It never ceases to amaze me how linking the
kinetic chain within our patient’s movement control leads them to have such
better automatic access to their functional movements.
The body is an amazing machine but also at times incredibly pragmatic and deals with what is easiest for the moment, not always able to project ahead the consequences of its actions. This can lead to interferences and compensations, which can cause their own problems making it much harder for patients to access their movement.
Improving the active alignment within a patient’s limb or between of our patient’s limbs/trunk/pelvis can have a huge impact on their ability to access functional patterns of movement. For example gaining improved upper limb alignment can give a more appropriate relationship between the upper limb, shoulder complex and trunk. This can allow them to gain a better ‘straight line’ hand path or a more active trunk alignment over the pelvis and lower limbs, and therefore the ease of access to the movement becomes greater.
We know from the literature that the cerebellum learns better from implicit information. If we can give our patients a better sensorimotor experience of movement within a session, making sure that it is variable and adaptable and improves the postural aspects of their movement control, we will be catching the Cerebellums attention. Stimulating the cerebellum, which works largely on a feed-forward basis, will improve its ability to make movement adaptations and refine the efficiency of the movement experience (Tada et al 2015).
We also know that intensity is paramount in learning and that a really good therapy experience needs to last longer than the session to make the ongoing adaptations, leading to long term skill acquisition (Winstein & Kay 2015). This is the difference between ‘performance’ and ‘motor learning’.
Understanding the environmental & psychological challenges that a patient has in their lives helps us to potentially guide the patient in managing their lives and really importantly, in developing appropriate strategies to reduce the negative influences on their learning experiences.
This week I have been working with a patient who has had a course of therapy focusing on strength & stamina training and she has worked hard to improve her movement skills. The difference in ease of movement when she gained a better adaptability of her so called ‘stronger side’ to allow better weight transfer to this side was huge. Knowing how she could use simple strategies to then achieve more typical sequences of movement made her feel hopeful and excited that her movement need not be such hard work.
For this lady, who suffers hugely from fatigue, this has been life changing and she is looking forward with renewed excitement to her trip to Disney World with her grandchildren.
If you would like to develop your Advanced Clinical Reasoning skills and make a difference to your patients, then consider coming on one of our Advanced Bobath Courses – have a look at the course scheduling on our website and get involved! We still have places on our 2018 courses available this year!
Tada M, Nishizawa M, Onodera O. (2015) Redefining cerebellar ataxia in degenerative ataxias: lessons from recent research on cerebellar systems. Journal of Neurology, Neurosurgery & Psychiatry 86, 922-928.
Winstein CJ, Kay DB (2015) Translating the science into practice: shaping rehabilitation practice to enhance recovery after brain damage. Progress in Brain Research 218, 331-60.