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New Generation in Rehabilitation. FEEDBACK IN PHYSICAL REHABILITATION. Dr. Avraham Cohen Chief Clinical Officer MediTouch Ltd. INTRODUCTION. 1. MOTOR LEARNING. 2. BIOFEEDBACK. 3. CLINICAL APPLICATIONS. 4. 2. Introduction. OPTIMAL REHABILITATION. REHAB. METHOD. REHAB. AIM. ?.

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Dr. Avraham Cohen Chief Clinical Officer MediTouch Ltd .


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Presentation Transcript
slide1

New Generation in Rehabilitation

FEEDBACK IN PHYSICAL REHABILITATION

Dr. Avraham Cohen

Chief Clinical Officer MediTouch Ltd.

slide2

INTRODUCTION

1

MOTOR LEARNING

2

BIOFEEDBACK

3

CLINICAL APPLICATIONS

4

2

slide3

Introduction

OPTIMAL REHABILITATION

REHAB. METHOD

REHAB. AIM

?

SENSORIMOTOR

IMPROVEMENT

FUNCTIONAL

ABILITIES

slide4

Motor learning

MOTOR

LEARNING

IN

REHABLITATION

slide5

Motor learning

DISABILITY

  • NEUROMUSCULAR / MUSCULOSKELETAL INJURIES
  • SENSORIMOTOR IMPAIRMENTS
  • DISABILITIES
slide6

Motor learning

DISABILITY

BODY FUNCTION

FUNCTIONAL ACTIVITIES

SOCIAL PARTICIPATION

slide7

Motor learning

APPROACHES

  • FUNCTIONAL
  • PRACTICE

IMPAIRMENT

IMPROVEMENT

slide8

Motor learning

APPROACHES

  • IMPAIRMENT
  • PRACTICE

FUNCTIONAL

IMPROVEMENT

slide9

Motor learning

CLINICAL REASONING

DIAGNOSIS

PHASE

MOVEMENTABILITY

slide10

Motor learning

BRAIN PLASTICITY

BRAIN'S ABILITY TO CHANGE

PHYSICALLY, CHEMICALLY AND FUNCTIONALLY THROUGHOUT LIFE.

