New Generation in Rehabilitation FEEDBACK IN PHYSICAL REHABILITATION

New Generation in Rehabilitation FEEDBACK IN PHYSICAL REHABILITATION Dr. Avraham Cohen Chief Clinical Officer Medi. Touch Ltd. 1

1 INTRODUCTION 2 MOTOR LEARNING 3 BIOFEEDBACK 4 CLINICAL APPLICATIONS 2

Introduction OPTIMAL REHABILITATION REHAB. METHOD REHAB. AIM ? SENSORIMOTOR IMPROVEMENT FUNCTIONAL ABILITIES 3

Motor learning MOTOR LEARNING IN REHABLITATION 4

Motor learning DISABILITY NEUROMUSCULAR / MUSCULOSKELETAL INJURIES SENSORIMOTOR IMPAIRMENTS DISABILITIES 5

Motor learning DISABILITY BODY FUNCTIONAL ACTIVITIES SOCIAL PARTICIPATION 6

Motor learning APPROACHES FUNCTIONAL PRACTICE IMPAIRMENT IMPROVEMENT 7

Motor learning APPROACHES IMPAIRMENT PRACTICE FUNCTIONAL IMPROVEMENT 8

Motor learning CLINICAL REASONING DIAGNOSIS PHASE MOVEMENT ABILITY 9

Motor learning BRAIN PLASTICITY BRAIN'S ABILITY TO CHANGE PHYSICALLY, CHEMICALLY AND FUNCTIONALLY THROUGHOUT LIFE. 10

Motor learning MOVEMENT INSTRUCTIONS MOTOR CORTEX RECEIVES INSTRUCTION AND FEEDBACK INPUT FROM VISUAL AND AUDITORY CORTEX 11

Motor learning MOTOR CORTEX RESPONSIBLE TO PLAN, CONTROL AND EXECUTE VOLUNTARY MOVEMENTS 12

Motor learning MOVEMENT INSTRUCTIONS VISUAL INPUT IS RESPONSIBLE FOR SELF OBJECTIVE UNDERSTANDING OF MOVEMENT 13

Motor learning MOVEMENT INSTRUCTIONS AUDITORY INPUT IS RESPONSIBLE FOR SELF SUBJECTIVE UNDERSTANDING OF MOVEMENT 14

Motor learning MOVEMENT INSTRUCTIONS OPTIMAL VOLUNTARY MOVEMENTS ARE EXECUTED BY OBJECTIVE AND SUBJECTIVE INPUTS AUDITORY VISUAL 15

Motor learning SPATIAL ORIENTATION VISUAL SYSTEM VESTIBULAR SYSTEM PERIPHERAL SENSATION PERIPHERAL MECHANOCEPTORS 16

Motor learning PERIPHERAL MECHANOCEPTORS MUSCLE SPINDLE TENDON GOLGI LIGAMENT ARTICULAR RECEPTORS SKIN RECEPTORS 17

Motor learning PERIPHERAL SENSATION DEEP SENSATION PROPERIOCEPTION - JOINT POSITION INFORMATION KINESTHESIA - JOINT MOVEMENT INFORMATION JOINT RESISTANCE - FORCE GENERATED WITHIN A JOINT CUTANEOUS SENSATION TEMPERATURE PAIN PRESSURE 18

Motor learning SPATIAL ORIENTATION HELPS TO MAXIMIZE BODY FUNCTION 19

Motor learning PERIPHERAL SENSATION PROPRIOCEPTION JOINT POSITION INFORMATION KINESTHESIA JOINT MOVEMENT INFORMATION 20

Motor learning PERIPHERAL SENSATION HELPS TO MINIMIZE BODY DAMAGE 21

Motor learning POSITIVE BRAIN REORGANIZATION OPTIMAL BRAIN ORGANIZATION MOVEMENT USING AMPLIFICATION OF WEAK AND REDUCTION OF DOMINANT INPUT MOTOR CORTEX AUDITORY CORTEX VISUAL CORTEX PERIPHERAL SENSATION 22

Motor learning REHABILITATION METHODS IOT TOT OPEN KINETIC CHAIN CLOSED KINETIC CHAIN HIGH RESOLUTION HIGH COORDINATION OBJECTIVE EVALUATION SUBJECTIVE EVALUATION IOT – Impairment Oriented Training TOT – Task Oriented Training 23

Motor learning PRACTICE TYPE BLOCKED A SERIES OF IDENTICAL PRACTICE RANDOM A SERIES OF DIFFERENT PRACTICE DISTRIBUTED MORE REST TIME THAN PRACTICE TIME MASSED MORE PRACTICE TIME THAN REST TIME 24

Motor learning PRACTICE METHOD LOCAL DEEP SENSATION OPEN KINETIC CHAIN KINESTHESIA PROPRIOCEPTION JOINT RESISTANCE LOW MUSCLE STRENGTH LIMITED MUSCLE RECRUITMENT LOW BALANCE ABILITY NO GROUND REACTION FORCE 25

Motor learning PRACTICE METHOD MULTI DEEP SENSATION CLOSED KINETIC CHAIN KINESTHESIA PROPRIOCEPTION JOINT RESISTANCE HIGH MUSCLE STRENGTH MULTI MUSCLE RECRUITMENT HIGH BALANCE ABILITY GRF WITH GROUND REACTION FORCE 26

Motor learning PRACTICE METHOD FOR MOBILITY OPEN CHAIN SHOULD BE USED FOR STABILITY STATIC CLOSED CHAIN SHOULD BE USED FOR CONTROLLED MOBILITY DYNAMIC CLOSED CHAIN SHOULD BE USED 27

