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Dr. Avraham CohenChief Clinical Officer MediTouch Ltd.
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FEEDBACK IN PHYSICAL REHABILITATION
N e w G e n e r a t i o n i n R e h a b i l i t a t i o n
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1 INTRODUCTION
MOTOR LEARNING2
BIOFEEDBACK3
4 CLINICAL APPLICATIONS
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OPTIMAL REHABILITATION
Introduction
FUNCTIONALABILITIES
SENSORIMOTORIMPROVEMENT
REHAB. AIMREHAB. METHOD
?
MOTORLEARNING
Motor learning
INREHABLITATION
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DISABILITY
DISABILITIES
NEUROMUSCULAR / MUSCULOSKELETAL INJURIES
SENSORIMOTOR IMPAIRMENTS
Motor learning
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DISABILITY
FUNCTIONAL ACTIVITIES
SOCIAL PARTICIPATION
BODY FUNCTION
Motor learning
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APPROACHES
FUNCTIONALPRACTICE
IMPAIRMENT IMPROVEMENT
Motor learning
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APPROACHES
IMPAIRMENTPRACTICE
FUNCTIONALIMPROVEMENT
Motor learning
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CLINICAL REASONING
DIAGNOSIS
PHASE
MOVEMENTABILITY
Motor learning
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BRAIN PLASTICITY
BRAIN'S ABILITY TO CHANGE PHYSICALLY, CHEMICALLY AND FUNCTIONALLY THROUGHOUT LIFE.
Motor learning
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MOVEMENT INSTRUCTIONS
MOTOR CORTEX RECEIVES INSTRUCTION AND FEEDBACK INPUT FROM VISUAL AND AUDITORY CORTEX
Motor learning
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MOTOR CORTEX
RESPONSIBLE TO PLAN, CONTROL AND EXECUTE VOLUNTARY MOVEMENTS
Motor learning
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MOVEMENT INSTRUCTIONS
Motor learning
VISUAL INPUT IS RESPONSIBLE FOR SELF OBJECTIVE UNDERSTANDING OF MOVEMENT
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MOVEMENT INSTRUCTIONS
Motor learning
AUDITORY INPUT IS RESPONSIBLE FOR SELF SUBJECTIVE UNDERSTANDING OF MOVEMENT
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MOVEMENT INSTRUCTIONS
OPTIMAL VOLUNTARY MOVEMENTS ARE EXECUTED BY OBJECTIVE AND SUBJECTIVE INPUTS
AUDITORY
VISUAL
Motor learning
SPATIAL ORIENTATION
VISUAL SYSTEM
PERIPHERAL MECHANOCEPTORS
VESTIBULAR SYSTEM
Motor learning
PERIPHERAL SENSATION
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PERIPHERAL MECHANOCEPTORS
Motor learning
MUSCLE SPINDLE
SKIN RECEPTORS
TENDON GOLGI
LIGAMENT ARTICULAR RECEPTORS
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PERIPHERAL SENSATION
PROPERIOCEPTION - JOINT POSITION INFORMATION
KINESTHESIA - JOINT MOVEMENT INFORMATION
JOINT RESISTANCE - FORCE GENERATED WITHIN A JOINT
DEEP SENSATION
TEMPERATURE
PAIN
PRESSURE
CUTANEOUS SENSATION
Motor learning
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SPATIAL ORIENTATION
SPATIAL ORIENTATION HELPS TO MAXIMIZE BODY FUNCTION
Motor learning
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PERIPHERAL SENSATION
PROPRIOCEPTION JOINT POSITION INFORMATION
KINESTHESIA JOINT MOVEMENT
INFORMATION
Motor learning
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PERIPHERAL SENSATION
