Efficient, functionally driven motor behavior is vital for surviving and thriving. If you are working with patients with neurological impairments, you know the challenges of retraining the damaged central nervous system (CNS).
These motor learning strategies, tailored to the CNS, will help you more efficiently train the skilled movement that patients with damaged motor systems are struggling to achieve.
4 Strategies to Drive Neuroplastic Changes in the Degenerating CNS
Patients with neurological disease require a special skill set of tools beyond the basics to guide motor learning because different areas of damaged brain tissue need different interventions. Damage to any one of these areas reduces the effectiveness of the brain to learn.
Motor learning strategies need to be tailored to the type of learning the patient will most benefit from. These include:
- Use-dependent practice—targets the motor cortex and its connection to the spinal cord. It requires conscious awareness and lots of practice to drive motor learning.
- Strategy-based learning—targets the prefrontal cortex to organize and execute the order and timing of movement. It requires conscious awareness for motor learning to occur.
- Error-based learning—allows the patient to learn from their errors. It targets the cerebellum and does not require conscious awareness. Motor memory is the unconscious result of this learning strategy.
- Reinforcement-based learning—relies on feedback from motor successes and failures. It targets the basal ganglia and requires conscious awareness to guide motor learning.
What does this mean in the real world of the treating therapist? You can use this guidance to form your interventions.
For instance, reinforcement-based learning, which involves giving feedback and positive reinforcement, would be the least effective strategy for a person with Parkinson’s disease. A more successful practice condition would be error-based learning, which lets the patient make movement errors and learn by them to develop motor memory. All of the other strategies would also be effective.
At the same time, error-based learning—using movement errors from perturbations—is the least effective approach for a person with cerebellar ataxia. Reinforcement-based learning, which makes them aware of successful movement, reinforces this success, and repeats the successful movement, is a better way for those with cerebellar damage to learn.
Although persons with different brain lesions will learn better with different strategies, repetition, repetition, repetition is the one universal strategy that is key to all motor learning.
Layering Motor Learning Techniques
Many other motor learning techniques are universally effective to relearn motor skills, and when used in conjunction with each other, they add to the success of the overall intervention.
These techniques include, but are not limited to:
- Use instructions effectively. This includes using external cues as the focus of attention. In addition, people with damage to the brain learn better with fewer verbal instructions.
- Challenge the patient with the correct amount of difficulty while still allowing them to be successful.
- Use visual cues, which always improve motor performance.
- Permit patients to make unrelated decisions about their treatment to enhance their outcomes. For instance, let them choose the area of the clinic in which they would like to work.
- Allow novice learners time to use mental imagery as a form of practice prior to having them complete physical practice.
Patients with Neurodegenerative Diseases Are Living Longer
The continued development of disease-modifying therapies allows patients with neurodegenerative diseases to live longer than ever before. While the aging population with neurodegenerative diseases develops the same comorbidities of normal aging, their disease makes interventions more challenging—and therefore, it is vital for therapists to use the right kind of intervention for the damaged brain.
How We Can Make a Difference
By understanding concepts of motor learning unique to patients with neurodegenerative conditions, we can design treatment plans for this special population of patients. We then can apply evidence-based treatment approaches to achieve successful outcomes.