It is only a 404 page thesis that I'm not going to read. It is your doctors responsibility to keep abreast of current news on stroke, so ask him/her to see if anything in there will change your stroke protocols. My reading of the abstract would have me believe that practically everything my therapists were teaching me were done the wrong way.
Learning can be explicit or
implicit.
Explicit learning takes place
intentionally, in the presence
of factual task-relevant knowledge;
whereas implicit learning takes place unintentionally, without concurrent
acquisition of knowledge about task performance.
The relative benefits of implicit
learning have been well investigated within healthy populations. Research consistently demonstrates that skills
learnt implicitly are more likely to be retained, and are more robust under
secondary task load. However, study protocols tend to involve laboratory
based activities, which do not take
into account the complexities of motor learning in natural settings. Direct
transferability of the findings to stroke rehabilitation is therefore questionable.
Two factors in explicit and implicit
learning are the concepts of attentional capacity and attentional focus.
Attentional capacity refers to the
ability to attend to and process incoming
information, whereas attentional focus refers to the
location of attention in relation to specific aspects of the task being performed.
Theories propose that focussing on specific
movements(internal focus)
may actually constrain or interfere
with automatic control processes that
would normally regulate movement,
whereas if attention is focussed towards the movement effect (external focus)
the motor system is able to more naturally self-organize, resulting in more
effective performance, and learning. An internal focus of attention is therefore
allied to
explicit learning; whilst an
external focus of attention is allied to implicit l
earning. This research aimed to improve
understanding of explicit and implicit learning within early gait rehabilitation
post stroke; primarily through the development and testing of explicit and implicit
models of learning interventions. It has comprised three phases; a review of
the literature;
an observational study to gain
insight into current practice; and a
feasibility study to test the
ability of therapists to deliver interventions with a bias towards either an
explicit or implicit approach. Therapists were found to favour the use of
explicit techniques; internally focussed instructions
and feedback statements were used in
high quantities. Practice therefore appeared to be
at odds with current evidence; albeit primarily from healthy populations.Guidance
for the delivery of explicit
and implicit learning models in
clinical practice was developed, and then
tested in a feasibility study.
Therapists demonstrated the ability to change their practice to bias either
explicit or implicit learning; both approaches were found to be acceptable to patients
and therapists. Recommendations are made on the content and evaluation of explicit
and implicit learning
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