Rethinking physical and rehabilitation medicine (eBook)

Title Page 3
Copyright Page 4
Members of the European Academy of Rehabilitation Medicine 5
CONTRIBUTORS 6
Table of Contents 9
EXECUTIVE SUMMARY 11
FOREWORD 18
PART I LEARNING AND EDUCATION INTO REHABILITATION STRATEGY 20
Learning and teaching: two processes to bear in mind when rethinking physical medicine and rehabilitation 21
Rehabilitation, a clear objective PRM, an ambiguous term for the medical specialty21
Learning and teaching: the two pillars of PRM strategy 22
The overwhelming power of normality and standards 24
The weight of empiricism and dogma 25
The weight of habit and received wisdom 27
Learning and teaching, toward new paradigms 28
Learning and teaching without going overboard 30
Conclusion 32
References 33
The International Classification of Functioning, Disability and Health (ICF), a unifying model for physical and rehabilitation medicine (PRM) 36
Introduction 36
The ICF 37
The ICF in the Perspective of the WHO and the UN System 37
Development of the ICF 38
The Structure of the ICF 39
Validity of the ICF 40
ICF-based classification and measurement 40
ICF categories: building blocks and reference units 40
ICF-based practical tools: ICF Checklist and ICF Core Sets 41
ICF Checklist 41
ICF Core Sets 41
Mapping the world of measures to the ICF and vice versa 42
ICF-based measurement of functioning 46
Measuring a single ICF category 46
Measuring across ICF categories 47
The ICF, a unifying model for PRM 48
ICF-based conceptualization of the public health strategy rehabilitation and the medical specialty (PRM) 48
ICF-based organization of “human functioning and rehabilitation research” 50
Developing PRM in the context of “human functioning and rehabilitation” 51
The ICF in rehabilitation management 52
Assessment 53
Assignment and intervention 58
Evaluation 58
Conclusion 65
References 66
Rehabilitation and norms 70
Meanings of the word “normal” 71
The “abnormal other”: a long history of discrimination 74
PRM: an alternate construction of the normal-abnormal contrast 75
The social model of disability: how the issue of normality shifted from the individual to the environment 77
Is it possible to reconcile medical practice and the socialmodel of disability? 79
Conclusion 82
References 82
PART II MPLICIT LEARNING: A BASIC LEARNING PROCESS 86
A historical perspective on learning: the legacy and actuality of I. M. Pavlov and N. A. Bernstein 87
Introduction 87
Biographies and historical context of the controversy between Pavlov and Bernstein 88
Biography of Ivan Petrovich Pavlov 88
Conditioned reflexes and Pavlov’s theory 89
Biography of Nicolaï Alexandrovitch Bernstein 90
The psychology of activity 92
Goal-directed activity and levels of description 92
A developmental approach 93
Interaction, mediation, internalization 93
The Bernstein-Pavlov controversy 94
Legacy 95
Pavlov and Behaviorism 96
Expansion of behaviorism in the United States 96
Hebb and adaptation in formal neural networks 97
Hebbian learning and cerebellar physiology 97
Bernstein and Russian Cybernetics 97
Presence and impact on motor control and sensorimotor learning today 99
Motor control: problems to solve in the control of movement 99
Acquisition of internal models and programs: role of reinforcement learning 100
Schmidt and generalized motor programs 100
Brain control of movement 101
Adaptive motor learning and internal models in the cerebellum 101
A dynamical view on motor control in Bernstein’s tradition 102
Synergies and the use of variability 103
Mass-spring models and equilibrium point control 103
Dynamical systems for learning and development 104
Conclusion 105
References 106
Introducing implicit learning: from the laboratory to the real life 110
Introduction 110
What are the characteristics of implicit learning? 113
In which situation do humans learn implicitly? 116
Implicit learning in the laboratory 116
Learning contemporary musical grammar: an example of real life implicit learning 118
What is the nature of the knowledge acquired through implicit learning? 120
Conclusion 122
References 122
Implicit learning, development, and education 126
Introduction 126
Implicit learning processes in development 127
Implicit learning processes in infancy, childhood, and aging 129
Implicit learning processes and pathology 131
The question of IQ independency 132
