Up first on Monday morning was Mary Gannotti with Dosage and Timing for Plasticity and Participation in Pediatric Neurological Populations.
Mary gave lots of good examples within the pediatric population, which I won’t really go into here, because I know next to nothing about the pediatric population. So instead, I’ll outline “the nuggets” of truth that can be applied to all populations.
For neurophysiological (neuroplastic) changes and therefore functional changes to occur, you need three ingredients in a treatment:
1) time. Lots of reps in usually what one thinks of here. In the specifics, research is saying 90 HOURS is the threshold. It doesn’t matter if it occurs 23/24 hours or 2 hours at a time, but 90 HOURS spent.
2) effort. Passive exercise doesn’t work (not to create neuroplasticity anyway. PROM has other benefits.) It has to be active or active-assistive, so that the patients’ own neurons are doing the firing, not the therapists’ or caregivers’. For those that lack volitional movement, I’ve seen some research that says that motor imagery fires the neurons just like they would if they actually did the movement. It went so far as motor imagery practice a good adjunct tool to treatment. For example, at my IRF the patients spend at least 3 hours a day in therapy. But send them with homework to their room for the rest of the time to close their eyes and mentally practice the desired movements. Mary didn’t mention motor imagery, but I am, obviously.
3) saliency. Whatever activity you’re working on has to be important, so that the patient is driven to work on it. For example, if you want a kid to walk across a room, put a puppy on the other side of the room. If you want an adult to walk 50 feet, put it in the context of walking their daughter down the aisle or maybe even just getting to the chair to rest across the way.
None of these ideas are particularly new, but it is good to review the cornerstones.