The Translational Cycle: Active Recovery Meets Functional Practice
Training the brain requires a completely different strategy than training the other systems in the body requires. The research clearly shows that restructuring the brain and nervous system requires the use of complex movement patterns. Simple overloads such as weight training or walking have little or no effect on the intricate wiring of the nervous system. As Gene Wilder stated in Young Frankenstein, "Hearts and kidneys are tinker toys! I am talking about the central nervous system!"
So what is the best way to proceed? One thing known for sure is that the central nervous system remaps itself in patterns called kinetic movement chains. For clients to get good at an activity, they must practice the kinetic movement chain on which that activity depends. Once a client does this, all the structures in the cerebral cortex, midbrain, spinal column, and peripheral nervous system are rewired to make that movement easier to perform.
But let’s not stop at remapping a movement. To truly accomplish the purpose of translational training, we must match the motor pattern training of the translational period to the improvements made in physical performance during the preceding training cycle. While the link between physical performance improvements and motor pattern training is not absolute, there are a number of logical decisions that allow us to choose one drill over another. Additionally, we can often incorporate tests as part of our training portfolio. A simple example illustrating the link between testing and training is the way music was added to the classic Harvard step test to create step aerobics. So let’s put on our thinking caps and restructure clients’ nervous systems to maximize the benefits of training.
Many physical therapy clinics and fitness facilities incorporate exercises simulating ADLs as part of rehabilitation after acute injury or surgery. Occupational therapists commonly have their patients practice everyday activities to improve function and increase independence. Additionally, several laboratories and clinics have compared ADL-specific training to standard resistance training protocols and have shown similar or greater improvements with ADL-based training. Additionally, ADL-based training alone is highly effective at improving independence in older persons. However, no one has matched ADL-specific drills to a standard training program using the periodized training cycles described in chapter 9.
Martin Ginis and colleagues (2006) compared a standard resistance training program with that same program combined with an educational component that explained the association between resistance training and improved ADL performance. The people in the combined program indicated that they could perform ADLs better as a result of the resistance training, and they had a greater belief in their capacity to perform ADL tasks when compared with the people who only performed the resistance training.
ADL-based motor learning cycles provide recovery and translate the physiological gains produced during training cycles into improvements in ADL performance. These translational cycles match the diagnosed needs of the client and therefore expand on the physiological improvements made during the training cycles to which they are linked. In this way the training and translational cycles combine to address the unique physiological and motor pattern needs of the individual.
To benefit fully from any training program, at least some portion of the program should concentrate on training motor patterns associated with your client’s daily activities.