Motor Learning

1. Motor Learning Process of acquiring or modifying motor skills through practice Leads to a relatively permanent change After CNS injury, relies on plasticity (CNS adaptation)

2. Factors that affect Motor Learning CNS arousal / multisensory approach Attention to task Patient motivation Type of memory needed Level / degree of movement required Type / timing of reinforcement Practice schedule Type of practice Environmental context

3. Stages of Motor Learning SKILL ACQUISITION Patient is getting the idea Many errors Performance inconsistent Frequent repetition and feedback needed Regular practice schedule needed

4. Stages of Motor Learning SKILL REFINEMENT Decrease in number / degree of errors Increase in consistency / efficiency of movement Distributed practice schedule often used in this stage

5. Stages of Motor Learning SKILL RETENTION Patient able to perform movement Patient able to achieve functional goals Objective to retain skill and transfer it to different settings Utilize motor problem-solving Random practice schedule useful

6. Measures of Learning The structure and quality of practice and feedback about performance influence the transfer of skills.

7. Types of Practice RANDOM Best if several tasks are planned Allows for problem-solving motor problems which aids retention

8. Types of Practice BLOCKED Repeated performance of the same motor skill Good during early learning or with confused patients

9. Types of Practice PRACTICE CONTEXTS Facilitates generalization of learning Change environments / conditions yet retain the motor skills required for the task Training should be realistic and in an appropriate environment

10. Feedback / Reinforcement INTRINSIC FEEDBACK Information received from the learner after performing the task Arises from sensory stimulation to tactile receptors, proprioceptors, and visual and vestibular systems May be limited in patients with sensory, perceptual or cognitive impairments

11. Feedback / Reinforcement EXTRINSIC FEEDBACK Information received from outside source Augments intrinsic feedback Can provide information on performance and/or results

12. Feedback / Reinforcement Use performance feedback vs. results feedback in treatment Give feedback more in the early stages and taper off when the patient can correct errors in movement Does frequent extrinsic feedback delay the development of intrinsic feedback?

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14. Weight Management • National Institutes of Health • 68% of American adults are overweight • More than 33.8% of American adults are obese • In 2007-2008, 32.3% of adult men and 35.5% of adult women were obese Weight Management

15. Basic Concepts of Weight Management • Body Composition • Fat-free mass and body fat • Fat-free mass: bone, water, muscle, connective tissue, organ tissues, and teeth • Body Fat • Essential fat: necessary for body to function • 3-5% of total fat in men, 8-12% in women • Fat Storage • Adipose tissue: connective tissue in which fat is stored • Subcutaneous fat: Located under the skin • Visceral Fat (intra-abdominal fat): Located around major organs • Factors Affecting Body Composition • Genetically determined number of fat cells • Cells can increase or decrease in size depending on • Age • Sex • Metabolism • Diet • Activity level • 1 pound of fat = 3500 calories Weight Management

16. Energy Balance • Energy balance is key to keeping a healthy ratio of fat and fat-free mass • You take in energy (calories) • You use up energy (calories) • Energy in = energy out, you maintain • your current weight • Energy in > energy out, you gain • weight • Energy in < energy out, you lose • weight Weight Management

17. Evaluating Body Weight and Body Composition • Overweight: Total body weight above recommended range for good health • Obesity: A more serious degree of overweight • Body Mass Index (BMI) • Based on the concept that weight should be proportional to height • Does not distinguish between fat weight and fat-free weight Weight Management

18. Body Composition Analysis • Most accurate and direct way to determine percent body fat • Hydrostatic (underwater) weighing and Bod Pod • Skinfold measurements • Thickness of fat under the skin • Electrical impedance analysis • Electricity prefers fat-free tissue Weight Management

19. Excess Body Fat and Wellness • The health risks of excess body fat • Reduces life expectancy by 10-20 years • Associated with: Unhealthy cholesterol and triglyceride levels, impaired heart function, and death from cardiovascular disease • Other health factors: hypertension, cancer, impaired immune function, gallbladder and kidney disease, skin problems, impotence, sleep and breathing disorders, back pain, arthritis, bone and joint disorders • Strong association with diabetes mellitus: a disease that disrupts normal metabolism Weight Management

