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

1 2 3 4 INTRODUCTION MOTOR LEARNING BIOFEEDBACK CLINICAL APPLICATIONS

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

Motor learning MOTOR LEARNING IN REHABLITATION

NEUROMUSCULAR / MUSCULOSKELETAL INJURIES SENSORIMOTOR IMPAIRMENTS Motor learning DISABILITY NEUROMUSCULAR / MUSCULOSKELETAL INJURIES SENSORIMOTOR IMPAIRMENTS DISABILITIES

FUNCTIONAL ACTIVITIES Motor learning DISABILITY BODY FUNCTION FUNCTIONAL ACTIVITIES SOCIAL PARTICIPATION

Motor learning APPROACHES FUNCTIONAL PRACTICE IMPAIRMENT IMPROVEMENT

Motor learning APPROACHES IMPAIRMENT PRACTICE FUNCTIONAL IMPROVEMENT

Motor learning CLINICAL REASONING DIAGNOSIS PHASE MOVEMENT ABILITY

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

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

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

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

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

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

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

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

PERIPHERAL SENSATION DEEP SENSATION CUTANEOUS SENSATION 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

Motor learning SPATIAL ORIENTATION SPATIAL ORIENTATION HELPS TO MAXIMIZE BODY FUNCTION

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

Motor learning PERIPHERAL SENSATION PERIPHERAL SENSATION HELPS TO MINIMIZE BODY DAMAGE

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

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

PRACTICE TYPE BLOCKED A SERIES OF IDENTICAL PRACTICE RANDOM 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

PRACTICE METHOD LOCAL DEEP SENSATION LOW MUSCLE STRENGTH 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

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

PRACTICE METHOD FOR MOBILITY OPEN CHAIN SHOULD BE USED FOR STABILITY 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

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

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

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

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

Biofeedback

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

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

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

KNOWLEDGE OF PERFORMANCE (KP) 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

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

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

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

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

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

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

TERMINAL FEEDBACK DEFINITION TERMINAL KR TERMINAL KP 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

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

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

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

Clinical applications 1. 2. 3.

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

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

Clinical applications FADED FEEDBACK DEVIATION LIMIT CAN BE CUSTOMIZED

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

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

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

Clinical applications QUALITATIVE FEEDBACK QUALITATIVE INFORMATION IS PROVIDED DURING PERFORMANCE

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

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

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