The question of resistance to neurological or psychological damages 132
Implicit learning processes and education or reeducation 134
Implicit learning processes outside of laboratory 134
A rationale for building implicit learning situations 135
Conclusion 138
References 138
Implicit learning and implicit memory in moderate to severe memory disorders 143
Introduction 143
Implicit learning and implicit memory in pathological conditions 144
Amnesia 144
Alzheimer’s disease 150
Implications for rehabilitation 154
Implicit memory 154
Learning statistical regularities 156
Conclusion 157
References 158
Learning processes and recovery of higher functions after brain damage 162
What are the principles of training in neuropsychology? 163
What are the theoretical bases of training in neuropsychology? 163
Training by the strategy of restoration of the function in deficit 163
Training by the strategy of reorganization 164
Pragmatic or “ecological” training 164
What are the neuropsychophysiological bases of training in neuropsychology? 164
Learning processes and reeducation of language disorders: development of ideas 167
Reconciliation of training techniques in aphasia 167
The pragmatic approach and the psychosocial approach 168
Learning processes and reeducation of perceptual gnostic disorders 169
Learning processes and memory disorders 172
Strategies of recovery 172
Strategies using preserved memory capacities (57) 173
Is training for the acquisition of complex knowledge possible? 174
Learning processes and executive function disorders 174
Do possibilities exist for training in dementias of the Alzheimer type? 177
Conclusion 177
References 178
PART III LEARNING, MEDICAL TRAINING, AND REHABILITATION PRACTICE 182
Benefits of learning technologies in medical training, from full-scale simulators to virtual reality and multimedia presentations 183
Introduction 183
Learning complex emergency procedures with a full-scale patient simulator during student medical training 184
An experimental study with experts and novices 184
Conclusion, future direction, and recommendations in full-scale simulator 192
From a full-scale mannequin-based simulator to computer screen-based microworld simulators in medical training 193
Limits of full-scale mannequin-based simulators 193
Potential benefits of microworld simulators 193
Virtual reality, haptic, and depth perception properties 195
Examples in medical training 195
Some “difficult” limiting questions 197
Spatial cognition and medical activities 197
Multimedia learning, animated pictures, 2-D, and 3-D 198
Animations versus static pictures to learn dynamic processes 198
Interactivity and user control upon the speed of the process principle 199
Cueing principle 200
Segmentation principle 200
Conclusion 201
References 201
Auditory training in deaf children 204
Introduction 204
Auditory education in deaf children: principles and traditional practice 204
Our experiment 208
Conclusion 210
References 211
Virtual reality for learning and rehabilitation 213
Introduction 213
Fundamental VR basic issues 214
Some VR tools 215
Computer basis of a virtual system 215
Visual sensory interfaces 215
Other sensory interfaces 216
Motor interfaces 217
Software tools 218
VR applications in cognitive learning for rehabilitation 219
VR applications in functional evaluation and training 222
VR applications in motor learning for rehabilitation 223
VR assets for learning and rehabilitation 225
Limitations 226
Conclusion 227
References 228
Augmented feedback, virtual reality and robotics for designing new rehabilitation methods 232
Introduction 232
Motor learning in patients with cerebral lesions 232
Augmented feedback for rehabilitation 234
Rehabilitation 235
Task-oriented rehabilitation 235
Task-oriented rehabilitation at the impairment level 236
Rationale 236
Studies using visual feedback 236
Studies using auditory feedback 237
Activity workbenches and augmented feedback 239
Real objects 239
Computer games and instrumented joysticks 240
Combining AF with robotics 240
Robotics and mechanical support of the upper limbs 240
Rehabilitation of hand function 242
VR and haptic technology 244
VR and assisted gait training 246
Use of augmented feedback to modify action-perception coupling 247
Visual-proprioception conflict and error management 247
Optic flow 248
Training regimens 248
Motor imagery and movement observation 248
Conclusion 249
References 250