PERIPHERAL SENSATION HELPS TO MINIMIZE BODY DAMAGE
Motor learning
OPTIMAL BRAIN ORGANIZATION MOVEMENT USING AMPLIFICATION OF WEAK AND REDUCTION OF DOMINANT INPUT
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POSITIVE BRAIN REORGANIZATION
Motor learning
VISUAL CORTEX
AUDITORY CORTEX
PERIPHERAL SENSATION
MOTOR CORTEX
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REHABILITATION METHODS
Motor learning
IOT – Impairment Oriented Training
HIGH RESOLUTION
OPEN KINETIC CHAIN
IOT
OBJECTIVE EVALUATION
CLOSED KINETIC CHAIN
HIGH COORDINATION
TOT
SUBJECTIVE EVALUATION
TOT – Task Oriented Training
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PRACTICE TYPE
BLOCKED A SERIES OF IDENTICAL PRACTICE
RANDOM A SERIES OF DIFFERENT PRACTICE
DISTRIBUTED MORE REST TIME THAN PRACTICE TIME
Motor learning
MASSEDMORE PRACTICE TIME THAN REST TIME
OPEN KINETIC CHAIN
PRACTICE METHOD
KINESTHESIA
PROPRIOCEPTION
JOINT RESISTANCE
LOCAL DEEP SENSATION
LIMITED MUSCLE RECRUITMENT
LOW BALANCE ABILITY
LOW MUSCLE STRENGTH
Motor learning
NO GROUND REACTION FORCE25
PRACTICE METHOD
KINESTHESIA
PROPRIOCEPTION
JOINT RESISTANCE
MULTI DEEP SENSATION
MULTI MUSCLE RECRUITMENT
HIGH BALANCE ABILITY
HIGH MUSCLE STRENGTH
Motor learning
WITH GROUND REACTION FORCE
CLOSED KINETIC CHAIN
GRF
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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
Motor learning
IMPAIRMENT FOCUS
SELECTIVE PRACTICE LEADS TO PREVENT COMPENSATORY MOVEMENT DEVELOPMENT
Motor learning
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DIFFICULTY LEVEL CUSTOMIZATION
TASK DIFFICULTY LEVEL CUSTOMIZED TO PATIENT PHYSICAL ABILITY
Motor learning
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INTENSIVE PRACTICE
Motor learning
INTENSIVE REPETITION OF CUSTOMIZED TASK ARE REQUIRED FOR MOTOR LEANING AND PHYSICAL REHABILITATION
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REACTION TIME
TIME PREDICTION AND TASK INSTRUCTION AFFECT ON REACTION TIME
Motor learning
Biofeedback
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KNOWLEDGE OF RESULT (KR)
KR IS THE INFORMATION ABOUT THE PERFORMANCE OUTCOME
DEFINITION
FEEDBACK WITH LESS SENSORIMOTOR INVOLVEMENTIN THE CORRECT MOVEMENT PERFORMANCE
DESCRIPTION
Biofeedback
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KNOWLEDGE OF RESULT (KR)
Biofeedback
KR CAN CAUSE COMPENSATORY MOVEMENT DEVELOPMENT
DISADVANTAGES
ADVANTAGES KR USED BY PATIENTS WITH BROAD SPECTRUM OF MOVEMENT ABILITIES
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KNOWLEDGE OF PERFORMANCE (KP)
KP IS THE INFORMATION ABOUT THE QUALITY OF PERFORMANCE
DEFINITION
Biofeedback
DESCRIPTIONFEEDBACK WITH MORE SENSORIMOTOR INVOLVEMENTIN THE CORRECT MOVEMENT PERFORMANCE
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KNOWLEDGE OF PERFORMANCE (KP)
USED IN BROAD SPECTRUM OF MOVEMENT ABILITIES
ADVANTAGES
Biofeedback
PROVIDES CONTINUING AND TERMINAL FEEDBACK
PROVIDES PROFESSIONAL TRAINING
PREVENTS COMPENSATORY MOVEMENT DEVELOPMENT
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FEEDBACK TYPES
INTERNAL
PERIPHERAL
SENSATION
VISION
AUDITION
EXTERNAL
REAL
AUGMENTED
Biofeedback
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FEEDBACK ACCURACY
