Summary rehab technology: motor learning

Rehab tech: MOTOR LEARNING IN THE CONTEXT OF TECHNOLOGY-SUPPORTED REHAB

TECHNOLOGY IN REHABILITATION – WHAT, WHY, HOW?
WHAT IS TECHNOLOGY?

 Which of the applications underneath can be called “technology that supports motor learning
rehabilitation”? (multiple answers are possible)
A. Robot system
B. Sensor system
C. Virtual reality
D. Bicycle -> niet echt
E. Walking frame
F. All answers are correct

WHAT IS TECHNOLOGY IN REHABILITATION?

 Assistive technology versus rehabilitation technology
 Robot technologies for passive movements, eg “Continuous Passive Motion” systems after knee Surgery
 Systems that facilitate and support active exercise therapy
- Nodig voor motor learning
- ROM zo ergonomisch mogelijk gebruiken
 FB nodig voor leren

1. REVIEW – TIMMERMANS ET AL. 2009
 Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and
therapist guidelines for rehabilitation technology design
- Analytical movement
 Enkel indien groot verband met taak
- ↑uithouding;CR-fitheid

1.1. STATE-OF-THE-ART APPROACHES IN MOTOR LEARNING
 Task-oriented training
 Sensory-motor training is a total package
- Training of basic functions prerequisite to skill training
- Skill training
- Improvement of endurance on muscular and/or cardiovascular level

 Principles of motor learning in rehabilitation
- Donald Hebbe (1904 – 1985) strengthening connections
- “ Fire together = Wire together”
- New post-synaptic dendrite spines appearing one hour after
stimulation – accompanying synaptic efficiency
- Veel hersenplasticiteit gebeurt volgens de manier dat we task
performance doen



 we willen dat de P beter wordt in taak specifieke
bewegingen
- daarom is het belangrijk om bij een behandeling
hier de nadruk op te leggen
 Schema
- enkel indien taak gerichte therapy
- CC-conections
 Cortico-cortico conections
 Beweging zo normaal mogelijk uitvoeren




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, Rehab tech: MOTOR LEARNING IN THE CONTEXT OF TECHNOLOGY-SUPPORTED REHAB


1.2. ACTIVE THERAPY APPROACHES
 Task-oriented training approaches
- Learning by solving task-specific problems, anticipatory movements, locomotor adjustments,
cognitive processing, finding efficient goal-oriented movement strategies
 Anticipatory movements: voorbereiding op beweging
 Personally and goal tailored training load
 Attention for bilateral (arm) training
 Real life objects:
- Zeker voor BL
- met de aandacht dat er heel veel taken bilateraal zijn --> real life training!
- Sensorimotor integration is important (Pavlides 1993)
 Sensorimotorische inegratie: connectie tussen sensorimotor cortex & primaire motor cortex
- fNIRS shows additional active brain area (prefrontal cortex) during real apple pealing vs mock apple
pealing
 met echte objecten trainen is heel belangrijk om het beste effect te verkrijgen
 er worden meer hersen regio's geactiveerd dit is niet bv bij een namaak appel en namaak mes

1.3. PERSONAL GOAL SETTING
 self-selected, well-defined, individually meaningful goals within patient capability
- Important for patient motivation and treatment-adherence
- Increases treatment results and increases efficiency of treatment

1.4. FEEDBACK
 Support for motor learning and motivator (shaping) (Magill 2007)
- Shaping: taak verdelen in ≠subtaken
 Needs to be tailored to the skill level of receiver (Magill 2007)
 Fading frequency
- Tijd geven om te luisteren naar intrisieke FB
 Mogen niet afhankelijk worden van FB
 Empty time slot before and after
- After: plannen hoe te ∆ met toepassing FB

 Figuur= belangrijke criteria rehab tech
- Global
 Verbal; avatar;video;…
- Analytical
 EMG;JERK; druk;…
- externe feedback = motor learning
- interne feedback = motivatie
- knowledge of results
 score beter? Ping bij einde oef?..
- knowledge of performnce
 quality
 compensaties,…




- prescripted feedback:

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