Interventions to Improve Motor function

Question 1

Interventions to Improve motor function

Answer 1

Multiple theories combined over time based on clinical practice in order to produce a treatment philosophy
-Evidence based practice

Question 2

Evidence based practice:

Answer 2

Understanding of motor function that is built on over time to validate therapeutic interventions, based on research. ( PT is derived from this process-This results in a frame work of understanding of movement and is demonstrated through therapeutic outcomes
Outcomes are categorized by interventions
a. Restorative interventions
b. Compensatory interventions
c. Preventative INterventions

Question 3

Restorative interventions

Answer 3

Promote and restore optimal functional ability i.e. ADL’s functional mobility skills, task-specific training etc

Question 4

Compensatory interventions:

Answer 4

Done becuase of co-morbidities ( one or more diseases in addition to a primary disorder), sever impairments, and decreased prognosis i.e. substitution training with supportive devices

Question 5

Preventative Interventions:

Answer 5

An attempt to minimize possible future impairments i.e. NDT, flexibility, gate, relaxation etc
-Can be used separately or at the same time.

Question 6

Motor Learning strategies:

Answer 6

Control, error detection, and correction through practice, feedback, and information processing
-Strategy development: therapist presents the skill in context to its relevant function and purpose

Question 7

Strategy development:

Answer 7

Therapist presents the skill in context to its relevant function and purpose.

• Modeling: therapist demonstrates the task exactly how it should be done
• Reference to correctness: pt is able to develop a cognitive map from the example to construct motor programs i.e. therapist have videotaped previous pt’s for demonstrations of desired skills to new patients with good results)
• Guided movement: therapist physically assists pt through the task, substituting for missing movements ask for it first
• Sensations of movement: The therapist active assistance for pt movement error, previews to the pt the correct mechanical movement, they get a “feel” for it ( this can include verbal cues)
• Active trial and error discovery: allow the patient to make mistakes for self correction to decrease dependence and increase independence ( let them do as much as they can within a reasonable range)

Question 8

Feedback:

Answer 8

Studies confirm its importance

• Intrinsic
• Extrinsic
• Concurrent feed back
• Terminal feedback

Question 9

Intrinsic

Answer 9

Inherent: natural to movement vision, vestibular input, proprioception etc.

Question 10

Extrinsic

Answer 10

Augmented: cues that are not normally used for movement verbal cues, tactile cues etc

Question 11

Concurrent feedback

Answer 11

Given while the task is being performed

Question 12

Terminal feedback

Answer 12

Given at the end of the task

-Therapist must consider each pt and assess the best type of feedback to be used

Question 13

Practice:

Answer 13

• General principals
• Negative Learning
• Distribution of practice

Question 14

General principals:

Answer 14

The more practice the greater the learning, improvements are greatest initially with smaller improvement over time

Question 15

Negative learning:

Answer 15

Incorrect movement that leads to bad habits

Question 16

Distribution of Practice

Answer 16

Rest vs. activities, a clinical decision

• Massed vs distributed practice:
• Blocked vs random practice
• Mental practice
• Part-whole practice
• Promoting active patient decision making and autonomy

Question 17

Massed vs distributed practice:

Answer 17

Rest time during treatment is less than practice time vs practice in chunks of time

Question 18

Blocked vs random practice:

Answer 18

Uninterrupted task practice of sequence without any other task performance (blocked) or tasks that are practiced randomly across trials (random)
-Studies conclude there is superior long term retention is formed using random practice.

Question 19

Mental practice:

Answer 19

Therapist has pt mentally image the task in their mind before physically performing the activity
-Studies have shown this technique can be effective

Question 20

Part-whole practice:

Answer 20

Therapist breaks tasks up into smaller more manageable treatments

Question 21

Promoting active pt decision making and autonomy

Answer 21

• Emphasis on pt successes
• Be a motivational coach
• Show the pt initial success
• Begin and end treatment on a positive note