PRECISE FEEDBACK COMPARED TO GENERAL ENCOURAGEMENT
Biofeedback
PA
TIE
NT
AB
ILIT
Y
REHABILITATION PERIOD
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FEEDBACK DOSAGE
FEEDBACK INTENSITY NEEDS TO INCREASE AS IMPAIRMENT SEVERITY INCREASES
Biofeedback
FE
ED
BA
CK
INT
EN
SIT
Y
IMPAIRMENT SEVERITY
TASK INTRINSIC FEEDBACK
PROVIDES VISION, AUDITION AND SENSATION INFORMATION
Biofeedback
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FADED FEEDBACK
FEEDBACK SHOULD BE PROVIDED IN DEVIATION LIMIT
Biofeedback
DEVIATION AREA
CORRECT AREA
FEEDBACK AREA
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REAL TIME FEEDBACK
PROVIDES IMMEDIATE INFORMATION, SHORT TERM MEMORY NOT REQUIRED
Biofeedback
TERMINAL FEEDBACK
KR AND KP INFORMATION THAT IS PROVIDED AFTER MOVEMENT PERFORMANCE
DEFINITION
Biofeedback
TERMINAL KRINFORMATION PROVIDED AFTER PERFORMANCE ON HOW TO IMPROVE MOVEMENT
TERMINAL KPA COMBINATION OF INFORMATION AND INSTRUCTION PROVIDED AFTER PERFORMANCE ON HOW TO IMPROVE MOVEMENT
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EXTERNAL FEEDBACK
EXTERNAL DEVICES PROVIDE INFORMATION DURING TASK PERFORMANCE
Biofeedback
NON MEASURABLE DEVICES
AUGMENTED FEEDBACK
MEASURABLE DEVICES
REAL FEEDBACK
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CHALLENGE EFFECT
Biofeedback
CHALLENGING TASK
INCREASE MOTIVATION
REPETITIVE PERFORMANCE
BETTER OUTCOME
BEFORE CHALLENGE
AFTER CHALLENGE
PERFORMANCE CORRECTION
LEADS TO SELF OBJECTIVE UNDERSTANDING OF PERFORMANCE
Biofeedback
POSITIVE FEEDBACK
NEGATIVE FEEDBACK
MOTION FEEDBACK
PERFORMANCE CONTINUATION
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1.2.3.
Clinical applications
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INSTRUCTION
DETAILED JOINT/S MOVEMENT INSTRUCTIONS CAN BE CUSTOMIZED
EXT. EXT. HOLD FLX. FLX. HOLD
Clinical applications
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TIME LINE FEEDBACK
CONCOMITANT FEEDBACK IS PROVIDED ON PAST AND PRESENT PERFORMANCE
PAST FUTUREPRESENT
Clinical applications
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DEVIATION LIMIT CAN BE CUSTOMIZED
FADED FEEDBACK
Clinical applications
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NO EXTRA AUDITORY / VISUAL FEEDBACK IS PROVIDED WHEN IN DEVIATION LIMIT
POSITIVE FEEDBACK
Clinical applications
EXTRA AUDITORY / VISUAL FEEDBACK IS PROVIDED WHEN OUT OF DEVIATION LIMIT
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NEGATIVE FEEDBACK
Clinical applications
QUANTITATIVE INFORMATION IS PROVIDED DURING AND AT THE END OF THE TASK
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QUANTITATIVE FEEDBACK
Clinical applications
QUALITATIVE INFORMATION IS PROVIDED DURING PERFORMANCE
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QUALITATIVE FEEDBACK
Clinical applications
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THE TASK CAN BE REPEATED FOR INTENSIVE PRACTICE
INTENSIVE TASK
CYCLE 1 CYCLE 2
Clinical applications
Repetitive practice
Motor learning
Real feedback
Difficulty levels
SUMMERY
MotivationIntensive practice
Functional practice
SUCCESSFUL
FUNCTIONAL RECOVERY56
Clinical applications
meditouch.co.il
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