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Evidence For Importance Of Task Specific Training For Learning Novel Skill In Rehabilitation, And Its Translation To Clinical Practice

1468 words - 6 pages

Introduction
There is growing evidence that therapists working in rehabilitation field should prescribe task-specific training to the patients with neurological disorders to accelerate their rehabilitation (1). Task-specific training is defined as the intervention where the patient is required to do specific motor skills and get feedback about their performance (1). This feedback will motivate patient to continue or modify their performance and hence reaching specific goals (1). There is evidence that neuroplasticity occurs as a result of learning new motor skill using task-specific training (3). Neuroplasticity is defined as the ability of the brain to change or reorganise itself as a ...view middle of the document...

The training for acquisition or relearning motor skill will use brain’s spared regions which are usually next to the damaged regions in the brain and therefore, restore the motor function (3). It is very important to understand that compensatory behavioural changes, as a result of injury, play an integral part of reorganisation of the damaged brain (5). However, these compensatory behavioural changes can also be maladaptive and interfere with improvement of impaired parts’ functions (5). A clinical example for that is when someone has a brain injury in one of the hemispheres; he or she is more likely to depend on the less-affected side of the body (5). The reliance on the less-affected side will be associated with major neuroplastic changes in the unaffected hemisphere (5). However, this reliance might also limit the person from engaging in some activities that improve the functions of the affected body side (5). Therefore, therapists design different rehabilitation approaches to facilitate cortical reorganisation to maximise the rehabilitation success (6). These approaches might include, constraint induced therapy (CIT), in which the unaffected limb is constrained and the affected one is forced to use (6). Therapists noticed that there are remarkable neuroplastic changes in the affected hemisphere as a result of using the affected limbs which maximise the rehabilitation success (6). Other rehabilitation approaches include; task-specific training for learning novel motor skills (6).
Importance of task-specific training
In the last two decades, evidence showed that task-specific training was useful in rehabilitation of many patients with traumatic brain injury (TBI), a spinal cord injury, sit-to-stand retraining, and gait retraining (1). A systematic review of repetitive functional task practice included 31 trials with 1078 post-stroke participants showed that, there was general improvement in motor function, and in both arms and lower limbs functions due to using of some forms of task-specific training (French et al. 2008). Additionally, in healthy people, learning a novel motor skill using task-specific training is associated with better performance of the task and more representation of these trained muscles in the primary motor cortex (M1) as compared to just repetitions of general exercise (6). For example, people suffering from neck pain were asked to repeat training of their deep flexor muscles of the neck independently of the more superficial muscles in order to treat the pain. This formed acquisition of a novel motor skill by using task-specific training (6). In another study to show the difference between task-specificity and general exercise; people who trained to do some skilled ankle movements showed increase of corticospinal excitability (5). However, people who trained to repeat normal unskilled ankle movements did not show any increase of corticospinal excitability (5). This proves that task-specific training is more...

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