2008stephens_strokegait & motor learning

2008stephens_strokegait & motor learning -...

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Modifications to Gait Training using a Motor Learning Approach: A Case Report Ellen Stephens, DPT Candidate UCSF/SFSU Graduate Program in PT
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Introduction: Problem • Stroke is a leading cause of serious, long-term disability in the United States Steinberger, 2007 • 700,000 people experience a stroke annually Steinberger, 2007 • 4.8 million stroke survivors in the United States DeJong, 2005
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Introduction: Problem • Physical Therapy is one of the most effective interventions for stroke • Gait training is associated with better outcomes • Motor Learning is an effective approach for stroke • Lack of protocols for use of Motor Learning gait training for stroke
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Introduction: Motor Learning • Active practice of context-specific motor tasks with appropriate feedback Pollock, 2007 • Based on science, exercise physiology, and biomechanics Pollock, 2007 • Applicable to stroke rehabilitation Krakauer 2006 • Drives neuroanatomical changes resulting in motor recovery, retention, and transfer Jonsdottir 2007,Nudo, Pollock 2007, Krakauer 2006
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Motor Learning Active Participation Problem-Solving Repetition Task-orientation Feedback Task Variance
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Motor Learning Active Participation Active involvement and the cognitive process of determining how to adapt movements in variable situations is considered the most important element of learning and retention Winstein,1999
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Motor Learning Feedback • Feedback is one of the most powerful variables affecting motor learning Winstein,1994 • Infrequent augmented feedback is optimal for motor learning Winstein, 1994
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Motor Learning Repetition • Time spent practicing a task is positively correlated to performance • Repetitive locomotor activity optimizes sensorimotor stimulation and increases neuroplasticity Sullivan, 2002
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Motor Learning Task variance Variable practice and tasks increase development, retention, and generalizability of motor control Jonsdottir 2007, Sullivan 2002, Krakauer 2006
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Motor Learning Task-orientation The topographic organization of the motor cortex is based on groupings of functionally related muscles Nudo
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Introduction: Purpose To describe the examination and clinical problem solving for the use of a motor learning approach for gait training in a 34 year old female post stroke To describe changes in gait parameters observed during the course of treatment
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Patient Description • 34-year-old female • Lives with parents, sister, and nephews • Prior function – Independent with ADL’s – Employed as a housekeeper • Patient signed HIPAA documentation and provided informed consent
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Medical Management • Admitted to acute facility with altered mental status • Diagnosed with left middle cerebral artery ischemic infarct • 10 days in acute facility • Did not receive tPA • Underwent clot retrieval surgery
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Examination: Observation • Alert and oriented • Mild Broca’s aphasia • Right-sided neglect • Right facial droop
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2008stephens_strokegait & motor learning -...

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