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

2. INTRODUCTION 1 MOTOR LEARNING 2 BIOFEEDBACK 3 CLINICAL APPLICATIONS 4 2

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

4. Motor learning MOTOR LEARNING IN REHABLITATION

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

6. Motor learning DISABILITY BODY FUNCTION FUNCTIONAL ACTIVITIES SOCIAL PARTICIPATION

7. Motor learning APPROACHES • FUNCTIONAL • PRACTICE IMPAIRMENT IMPROVEMENT

8. Motor learning APPROACHES • IMPAIRMENT • PRACTICE FUNCTIONAL IMPROVEMENT

9. Motor learning CLINICAL REASONING DIAGNOSIS PHASE MOVEMENTABILITY

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

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

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

13. Motor learning MOVEMENT INSTRUCTIONS VISUAL INPUT IS RESPONSIBLE FOR SELFOBJECTIVE UNDERSTANDING OF MOVEMENT

14. Motor learning MOVEMENT INSTRUCTIONS AUDITORY INPUT IS RESPONSIBLE FOR SELFSUBJECTIVE UNDERSTANDING OF MOVEMENT

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

16. Motor learning SPATIAL ORIENTATION VISUALSYSTEM VESTIBULAR SYSTEM PERIPHERAL SENSATION PERIPHERAL MECHANOCEPTORS

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

18. 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

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

20. Motor learning • PERIPHERAL SENSATION PROPRIOCEPTIONJOINT POSITION INFORMATION KINESTHESIA JOINT MOVEMENT INFORMATION

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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

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

29. Motor learning DIFFICULTY LEVEL CUSTOMIZATION TASKDIFFICULTY LEVEL CUSTOMIZED TO PATIENT PHYSICAL ABILITY

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

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

32. Biofeedback

33. 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

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

35. 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

36. 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

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

38. Biofeedback FEEDBACK ACCURACY PRECISE FEEDBACK COMPARED TO GENERAL ENCOURAGEMENT PATIENTABILITY REHABILITATION PERIOD

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

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

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

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

43. 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

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

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

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

47. Clinical applications 1. 2. 3.

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

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

50. Clinical applications FADED FEEDBACK DEVIATION LIMIT CAN BE CUSTOMIZED