20. Body Fat Distribution and Health • Apple shape • Pear shape • Assessed by measuring waist circumference • Total waist measurement of more than 40 inches for men and 35 inches for women is associated with increased risk of disease • Large waist circumference can be a marker for increased risk of diabetes, high blood pressure, and CVD, even in people with a BMI in the normal range Weight Management

21. Body Image • Collective picture of the body as seen through the mind’s eye • Perceptions • Images • Thoughts • Attitudes • Emotions Weight Management

22. Problems Associated with Very Low Levels of Body Fat • Very low body fat is less than 8-12% for women and less than 3-5% for men • Extreme leanness has been linked to problems with • Reproductive disorders • Circulatory disorders • Immune system disorders • Female Athlete Triad • Abnormal eating patterns • Amenorrhea • Decreased bone density Weight Management

23. Factors Contributing To Excess Body Fat • Genetic Factors • 25% to 40% of an individual’s body fat • The tendency to develop weight is inherited, what you do does matter • Physiological Factors • Metabolism • Resting metabolic rate (RMR): the energy required to maintain vital body functions while the body is at rest Weight Management

24. Lifestyle Factors • Eating • Physical activity • Psychosocial factors • Emotions • Distraction from difficult feelings • Helps regulate emotions • Coping strategies • Socioeconomic status • Family and culture Weight Management

25. Adopting A Healthy Lifestyle For Successful Weight Management • Diet and eating habits • Total calories • MyPyramid suggestions • Best approach for weight loss is combining an increase of exercise with moderate calorie restriction • Portion Sizes • Energy (Calorie) Density • Eating Habits • Small, frequent meals • Set rules to govern your food choices • Eat in moderation Weight Management

26. Physical Activity and Exercise • Increasing physical activity is a better approach to losing weight than cutting food intake • Regular physical activity: • Protects against weight gain • Maintains weight loss • Improves quality of life Weight Management

27. Thinking and Emotions • Low self-esteem • “Ideal self” • “Self-talk” can either be self-deprecating or motivating • Realistic beliefs and goals Weight Management

28. Coping Strategies • Appropriate coping strategies help you deal with the stresses of life and help with weight management • Overeating is not an appropriate coping strategy • Use food appropriately • To fuel life activities • Foster growth • Bring pleasure • Find new coping strategies Weight Management

29. Approaches to Overcoming A Weight Problem • Doingit yourself • Lose 0.5-2.0 pounds per week • Initial weight loss occurs from fluid loss • Smaller, mostly fat, losses later in the diet are better than initial larger, mostly fluid, losses • Reasonable weight loss: 8-10% of body weight over 6 months • Dietary supplements and diet aids • Formula drinks and food bars • Herbal supplements • Other supplements Weight Management

30. Prescription Drugs • Appetite suppressants • All prescription weight-loss drugs have potential side effects • Recommended only for people who have been unable to lose weight with nondrug options or who have a BMI over 30 Weight Management

31. Surgery • Treatment of last resort • Only for severely obese • 5.7% of American adults qualify as severely, or morbidly, obese • NIH recommends gastric bypass for individuals with a BMI of 40 or higher Weight Management

32. Eating Disorders • Problems with body weight and weight control • Characterized by severe disturbances in body image, eating patterns, and eating-related behaviors • Disordered eating affects an estimated 10 million American females and 1 million males • About 90% of eating disorders begin during adolescence. Some begin as young as 8 Weight Management

33. Anorexia Nervosa • Failure to eat enough food to maintain a reasonable body weight • Affects 3 million people – 95% are female • Characteristics of anorexia nervosa • Fear of gaining weight • Distorted body image • Compulsive behaviors and rituals • Excessive exercise • Health risks of anorexia nervosa • Loss of menstruation • Intolerance to cold • Low blood pressure and heart rate • Dry skin covered by fine body hair • Hands and feet may swell and take on a blue tinge • Variety of medical complications – electrolyte imbalance, heart failure, cardiac arrest • Depression and suicide Weight Management

34. Bulimia Nervosa • Recurring episodes of binge eating followed by purging • Begins in adolescence or young adulthood • Characteristics of bulimia nervosa • Rapidly consumes food, then purges • Done in secret • After a binge, individual feels ashamed, disgusted and physically and emotional drained • Health risks of bulimia nervosa • Erodes tooth enamel • Deficient calorie intake • Liver and kidney damage • Cardiac arrhythmia • Chronic hoarseness • Esophageal tearing • Rupture of the stomach • Increased depression • Disturbances in cognitive functioning Weight Management

