To start with, lets discuss some relevant background research regarding proprioception, injury, learning, and how all this ties into the unique visual feedback system that your clinic can incorporate to help assist patients.
When considering how people learn, lets look at some general information about auditory, experiential, and visual learners. According to Bradford et al, “Verbal learners, a group that constitutes about 30% of the general population, learn by hearing. They benefit from class lectures and from discussion of class materials in study groups or in oral presentations, but chafe at written assignments. Experiential learners - about 5% of the population - learn by doing and touching, and clinical work, role-playing exercises, and moot court are their best instructional modalities. Visual learners - the remaining 65% of the population - need to see what they are learning” (1)
Are we missing out by not making exercise more "visual" for our patients???
Although this research applies to more of a classroom setting, we can extrapolate these results and apply them to the context of rehabilitation and motor learning. In lieu of this information, if goals in rehabilitating your patient are directed at teaching your patient about body awareness, movement, and understanding their movement strategies or position, we may be missing a crucial part of our education by not using visual feedback.
Research has also noted that the use of “external cues” for motor-learning (ie mirrors, targets, etc) are superior to the use of “internal cues” (ie instruction on how to move during a task) (2). Visual feedback with the Motion Guidance laser device offers a much superior external cue than targets or mirrors, as the feedback is instant and the cue is something the person can directly follow and understand, without the unnecessary cognitive processes of verbal instruction: they see it.
There has been much conversation on the need for compliance during home exercise programs, and during rehab in general as well. What might increase compliance? For a start, the activity needs to make sense as in what the purpose of doing it is, as well as be stimulating. Laser visual feedback covers both these areas: it offers an instant assessment of movement, while instantly allowing the visualization of progress and movement control. This may be especially important among the cohort of youth athletes, who are more likely to view exercise with laser visual feedback as a game, but the concept applies to everyone, as the majority of persons across all age groups are visual learners.
Our bodies have inherent mechanisms to allow us to know where we are in space. This includes vision, tactile sensation, and proprioceptive sensation. Laser guided visual feedback rehabilitation covers all grounds, to create a learning experience that is all encompassing of these mechanisms. Research has shown that our brain’s representation of our body undergoes changes when we are injured. This has been labeled “cortical smudging” or “altered-body mapping” by educators on the topic (3). Essentially, after injury, our discrimination of the injured body part is globally diminished, in all inherent mechanisms. This includes 2-point discrimination (being able to accurately feel and discern pin-prick sensation), as well as “joint positional awareness.” Joint Positional Awareness (JPE) is our ability to understand where our body is in space. Trevelean et al (4) have conducted numerous studies concluding that after whiplash, subjects have difficulty discerning their head position when tested with visual feedback from a laser pointer.
This phenomenon has also been noted in lower back pain patients (5), knee pain (6) as well as shoulder pain patients (7), and the concept applies to every body part. Can we use this knowledge to help us rehabilitate our patient’s condition? Yes! It is as simple as adding visual feedback to movement, and practicing joint positional awareness, motor control, and movement strategy. What can assist in changing the cortex, the brain’s “body-map”? Afferent inputs! These can be both positively or negatively reinforced, by practicing normal fluid movements, or maladaptive antalgic movements, respectively. If motor commands are not compatible with somatosensory feedback, and this continues persistently, we are left with a dysfunctional system under the influence of pain.
Our brain's understanding of our body is organized,
and can undergo changes via neuroplasticity.
There are a boat-load of ways to influence proprioception. These may include manual therapy (tactile afferent input), taping (the research seems to conclude that, while not actually changing biomechanical interfaces, beneficial results exist due to a change in how we (our brain) “views” the body part under the influence of a novel stimuli. This doesn’t make it a sham per say, as any means in disrupting a pain full habitual experience can be beneficial to the person physically and psychologically. We can influence cortical reorganization by applying specific exercises that emphasize joint repositional awareness, and specific neuromuscular control (such as attempting to move a body part guided by visual feedback with a laser pointer, with the goal of precision and accuracy.) Again, it is as simple as practicing these tasks.
Visual feedback training for lumbo-pelvic awareness: pelvic tilting
Here is an example of using the Motion Guidance laser pointer device with cervical JPE:
The Motion Guidance concept is, by nature, a creative concept that can be applied to any body part, to yield instant positional awareness. Functions may include “static functions”, where the laser is kept centered while the body moves (such as keeping the laser centered while performing a "bird dog" exercise, or dynamic (such as moving the laser as far as possible upward and downward during lumbopelvic ROM exercise):
“dynamic functions” can be endlessly: a few examples would be neck in tracking patterns for cervical motor control, shoulder working on ROM, and lower chain loading control:
Beyond clinic use, clinicians can offer their patients home-units to train with visual feedback at home, based on the specific need of the patient, at the discretion of the care provider. This is where compliance may be enhanced, as the visual feedback training is innately understood, and requires no additional feedback other than instructions on what the goals are.
Motion Guidance patient packs can be purchased in bulk at discount rates, and offered to patients through your clinic, as a means of not only giving your patient a tool that may help retain between session learning objectives, but also gain clinic revenue.
Patient packs are sold in sets of 5, for clinicians to distribute to patients.
For further video examples of applying the concept to cervical, shoulder, lumbar, lower chain, and general balance applications, browse our YouTube Channel.
Dr. Tal Blair via Motion Guidance
Dr. Tal Blair via Motion Guidance
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!
Keeping it Eclectic...
Post a Comment
Post a Comment