raising the exciting possibility that these techniques might be therapeutically beneficial for neurorehabilitation following brain injury. However, the short duration and instability of induced effects currently limits their usefulness.

To date, trials investigating the therapeutic value of neuroplasticity-inducing NIBS have used either single or multiple treatment sessions, typically repeated once-daily for 1 to 2 weeks. Although multiple stimulation sessions are presumed to have cumulative effects on neuroplasticity induction, there is little direct scientific evidence to support this “once-daily” approach. In animal models, the repeated application of stimulation protocols spaced using relatively short intervals (typically of the order of minutes) induces long-lasting and stable changes in synaptic efficacy. Likewise, learning through spaced repetition facilitates the establishment of long-term memory. In both cases, the spacing interval is critical in determining the outcome.

Emerging evidence in healthy human populations suggests that the within-session spacing of NIBS protocols may be an effective approach for significantly prolonging the duration of induced neuroplastic changes. Similar to findings in the animal and learning literature, the interval at which spaced NIBS is applied seems to be a critical factor influencing the neuroplastic response. In this Point of View article, we propose that to truly exploit the therapeutic opportunities provided by NIBS, future clinical trials should consider the optimal spacing interval for repeated applications.

via Spaced Noninvasive Brain Stimulation.

[THESIS] Movement Skill Generalization Relevant to Robotic Neuro-rehabilitation – Full Text PDF

SUMMARY

Upper limb extremity rehabilitation practices are increasingly involving robotic interaction for repetitive practice, and there is growing skepticism whether such systems can provide the relevant practice that can be generalized (or transferred) to functional activities in the real world.

Most importantly, will patients be able to generalize in three critical ways: (1) to unpracticed directions, (2) to unpracticed movement distances, and (3) to unpracticed weight-eliminated conditions? Rather than presuming that patients could generalize in three conditions, this study tested multiple hypotheses to see if there was any evidence of such generalization ability in healthy individuals.

We found that there was some evidence in all conditions except for the ability of healthy subjects to generalize to large movements after practicing small. Such results suggest that larger robotic systems are advantageous for training functional motions” that would not be possible with smaller systems [37]…

[PDF] Movement Skill Generalization Relevant to Robotic Neuro-rehabilitation