Research Roundup: December 2020

 

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Multiple Processes Independently Predict Motor Learning

Perry et al. J Neuro Engineering Rehabil (2020) 17:151 https://doi.org/10.1186/s12984-020-00766-3. 

The authors of this paper used an ethological approach to test the hypothesis that practice-related refinements of multiple behavioural features would be independently predictive of motor learning.

 

Key Points
  • Motor learning results from neural adaptations that produce refinements of behavioural features of motor tasks.

  • Motor learning can induce changes in visual processing that are associated with the refinements of skilled limb movement.
  • The interactions between skilled limb movements and visual search lead to coordinated patterns of the eyes and limbs (ie., hand-eye coordination).
  • Experts with different visuomotor skills have better control of eye movements than novices.
  • Interventions designed to improve control of eye movements and attention lead to improvements in visuomotor performance.
  • Cortical areas that are known to process peripheral visual information exhibit greater involvement during motor tasks.
  • Refinements of hand-eye coordination may contribute to motor learning.

  • Sensory processes contribute to the planning and execution of skilled limb movements.
  • Information from sensory feedback provides reinforcement, which plays an important role in motor learning.
  • Increases in movement speed have a positive effect on task performance.

  • Skilled limb movements, visual search, and hand-eye coordination are independent predictors of motor learning.
  • Studies of motor learning should account for the various processes that may influence improvements in task performance.

 

Clinically: Pilates in Practice
  • Integrate vision!
    • Visual search is a separate task to be trained, and does not necessarily involved eye movement. 
  • Practice limb movements to task-specificity with and without vision. 
  • Integrate head/neck mobility so that gaze follows the hand(s) during movement; throwing pearls on the Cadillac; archer on the Reformer; standing arm circles at the Tower.
  • Introduce external stimuli to the functional task to challenge hand-eye coordination.

 

 

 

Hip-Spine Syndrome: Rationale for Ischiofemoral Impingement, Femoroacetabular Impingement and Abnormal Femoral Torsion Leading to Low Back Pain

Anthony N Khoury, Munif Hatem, Joshua Bowler, Hal David Martin, Hip–spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain, Journal of Hip Preservation Surgery, hnaa054

This narrative review explains the mechanism by which abnormal hip pathologies contribute to low back pain in patients without hip osteoarthritis.

 

Key Points
  • Hip abnormalities limiting hip flexion and/or extension require compensation from the pelvis and lumbar spine for the lack of sagittal movement at the hip.
  • Between 13.1% and 37.5% of the total hip flexion is provided by the pelvis through sagittal movement at the lumbopelvic area.

  • Abnormalities at the hip joint contributing to low back pain include flexion deformities, osteoarthritis, developmental dysplasia, and limited hip range of movement.
  • The bony overgrowth of a cam impingement produces shear forces resulting in an ‘outside-in’ acetabular cartilage damage and labral tears, which amplifies the damage as the femoral head–neck junction rolls into the acetabulum.
  • Cam and pincer deformities cause premature femoroacetabular coupling in flexion and affect the lumbopelvic structures, namely the pubic symphysis, sacroiliac joint, and lumbar spine.
  • Cam and pincer impingements increase sacroiliac and lumbar spine stresses.

  • Limited spine mobility is present in symptomatic patients with femoroacetabular impingement, requiring more flexion at the hip to achieve sitting position, which may lead to impingement between the acetabulum and proximal femur.

  • Abnormal femoral torsion affects the capsulo-labral and musculotendinous structures of the hip and lumbar spine, and may contribute to increased lumbopelvic pain.
  • Abnormal gait displayed by patients with abnormal femoral torsion is a result of the rotational misalignment of the lower extremities.

  • Ischiofemoral space is decreased in the longer side of individuals with leg length inequality.
  • The limitation in hip extension in individuals with increased femoral torsion is caused by contact between the femoral neck and acetabulum or the trochanter and ischium.
  • Tension in the ischiofemoral ligament decreases by externally rotating the hip.

  • Pelvic incidence, which is the sum of pelvic tilt and sacral slope, is a constant value for any given patient:
    • When the pelvic tilt increases, the sacral slope decreases;
    • When the pelvic tilt decreases, the sacral slope increases.

 

Clinically: Pilates in Practice
  • Work on lumbopelvic mobility; seated roll backs, assisted roll ups; side leg kick.
  • Hip rotation mobility is integral, always working into comfortable ranges; use rotator discs; sleeper/side leg press in hip internal rotation. 
  • Pubic symphysis and sacroiliac joint integrity support equal pelvic mobility   bilaterally;  side to side on the Mat; teaser on the Wunda Chair
  • Work to centre the femoral head prior to movement: recall the function of the hamstrings and rotator cuff of the hip.

 

 

Motor Learning Adaptations at The Spinal Cord Level Are Task and Time-Dependent: Implications for Future Investigations And Treatment Interventions

Girts, Ryan M., Kylie K. Harmon, Tristan M. Starling‐Smith, Gerard‐Kyle B. Abad, Molly Gradl, Zachary Logeson, and Johnathon Methven. "Motor learning adaptations at the spinal cord level are task‐ and time‐dependent: Implications for future investigations and treatment interventions." The Journal of Physiology, 2020. doi:10.1113/jp280473.

 

Key Points
  • Learning occurs at the motor neuron or spinal level, as evidenced by downregulation in H-reflex amplitude.
    • The H-reflex is an electrically induced reflex that doesn’t occur naturally in the human body.
    • The H-reflex may not accurately reflect motor neuron excitability, considering that synaptic connections between afferent and motor neurons may be subject to presynaptic modification.

  • Motor learning and neuromuscular control is task-specific.
  • Task-specificity is relevant in the context of strength-training adaptations and transferability.
  • The intensity of the practiced task contributes to motor learning.
  • Greater task intensity has been found to be associated with greater changes in neuroplasticity and corticospinal excitability.

  • Findings from this study support the use of task-specificity and intensity for motor learning in both rehabilitation and performance settings.
  • Clinicians who want to induce neuroplastic changes for improved motor learning should consider individualizing the parameters that may affect neuroplasticity, including intensity and task-specificity.

 

Clinically: Pilates in Practice
  • Task specificity is important - choose choreography that mimics the relevant functional task, not preordained movement patterns; rowing series on the Reformer; step ups on the Wunda Chair; spine stretch on the Cadillac are all great exercises where changing the choreography can completely change the functional training task.
  • Work at an intensity that supports learning: apply appropriate load, number or repetitions, and frequency of training.
    • This requires communication and observation.
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