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

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Presentation on theme: "Dr. Avraham Cohen Chief Clinical Officer MediTouch Ltd. 1 FEEDBACK IN PHYSICAL REHABILITATION New Generation in Rehabilitation."— Presentation transcript:

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

2 2 INTRODUCTIONMOTOR LEARNINGBIOFEEDBACKCLINICAL APPLICATIONS

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

4 MOTOR LEARNING Motor learning IN REHABLITATION 4

5 5 DISABILITY DISABILITIES NEUROMUSCULAR / MUSCULOSKELETAL INJURIES SENSORIMOTOR IMPAIRMENTS Motor learning

6 6 DISABILITY FUNCTIONAL ACTIVITIES SOCIAL PARTICIPATION BODY FUNCTION Motor learning

7 7 APPROACHES FUNCTIONAL PRACTICE IMPAIRMENT IMPROVEMENT Motor learning

8 8 APPROACHES IMPAIRMENT PRACTICE FUNCTIONAL IMPROVEMENT Motor learning

9 9 CLINICAL REASONING DIAGNOSIS PHASE MOVEMENT ABILITY Motor learning

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

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

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

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

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

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

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

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

18 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 18

19 SPATIAL ORIENTATION SPATIAL ORIENTATION HELPS TO MAXIMIZE BODY FUNCTION Motor learning 19

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

21 21 PERIPHERAL SENSATION PERIPHERAL SENSATION HELPS TO MINIMIZE BODY DAMAGE Motor learning

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

23 23 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

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

25 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 FORCE 25

26 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 26

27 27 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

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

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

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

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

32 Biofeedback 32

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

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

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

36 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 36

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

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

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

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

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

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

43 TERMINAL FEEDBACK KR AND KP INFORMATION THAT IS PROVIDED AFTER MOVEMENT PERFORMANCE DEFINITION Biofeedback 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

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

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

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

47 1. 2. 3. Clinical applications 47

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

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

50 50 DEVIATION LIMIT CAN BE CUSTOMIZED FADED FEEDBACK Clinical applications

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

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

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

54 QUALITATIVE INFORMATION IS PROVIDED DURING PERFORMANCE 54 QUALITATIVE FEEDBACK Clinical applications

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

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

57 meditouch.co.il 57


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