35. Other Eating Disorders • Binge-Eating • Similar to bulimia, except no purging behavior • Likely to be obese • Increased health risks • Higher rates of depression and anxiety • Borderline Disordered Eating • Have some symptoms of eating disorders but do not meet full diagnostic criteria for eating disorder Weight Management

37. * Increased energy level * Increased cardiovascular fitness * Increased HDL levels * Overall wellness * Better quality of life * Decreased mortality rates due to preventable illnesses (Diabetes, Osteoporosis, some cancers (Colon/Breast), and Cardiovascular disease) Why Exercise

38. What is Physical Fitness? • The body’s ability to respond or adapt to the demands and stress of physical effort • Health-related fitness: 5 components • Cardiorespiratory endurance • Muscular strength • Muscular endurance • Flexibility • Body composition

39. What is Physical Fitness? • Cardiorespiratory Endurance- ability to perform prolonged, large-muscle, dynamic exercise at moderate to high intensity • Muscular Strength- amount of force a muscle can produce with a single maximum effort • Muscular Endurance- ability to resist fatigue and sustain a given level of muscle tension • Flexibility- ability of joints to move through their full range of motion • Body Composition–proportion of fat and fat-free mass (muscle, bone, and water) in the body • Skill-Related Components of Fitness – speed, power, agility, balance, coordination and reaction time. Tends to be sport specific

40. Physical Activity and Exercise for Health and Fitness • The Centers for Disease Control and Prevention (CDC) recent statistics about American adults: • About 31% participate in some leisure-time physical activity • Between 2003 and 2009, that leisure-type physical activity decreased by nearly 6% • Physical activity levels are higher in men than in women but decline with age in both • Levels are lower in Hispanics, American Indians, and blacks than in whites • People with higher levels of education are more active. 54% of college grads exercise regularly compared to 31% of high school dropouts

41. The Benefits of Exercise • Improved cardiorespiratory functioning • More efficient metabolism and improved cell health • Improved body composition • Reduced risk of premature • death

42. Disease Prevention and Management • Cardiovascular Disease • Prevention = Exercise • Improves cholesterol levels • Improves blood pressure • Improves insulin resistance • Interferes with the disease itself • Lowers risk of heart disease and stroke • Cancer • Osteoporosis • Type 2 Diabetes

43. Improved Psychological and Emotional Wellness • Reduced anxiety and depression • Improved sleep • Reduced stress • Enhanced self-esteem and • sense of self-efficacy • Enhanced creativity and • intellectual functioning • Improved interpersonal wellness

44. Physical Activity and Exercise for Health and Fitness • Improved immune function • Prevention of injures and low-back pain • Improved wellness for life

45. Designing Your Exercise Program: First Steps • Medical clearance • Men over 40 and women over 50 • Basic principles of physical training • Specificity • Progressive overload • Frequency • Intensity • Time • Type • Reversibility • Individual differences • Selecting activities

46. Cardiorespiratory Endurance Exercises • Frequency - 3-5 days per week • Intensity • Maximal oxygen consumption (VO2max) • Target heart rate range • Duration - 20-60 minutes per workout • Type • The warm-up and cool-down

47. Developing Muscular Strength and Endurance • Types of strength training exercise • Resistance exercise • Isometric (static) exercise • Isotonic (dynamic) exercise • Choosing equipment • Choosing exercises • Frequency • Intensity and time • A caution about supplements

48. Flexibility Exercises • Proper stretching technique • Statically • Ballistic (bouncing) is dangerous • Active • Passive • Frequency • Intensity and time

49. Getting Started and Staying on Track • Selecting instructors, equipment, and facilities • Finding help and advice about exercise • Selecting equipment • Choosing a fitness center • Eating and drinking for exercise • Balanced diet • Drink before and during exercise • 2 cups, 2 hours before • Manage your fitness program • Start slowly, get in shape gradually • Exercising consistently • Assessing your fitness • Preventing and managing athletic injuries • Staying with your program

50. Functional performance directly affects, occupational performance (ADL’s, IADL’s, etc.), performance skills (energy, endurance, etc.), and performance patterns (roles, habits, etc.) Physical exercise has been shown to have a significant impact on functional performance as individuals begin to age. Points to remember