slide11

Motor learning

MOVEMENT INSTRUCTIONS

MOTOR CORTEX RECEIVES INSTRUCTION AND FEEDBACK INPUT FROM VISUAL AND AUDITORY CORTEX

slide12

Motor learning

MOTOR CORTEX

RESPONSIBLE TO PLAN, CONTROL AND EXECUTE

VOLUNTARY MOVEMENTS

slide13

Motor learning

MOVEMENT INSTRUCTIONS

VISUAL INPUT IS RESPONSIBLE FOR SELFOBJECTIVE UNDERSTANDING OF MOVEMENT

slide14

Motor learning

MOVEMENT INSTRUCTIONS

AUDITORY INPUT IS RESPONSIBLE FOR SELFSUBJECTIVE UNDERSTANDING OF MOVEMENT

slide15

Motor learning

MOVEMENT INSTRUCTIONS

OPTIMAL VOLUNTARY MOVEMENTS ARE EXECUTED BY OBJECTIVE AND SUBJECTIVE INPUTS

AUDITORY

VISUAL

slide16

Motor learning

SPATIAL ORIENTATION

VISUALSYSTEM

VESTIBULAR SYSTEM

PERIPHERAL SENSATION

PERIPHERAL MECHANOCEPTORS

slide17

Motor learning

PERIPHERAL MECHANOCEPTORS

MUSCLE SPINDLE

TENDON GOLGI

LIGAMENT ARTICULAR RECEPTORS

SKIN RECEPTORS

slide18

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

slide19

Motor learning

SPATIAL ORIENTATION

SPATIAL ORIENTATION HELPS TO MAXIMIZE BODY FUNCTION

slide20

Motor learning

  • PERIPHERAL SENSATION

PROPRIOCEPTIONJOINT POSITION INFORMATION

KINESTHESIA JOINT MOVEMENT INFORMATION

slide21

Motor learning

  • PERIPHERAL SENSATION
  • PERIPHERAL SENSATION HELPS TO MINIMIZE BODY DAMAGE
slide22

Motor learning

POSITIVE BRAIN REORGANIZATION

OPTIMAL BRAIN ORGANIZATION MOVEMENT USING AMPLIFICATION OF WEAK AND REDUCTIONOF DOMINANT INPUT

MOTOR CORTEX

AUDITORY

CORTEX

VISUAL

CORTEX

PERIPHERAL

SENSATION

slide23

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

slide24

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

slide25

Motor learning

PRACTICE METHOD

LOCAL DEEP SENSATION

OPEN KINETIC CHAIN

KINESTHESIA

PROPRIOCEPTION

JOINT RESISTANCE

LOW MUSCLE STRENGTH

LIMITED MUSCLE RECRUITMENT

LOW BALANCE ABILITY

NOGROUND REACTION FORCE

slide26

Motor learning

PRACTICE METHOD

MULTIDEEP SENSATION

CLOSED KINETIC CHAIN

KINESTHESIA

PROPRIOCEPTION

JOINT RESISTANCE

HIGHMUSCLE STRENGTH

MULTI MUSCLE RECRUITMENT

GRF

HIGH BALANCE ABILITY

WITH GROUND REACTION FORCE

slide27

Motor learning

PRACTICE METHOD

FOR MOBILITY

OPEN CHAIN SHOULD BE USED

FORSTABILITY

STATIC CLOSED CHAIN SHOULD BE USED

FORCONTROLLED MOBILITY

DYNAMIC CLOSED CHAIN SHOULD BE USED

slide28

Motor learning

IMPAIRMENT FOCUS

SELECTIVE PRACTICE LEADS TO PREVENT COMPENSATORY MOVEMENT DEVELOPMENT

slide29

Motor learning

DIFFICULTY LEVEL CUSTOMIZATION

TASKDIFFICULTY LEVEL CUSTOMIZED TO PATIENT PHYSICAL ABILITY

slide30

Motor learning

INTENSIVEPRACTICE

INTENSIVE REPETITION OF CUSTOMIZED TASK ARE REQUIRED FOR MOTOR LEANING AND PHYSICAL REHABILITATION

slide31

Motor learning

REACTION TIME

TIME PREDICTION AND TASK INSTRUCTION AFFECT ON REACTION TIME

slide33

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

slide34

Biofeedback

KNOWLEDGE OF RESULT (KR)

ADVANTAGES

KR USED BY PATIENTS WITH BROAD SPECTRUM OF MOVEMENT ABILITIES

DISADVANTAGES

KR CAN CAUSE COMPENSATORY MOVEMENT DEVELOPMENT

slide35

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

slide36

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

slide37

Biofeedback

FEEDBACK TYPES

  • INTERNAL
  • EXTERNAL
  • PERIPHERAL
  • SENSATION
  • REAL
  • AUGMENTED
  • VISION
  • AUDITION
slide38

Biofeedback

FEEDBACK ACCURACY

PRECISE FEEDBACK COMPARED TO GENERAL ENCOURAGEMENT

PATIENTABILITY

REHABILITATION PERIOD

slide39

Biofeedback

FEEDBACK DOSAGE

FEEDBACK INTENSITY NEEDS TO INCREASE AS IMPAIRMENT SEVERITY INCREASES

FEEDBACK INTENSITY

IMPAIRMENT SEVERITY

slide40

Biofeedback

TASK INTRINSIC FEEDBACK

PROVIDES VISION, AUDITION AND SENSATION INFORMATION

slide41

Biofeedback

FADED FEEDBACK

FEEDBACK SHOULD BE PROVIDED IN DEVIATION LIMIT

FEEDBACK AREA

DEVIATION AREA

CORRECT AREA

slide42

Biofeedback

REAL TIME FEEDBACK

PROVIDES IMMEDIATE INFORMATION, SHORT TERM MEMORY NOT REQUIRED

slide43

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

slide44

Biofeedback

EXTERNAL FEEDBACK

EXTERNAL DEVICES PROVIDE INFORMATION DURING TASK PERFORMANCE

  • NON MEASURABLE DEVICES
  • MEASURABLE DEVICES

AUGMENTED FEEDBACK

REAL FEEDBACK

slide45

Biofeedback

CHALLENGE EFFECT

BEFORE CHALLENGE

  • CHALLENGING TASK
  • INCREASE MOTIVATION

AFTER CHALLENGE

  • REPETITIVE PERFORMANCE
  • BETTER
  • OUTCOME
slide46

Biofeedback

MOTION FEEDBACK

LEADS TO SELF OBJECTIVE UNDERSTANDING OF PERFORMANCE

  • POSITIVE FEEDBACK
  • NEGATIVE FEEDBACK

PERFORMANCE CONTINUATION

PERFORMANCE CORRECTION

slide48

Clinical applications

INSTRUCTION

DETAILED JOINT/S MOVEMENT INSTRUCTIONS CAN BE CUSTOMIZED

EXT.

EXT. HOLD

FLX.

FLX. HOLD

slide49

Clinical applications

TIME LINE FEEDBACK

CONCOMITANT FEEDBACK IS PROVIDED ON PAST AND PRESENT PERFORMANCE

PAST

PRESENT

FUTURE

slide50

Clinical applications

FADED FEEDBACK

DEVIATION LIMIT CAN BE CUSTOMIZED

slide51

Clinical applications

POSITIVE FEEDBACK

NO EXTRA AUDITORY / VISUAL FEEDBACK IS PROVIDED WHEN IN DEVIATION LIMIT

slide52

Clinical applications

NEGATIVE FEEDBACK

EXTRA AUDITORY / VISUAL FEEDBACK IS PROVIDED WHEN OUT OF DEVIATION LIMIT

slide53

Clinical applications

QUANTITATIVE FEEDBACK

QUANTITATIVE INFORMATION IS PROVIDED DURING AND AT THE END OF THE TASK

slide54

Clinical applications

QUALITATIVE FEEDBACK

QUALITATIVE INFORMATION IS PROVIDED DURING PERFORMANCE

slide55

Clinical applications

INTENSIVE TASK

THE TASK CAN BE REPEATED FOR INTENSIVE PRACTICE

CYCLE 1

CYCLE 2

slide56

Clinical applications

SUMMERY

Motivation

Intensive practice

Functional practice

Motor learning

Difficulty levels

Repetitive practice

Real feedback

SUCCESSFUL

FUNCTIONAL RECOVERY