Motor Learning, Motor Control and Neuroplasticity

Regaining movement function through therapeutic exercise has been a central theme for the field of physical therapy since the profession's beginning.

* Prior mid-20th century theories: based on assumption that functional movement is under a rigid hierarchal control within the nervous system. * During this era, treatment approaches such as proprioceptive neuromuscular facilitation (PNF), Bobath, Rood, Ayers, Johnstone, and Brunnstroms, were developed. They had something in common: very keen observers of movement, normal and abnormal * Theories DO change, but keen visual observations of functional movements and limitations will always remain a critical skill for the PT and PTA. * Many of previously mentioned approaches are still used and retain similar treatment applications and interventions; however, the treatment rationale for each of the various approaches utilizes more current research and basic science to explain its validity.

"The study of how individuals acquire, modify, and retain motor memory patterns so that programs can be used, reused, and modified during functional activities."

1. Learning is a process of acquiring the capability for skilled action. 2. Learning results from experience or practice 3.

Learning cannot be measured directly-instead, it is inferred based on behavior 4. Learning produces relatively permanent changed in behavior, thus short-tern alteration are not thought of as motor learning.

Refers to the way a therapist chooses to teach the motor activity * Whole Learning * Pure-Part Learning * Progressive/Sequential-Part Learning * Whole to Part to Whole Learning

practicing a behavior or fast in its entirely

Used for complex activities where there component parts are discrete motor programs in and of themselves.

employed when teaching intermediate skills and serial tasks that require many steps that must be performed in a specific sequence in order to be considered successful.

Whole to part to while learning in the most frequently used in the clinical environment. First asked to perform the whole task; the clinical then breaks down the task into separate components and reconstitutes the entire programs

Frequency of which the patient practices the taste * Mass Practice * Intermittent/Scheduled Practice * Random Practice

used to learn or relearn a skill that is essential for ADL's. The opportunity for a patient to repetitively practice a motor pattern or functional movement with with interruptions; this hopes limit distractions that can hinder the CNS from remembering the program being taught. Once the skill is learned and established within CNS, no longer need to mass practice, unless external environment changes.

program is available to the patient's CNS, but impairment errors occur and practice is still needed to insure long-term motor memory.

practice done independently without a scheduled frequency of a practice. This is the responsibility of the patient or caregiver.

Stage 1: Cognitive Stage/Acquisition of Motor SkillStage 2: Associative Stage/RefinementStage 3: Autonomous/Retention

* The patient is learning a new skill or relearning an old one as a whole activity. (whole learning) * At this stage, an individual needs to practice often and needs a lot of external feedback from the practitioner in order to be successful. * However, allowing patient to practice and self-correct is important during this initial stage.

* Giving the patient time to self-correct before providing the external feedback is important * The environment used for practice should be consisted, and the type of practice is generally mass practice.

* When a patient can fun the program within specific environmental constraints, will have decrease in error during the activity, and will apply less effort during performance. * Usually environment is consistent, although variance in the specific in the specific components is present * Allowing the patient to refine the movement and self-correct.

* The patient moves to a variety of different environments and retains control of the whole program * The try hallmark of learning is the ability to retain the skill and transfer the skill into different setting.

At this time, practice is usually random and part of everyday life.

* based on upon sensory responses inherent to the patient's body as a part of the desired moment itself. * The PT should determine whether there is conflict or

* based upon outside source providing feedback. * This type of feedback can lead to better performance during motor activity, but until the patient self-corrects using inherent feedback, independence is not obtained. (the patient will learn to rely on the external feedback

* Knowledges of performance: uses sensory system to inform the patient as to whether the quality or efficiency of the movement * Knowledge of results: informs the patient as to whether the task is accomplished or how close the movement comes to accomplishing the task.

* Summer feedback: provided feedback after a set number of trials of the fast * Faded feedback: initially provides feedback after every trial, then decreasing to every other trial, every third, every fourth etc. most effective * Bandwidth feedback: which provides feedback only when the performance of the task is beyond a given range for errors * Delayed feedback: PTA withholds the feedback for a short time. Allows self-assesment of performance

* The study how an individual controls movement already acquired. * The PTS can recognize a change in the control of a pattern or fictional skill and inform PT. * The patient's ability to perform a task is dependent upon his or her own inherent mechanism, which may vary. * Motor control means the control an individual has given the unique characteristics of that individual.

Differences occur before injury or disease as well as following. It is up to the PT to guide the PTA's interventions in order to optimize the functional recovery of the patient.

* Defined as the brain's ability to adapt and use cellular adaptations to learn to relearn functions previously lost due to cellular death by trauma or disease at any point. * Research shows that given an appropriate environment to learn in, the BRAIN CAN LEARN or RELEARN despite cellular damage * Question: when treating a patient, is it better to trigger a patient's normal walking pattern before resulting to compensatory techniques? Why? Normal walking...muscle memory.

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