Part 2 of my notes- this section relates to sensory changes/neural plasticity
that has been found in monkeys and some rehab principles being integrated
into hand therapy. Pretty wild stuff (I would have only imagined in sci-fi
novels
20 years ago) and hope for some of the worst sufferers that there is more
"out there" to help with their problems.
Dee
Stressful repetitive hand use has negative effects on peripheral and central
nervous structures
Performance of highly repetitive tasks appears to lead to central spinal cord
changes
Some of the "learning" can be understood by looking at "positive and negative
learning" principles
Positive Learning Principles
Attended
Repetitive but variable
Consistently performed
Rewarded
Spaced over time
Progress from non-target task to functional target task
Negative learning initially occurs as a consequence of behaviors that are
Attended
Repetitive
Consistently performed over time
Unvaried
Very rapid, unusually fast
Limits in neural plasticity
CNS capacity is challenged when behaviors
Become habitual
Stereotypical
Rapid enough to exceed set neural processing time-integration time
Stereotypical behaviors that occur near simultaneously prevent CNS from being
able to generate precise outputs and interfere with normal sensorimotor
feedback. Neural structures compete for refractory periods, neurochemicals,
etc.
Outcomes of negative learning
Cortical representations shrink
Adjacent cortical areas expand and become dysfunctional
Imbalance between sensory input and motor output
Sensory system can become abnormally sensitive (decreased threshold for
excitation/pain)
Assumptions for Retraining
If it is possible to drive positive changes, then negative neural adaptation
can be reversed
Positive learning
Increases the area of representation of the body part on the cortex
Increases myelination
Facilitates dendritic complexity
Enhances secretion of neurotransmitters which continue to enhance
learning
General goals for Retraining
Educate to be the best therapist
Commitment to positive health, fitness, posture
Stress management
Positive expectations for improvement
Images pain free movement
Apply normal hand biomechanics in all tasks
Integrate graded stress free patterns of movement
Restoring normal neurophysiological function
Quiet the nervous system to decrease sensitivity
Facilitate sensorimotor learning activities to
Normalize functional and somatosensory representations
Facilitate different pathways of activation
Restore normal sensorimotor gating, activation thresholds
Requires 6 months to 1 yr with daily program and 2-4x/mo
Natural alignment/use- biofeedback
Restore/focus on curves of hand
Rougher textures- the more you can modify a grip the less demand
Objects of same weight and size will be held more lightly if rough surface
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