123 School Work

In order to re educate normal movement the physiotherapist must provide the patient with feedback about

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  This essay will look at re-education of movement in relation to the relearning of skilled movements that have been lost through neurological trauma or disease; the role that feedback has within the programme of recovery and the commonly occurring clinical features of neurological dysfunction that may impact on the feedback strategy.
  
  Skilled motor performances are consistent, intentional, task orientated movements that are highly co-ordinated (spatial-temporal relationship) and allow for investigation and interaction with the physical and social environment (O'Sullivan & Schmitz, 1994). They may be discrete having a recognisable beginning and end, for instance locking a wheelchair or grasping an object or serial a series of discrete movements in a particular sequence, such as raising a fork to the mouth when eating, or continuous involving repetitive, uninterrupted movements that have no distinct beginning and ending, for example walking and ascending/descending stairs. They (motor skills) are acquired through a process of learning (Welford, 1976) in which three stages have been identified: the cognitive, associative, and autonomous (Galley & Forster, 1987). The characteristics of the learner are different at each stage, which will affect the type of instruction and feedback chosen by the physiotherapist.
  
  
  
  Second only to practice, feedback is a very important factor that influences learning; practice with the right or wrong feedback is more effective than practice alone (Thorndyke, 1927). Feedback includes all the sensory information that is available to the patient during or after performance of a movement or functional task (Nicholson 1997) and is broadly categorised as intrinsic and extrinsic. Intrinsic feedback is internally generated sensory information (such as proprioception, vision and stereognosis) that is usually inherent in the performance of a task. However, these sensory cues may be impaired in neurological dysfunction preventing the patient from independently establishing the success of a movement (Schmidt & Lee, 1999) and therefore more reliance is placed upon the physiotherapist to provide external (extrinsic, augmented) feedback providing knowledge of results (KR) and knowledge of performance (KP) utilizing methods such as verbal, manual, auditory or visual stimuli in which to inform the patient.
  
  KR is the terminal post-task feedback (usually verbal) provided to the patient about the outcome of the movement a task oriented goal (Salmoni et al, 1984), whereas KP provides the patient with feedback on the quality of the movement pattern used to achieve the goal (Shumway-Cook & Woollacott, 2001)...