Motor Learning and Neuroplasticity in Rehabilitation

Here's a brief summary of an excellent paper by Boudreau et al from Manual Therapy. 

The purpose of this paper was to summarize several important aspects of motor-skill training for enhancing musculoskeletal rehabilitation.

Cortical Neuroplasticity: a dynamic feature of life that encompasses functional or morphological change in properties of neurons (connection strength, represenational patterns, neuron reorganization.

• Positive changes: improvements in motor performance
• Negative changes: decreases in performance, such as in the presence of chronic pain (low back pain resulting in decreased cortical spinal drive in lumbar musculature and subsequent shift in somatosensory representation)

It is hypothesized that motor-skill training can influence the direction of change in cortical neuroplasticity.

• That is, the representation of muscles affected by pain in the sensorimotor system.

Potential effects of motor-skill training:

• Improvements in task performance
• Improvements secondary to very short training intervals.
• Improvements occuring in two stages - 1) fast learning (following a single training session); 2) slower learning (across several sessions of practice)
• Improvements with activation of inhibited/delayed musculature via repeated voluntary contractions.

Methods of Optimizing Rehabilitation:

• Skilled training - skilled/precision tasks (vs strength training) should be performed to facilitate neuroplastic changes, and subsequently improvements in motor behaviour.
• Negative effects of the presence of pain during novel motor skill acquisition - since pain alters excitability of the primary motor cortex in a rapid manner, these responses are generally protective and counterintuitive in the motor-learning process. Negative effects are also demonstrated in the presence of low quality sleep, stress, and attention deficits. Therefore, motor-skill learning should be relatively pain free.
• Protective effect of motor-skill training - training prior to acute experimental pain may prevent unwanted cortical neuroplastic changes.
• Cognitive effort - the greater the complexity of a skilled task and its corresponding intent, results in greater cortical representation and changes.
• Quality - since no difference seems to exist with greater repetitions of within-session skill learning tasks, the primary focus of each rehabilitation session should be quality of performance.

The above information was derived from a multitude of studies and demonstrates that motor-skill training may positively influence cortical neuroplasticity in musculoskeletal rehabilitation
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