NEUROLOGICAL REHABILITATION OPTIMIZING MOTOR PERFORMANCE PDF

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Neurological Rehabilitation Optimizing Motor Performance Pdf

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rehabilitation optimizing motor performance neurological pdf - downloadneurological rehabilitation optimizing motor performance pdf. free pdf. This second edition of Neurological Rehabilitation: Optimizing Motor Performance provides a practical, task-oriented approach to rehabilitation. for training this action neurological rehabilitation optimizing motor performance 2e - [pdf]free neurological rehabilitation optimizing motor.

Physiotherapists are making a major change away from method- Janet entered the physiotherapy profession in , at a time ologies developed in an earlier time for which there is no when the average working life of a physiotherapist was 5 years — evidenciary support, and increasingly using methods that are she went on to devote close to 60 highly productive years to congruent with current knowledge and for which there is her profession.

Janet never retired; until her death she held an encouraging evidence. The results of suitably rigorous clinical honorary position of Associate Professor in the Faculty of trials eventually contribute to evidence-based practice.

She inspired and empowered generations of These books have been translated into most European languages physiotherapists.

Arabic and Farsi. The books have stimulated many passionate Competing interests: Nil. Acknowledgements: Nil. To engage in these debates, Janet travelled, collaborated with Correspondence: Colleen Canning, Faculty of Health international scientists, taught and presented conference papers in Sciences, The University of Sydney, Sydney, Australia.

Janet and Roberta worked, discussed, Email: colleen.

Carr JH, Shepherd R. Physiotherapy in Disorders of the Brain.

London: Heinemann; forward applied to other areas of rehabilitation. The breadth of her The Motor Relearning Programme for Stroke. Neurological Rehabilitation: Optimizing Motor Performance.

Oxford: Butterworth Heinemann; However, the intensive and repetitive practice required to improve performance may not be demanded if patients are perceived to fatigue easily, particularly if they are elderly.

Fatigue may be viewed as con traindicative and necessitating rest, instead of as a manifestation of the need to get stronger and develop more endurance. The past decade has seen an accumu lation of data that provide reassurance of the safety of exercise and physical conditioning programmes following stroke Ch. The beneficial effects of such programmes include not only improved physiological responses but also improved functional motor performance. Simple ways to increase exercise toler ance and endurance, even in the early stages, may include setting goals such as increasing the speed of movement and the number of repetitions.

The results can be graphed, providing the patient with feedback information and motivation.

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Challenges to customary delivery of intervention can be difficult for clinicians because such practices have been built on long-standing traditions and beliefs and a culture which has not until recently demanded evidence of efficacy. The attitude that the critical method of therapy delivery is a one-to-one interaction, with emphasis on physical handling of the patient in order to facilitate more normal movement, does not fit well with modern views of the patient as active learner and the therapist as teacher or coach.

Increasing numbers of clinical studies are supporting the use of more varied methods of delivery and more active methods of intervention. Skill has been defined as 'any activity that has become better organized and more effective as a result of practice' Annett and also as 'the ability to consistently attain a goal with some economy of effort' Gentile Everyday activities, even such apparently simple ones as standing up from a seat, constitute motor skills.

They are complex actions, made up of segmental movements linked together in the appropriate spatial and temporal sequence. The person with motor impairments following a neural lesion needs to learn again how to control segmental movement so that the spatial configuration and temporal sequencing of body movements brings about an effective action, thereby achieving the individual's goal with minimum energy expenditure. Task-oriented training is critical to gaining the necessary control.

In attempting to regain movement control, however, the degree of muscle weakness may be such that initially the patient also has to practise exercises for activating and sustaining activity in specific muscle groups. An important characteristic of acquiring skill is that learning seems to take place in overlapping stages.

Two models that have been proposed give insights useful to the clinic. An early study described three stages of learning: an early or cognitive stage, an intermediate or associative stage and a final or autonomous stage Fitts and Posner The learning stages have also been described as first getting the idea of the movement, then developing the ability to adapt the movement pattern to the demands of the environment Gentile In both cases the initial stage is cognitive.

Early after stroke, patients with a lesioned system are struggling to learn again how to perform even simple movements as well as everyday actions. They need to practise repetitively in order to get the idea of the action they are re learn ing and to train the neural coordination necessary for effective performance. As they gain more strength and control, less attention can be directed toward performing the action and more attention to the goal and relevant environmen tal cues.

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As motor control and skill develop, changes occur at different levels. For example, with more intersegmental control there is less tendency to 'freeze' the degrees of freedom.

There is also a decrease in energy expenditure.

The focus of attention shifts. In walking, the focus of visual attention shifts from the feet to the surrounding environment; 'star billing' for sit-to-stand changes from foot placement and speed of trunk rotation to steadying a glass of water while stand ing up.

Being aware of the characteristics of each stage enables the therapist to provide the appropriate practice conditions to optimize performance. For movement to become more automatic, intensive practice is required in order to increase endurance as well as the opportunity to practise adapting the action to varying environmental demands - for example, walking in different environments, coping with several simultaneous demands such as doing two things at once.

Attentional abilities required for everyday functioning include the ability to focus attention on a task, to sustain concentration, to shift attention if add itional task-relevant material comes along but to ignore distracting, irrelevant inputs.

Training techniques to overcome these deficits involve highlighting the task to bring it to the patient's attention, reinforcing maintenance of attention to task and its relevant cues, and adding distractions to the environment then reinforcing the 'filtering out' of such inputs Adams Learning of motor skills involves two critical components, particularly in the early stages: 1.

A number of recent studies demonstrate that the person's attentional focus can have a decisive influence on motor performance and learning Wulf et al.

It is important to decide what the patient should pay attention to dur ing practice. Two methods of directing the focus of attention are demonstra tion both live and recorded and verbal instruction. Demonstration, or modelling of an action, gives the therapist the opportunity to point out the key components of the action.

A demonstration assists the patient to get the idea of the spatial and temporal features of the action, the 'shape' or topology of the movement Fig.

In the early stages of learning, instructions should be brief, with no unnecessary words. They should cue the patient to concentrate on one or two critical features of the action Fig.

In standing up practice, for example, the patient is drilled to place feet back, swing upper body forward at the hips and stand up, and can verbalize this sequence while practising. A stick figure drawing can reinforce these key elements.

Neurological Rehabilitation E-Book (2nd ed.)

Asking the patient to list what cues they are to focus on aids mental rehearsal and enables the therapist to judge what the patient has gained from both instruction and demonstration. Gradually the patient internalizes these details and can start to think more of the goal of the action e. At this later stage, instructing the patient to focus on the details of their perform ance may actually be detrimental.

There is increasing evidence that directing learners to the effects of their movements, i.

Similarly, at this stage of learning, verbal instructions are used in directing attention to specific environmental features or events. Like this presentation? Why not share! An annual anal Embed Size px.

Neurological Rehabilitation: Optimizing Motor Performance

Start on. Show related SlideShares at end. WordPress Shortcode. Published in: Full Name Comment goes here. Are you sure you want to Yes No. Be the first to like this. No Downloads. Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide.Chapter 1 reviews plasticity in the brain and the role of practice and challenge in brain reorganization; chapter 2 builds on this by discussing task-specific practice, the principles of motor learning, and clinical applications of these principles in neuro-rehabilitation.

A demonstration assists the patient to get the idea of the spatial and temporal features of the action, the 'shape' or topology of the movement Fig. Simple ways to increase exercise toler ance and endurance, even in the early stages, may include setting goals such as increasing the speed of movement and the number of repetitions. Acknowledgements: Nil.

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