Motor learning IMPAIRMENT FOCUS SELECTIVE PRACTICE LEADS TO PREVENT COMPENSATORY MOVEMENT DEVELOPMENT 28

Motor learning DIFFICULTY LEVEL CUSTOMIZATION TASK DIFFICULTY LEVEL CUSTOMIZED TO PATIENT PHYSICAL ABILITY 29

Motor learning INTENSIVE PRACTICE INTENSIVE REPETITION OF CUSTOMIZED TASK ARE REQUIRED FOR MOTOR LEANING AND PHYSICAL REHABILITATION 30

Motor learning REACTION TIME PREDICTION AND TASK INSTRUCTION AFFECT ON REACTION TIME 31

Biofeedback 32

Biofeedback KNOWLEDGE OF RESULT (KR) DEFINITION KR IS THE INFORMATION ABOUT THE PERFORMANCE OUTCOME DESCRIPTION FEEDBACK WITH LESS SENSORIMOTOR INVOLVEMENT IN THE CORRECT MOVEMENT PERFORMANCE 33

Biofeedback KNOWLEDGE OF RESULT (KR) ADVANTAGES KR USED BY PATIENTS WITH BROAD SPECTRUM OF MOVEMENT ABILITIES DISADVANTAGES KR CAN CAUSE COMPENSATORY MOVEMENT DEVELOPMENT 34

Biofeedback KNOWLEDGE OF PERFORMANCE (KP) DEFINITION KP IS THE INFORMATION ABOUT THE QUALITY OF PERFORMANCE DESCRIPTION FEEDBACK WITH MORE SENSORIMOTOR INVOLVEMENT IN THE CORRECT MOVEMENT PERFORMANCE 35

Biofeedback KNOWLEDGE OF PERFORMANCE (KP) ADVANTAGES USED IN BROAD SPECTRUM OF MOVEMENT ABILITIES PROVIDES CONTINUING AND TERMINAL FEEDBACK PROVIDES PROFESSIONAL TRAINING PREVENTS COMPENSATORY MOVEMENT DEVELOPMENT 36

Biofeedback FEEDBACK TYPES INTERNAL PERIPHERAL SENSATION VISION EXTERNAL REAL AUGMENTED AUDITION 37

Biofeedback FEEDBACK ACCURACY PATIENT ABILITY PRECISE FEEDBACK COMPARED TO GENERAL ENCOURAGEMENT REHABILITATION PERIOD 38

Biofeedback FEEDBACK DOSAGE FEEDBACK INTENSITY NEEDS TO INCREASE AS IMPAIRMENT SEVERITY INCREASES IMPAIRMENT SEVERITY 39

Biofeedback TASK INTRINSIC FEEDBACK PROVIDES VISION, AUDITION AND SENSATION INFORMATION 40

Biofeedback FADED FEEDBACK SHOULD BE PROVIDED IN DEVIATION LIMIT FEEDBACK AREA DEVIATION AREA CORRECT AREA 41

Biofeedback REAL TIME FEEDBACK PROVIDES IMMEDIATE INFORMATION, SHORT TERM MEMORY NOT REQUIRED 42

Biofeedback TERMINAL FEEDBACK DEFINITION KR AND KP INFORMATION THAT IS PROVIDED AFTER MOVEMENT PERFORMANCE TERMINAL KR INFORMATION PROVIDED AFTER PERFORMANCE ON HOW TO IMPROVE MOVEMENT TERMINAL KP A COMBINATION OF INFORMATION AND INSTRUCTION PROVIDED AFTER PERFORMANCE ON HOW TO IMPROVE MOVEMENT 43

Biofeedback EXTERNAL FEEDBACK EXTERNAL DEVICES PROVIDE INFORMATION DURING TASK PERFORMANCE NON MEASURABLE DEVICES AUGMENTED FEEDBACK REAL FEEDBACK 44

Biofeedback CHALLENGE EFFECT CHALLENGING TASK BEFORE CHALLENGE INCREASE MOTIVATION REPETITIVE PERFORMANCE AFTER CHALLENGE BETTER OUTCOME 45

Biofeedback MOTION FEEDBACK LEADS TO SELF OBJECTIVE UNDERSTANDING OF PERFORMANCE POSITIVE FEEDBACK NEGATIVE FEEDBACK PERFORMANCE CONTINUATION PERFORMANCE CORRECTION 46

Clinical applications 1. 2. 3. 47

Clinical applications INSTRUCTION DETAILED JOINT/S MOVEMENT INSTRUCTIONS CAN BE CUSTOMIZED EXT. HOLD FLX. HOLD 48

Clinical applications TIME LINE FEEDBACK CONCOMITANT FEEDBACK IS PROVIDED ON PAST AND PRESENT PERFORMANCE PAST PRESENT FUTURE 49

Clinical applications FADED FEEDBACK DEVIATION LIMIT CAN BE CUSTOMIZED 50

Clinical applications POSITIVE FEEDBACK NO EXTRA AUDITORY / VISUAL FEEDBACK IS PROVIDED WHEN IN DEVIATION LIMIT 51

Clinical applications NEGATIVE FEEDBACK EXTRA AUDITORY / VISUAL FEEDBACK IS PROVIDED WHEN OUT OF DEVIATION LIMIT 52

Clinical applications QUANTITATIVE FEEDBACK QUANTITATIVE INFORMATION IS PROVIDED DURING AND AT THE END OF THE TASK 53

Clinical applications QUALITATIVE FEEDBACK QUALITATIVE INFORMATION IS PROVIDED DURING PERFORMANCE 54

Clinical applications INTENSIVE TASK THE TASK CAN BE REPEATED FOR INTENSIVE PRACTICE CYCLE 1 CYCLE 2 55

Clinical applications SUMMERY Motivation Intensive practice Motor learning Repetitive practice Functional practice Difficulty levels Real feedback SUCCESSFUL FUNCTIONAL RECOVERY 56

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