Tuesday, May 14, 2019

Sleep Hygiene and the Movement System- Part I



The world is catching on to the value of sleep.  While quotes such as “I’ll sleep when I’m dead” were exclaimed and touted as a badge of honor, an indication of an individual squeezing the most out of life, sleep is now more and more valued as a key pillar of health and wellness. 


This blog series will cover sleep as it’s related to motor learning,  injury prevention, and recovery.  Today’s focus will be motor learning.  Much of the content here is inspired by a book that I’ve read and re-read multiple times over the past 1.5 years.  It’s called, “Why We Sleep: Unlocking thePower of Sleep and Dreams”, authored by Matthew Walker, PhD.  I highly recommend the book. It’s a fascinating read.


How does sleep help with motor skill acquisition, anything from learning to ride a bike, play a sport, drive a car?

For every skill we master, there is a routine associated with the skill that lives in the brain. 

Dr. Walker’s research demonstrates that after learning or practicing a skill, your brain will continue to improve the skill routine with a solid night’s sleep.  Thus, practice does not make perfect, but practice, followed by a night of sleep, makes perfect.

One of the key studies associated with this discovery involved a group of right-handed subjects who were asked to learn to type a number sequence on a keyboard.  Performance and improvement were tracked over the course of a training session.  Then subjects were given a 12-hour break, after which they were re-tested on their performance of the sequence.  Half the subjects learned the sequence in the morning, thus the re-testing period came 12 hours later after being awake during the day. The other half learned the sequence at the end of the day and were re-tested the following morning after a full eight hours of sleep.  The group that was  re-tested after a night’s sleep demonstrated a 20% jump in performance speed and a 35% improvement in accuracy whereas the group that was re-tested after a 12-hour period of being away did not demonstrate improvement.

Sleep transfers the motor programs from circuits that operate at the conscious level of control to brain circuits that operate below the level of consciousness (subcortical circuitry), embedding the skills as habits.

If you’ll recall, our nightly sleep cycle is divided into stages and we cycle between NREM (non-rapid eye movement) and REM (rapid eye movements) stages throughout the night.  Motor skill enhancement is related to stage 2 NREM, particularly in the last two hours of an eight-hour night of sleep. Additionally, Walker’s research found the highest amount of brainwave activity in the areas of the brain just above the motor cortex, which is indicative of the specificity with which sleep treats the brain. 

Given the above research, we and our patients should all think twice about cutting the last two hours of nightly sleep short as we so often do in order to get a jump start on the day.

Stay tuned for Part II in two weeks on sleep and injury prevention and recovery.

Kelly Grimes is a physiotherapist with Columbia University Medical Center in New York and an instructor with Movement Links.  She is interested in learning how to help herself, her clients, and those she loves reach for better versions themselves in all aspects of life.

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References

1. Walker M. Why We Sleep: Unlocking the Power of Sleep and Dreams. New York, NY: Scribner; 2015.
2. Walker MP, Brakefield T, Morgan A, Hobson JA, Stickgold R. Practice with Sleep Makes Perfect: Sleep-Dependent Motor Skill Learning. Neuron. 2002;35:205-211.
3. Kuriyama K, Stickgold R, Walker MP. Sleep-dependent learning and motor-skill complexity. Sleep and Memory/Research. 2004;11:705-713.

Wednesday, April 17, 2019

Nutrition and PT Practice



Diet and nutrition are vital parts of the body healing and a key component to many conditions that physical therapists manage daily.  As a physical therapist we must be knowledgeable and comfortable addressing this with our patients.  But with so many new diets, fads and supplements, where do we start?




The APTA position is that it is “the role of the physical therapist to screen for and provide information on diet and nutritional issues to patient, clients and community within the scope of practice.” Because each state has a different scope of PT practice it is important to make sure that you understand varying stances, particularly the position of the state in which you practice.  For example, some states are silent on nutrition and therefore can turn to state laws governing nutrition advice.  Some states may only allow a registered dietician to give nutritional advice while others allow health care practitioners to give advice but only allow registered dietitians to bill.

Starting them young! The Byerly boys (two of Jessie's three kids) hard at work helping prep a meal :) 

Avoiding discussion on nutrition is leaving a void in practice and healing.  Here are just a few examples:

·      Obesity leads to changes in body composition.  An increase in fat tissue, adipose, changes your body’s metabolism, ability to regulate insulin which in turn has a correlation and influence on inflammation and pain. Medicare has instituted Body Mass Index assessments.  But, how many in practice set goals, such as patient education, around those assessments? 

·      In a dehydrated state muscles will not receive the proper oxygen they need to heal.  What is happening? Our bodies pull water from skin and muscles to protect our vital organs. So, in order for our patients to heal, hydration should be a key component to their plan. 

·      Smoking, nicotine specifically, decreases the efficiency of heart and lungs thus the delivery of oxygen to the body.  Without oxygen, as discussed, muscles are dehydrated and weak. Lack of oxygen also results in slower healing and general fatigue.   There is also a study that links smoking to chronic pain.

·      There is a growing body of evidence suggesting that nutrition may play a key role in concussion management. Research supports the use of key nutrients and sufficient caloric intake to reduce the inflammatory responses that occur in post-concussion and in post-concussive disorders.  

Poor nutrition, dehydration and other poor lifestyle habits can have a direct effect on our patients’ outcomes.  It is important to not only recognize when this is occurring but take steps in optimizing the healing environment.


As the Director for Clinical Education for CORA Physical Therapy, Jessie Byerly has spent much of her career devoted to enhancing post- professional education for clinicians.  She is a Movement Links certified practitioner and instructor. She uses her specialty in movement science, and passion to teach youth about sports wellness and injury prevention. 

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References:

1. Rea BL, Marshak HH, Neish C, Davis N. (2004) The role of health promotion in physical therapy in California, New York, and Tennessee. Physical Therapy 84: 510–523

2. Morris DM1, Kitchin EM, Clark DE. (2009) Strategies for optimizing nutrition and weight reduction in physical therapy practice: The evidence. Physiotherapy Theory and Practice, 25(5–6):408–423

3. Ashbaugh, Andrew DO, MPH; McGrew, Christopher MD, FACSM. The Role of Nutritional Supplements in Sports Concussion Treatment Current Sports Medicine Reports: January/February 2016 - Volume 15 - Issue 1 - p 16–19.