A representative subject is swaying by reading aloud the word SWAY three times in preparation to rise from the toilet seat
Primes are contextually or spatially relevant stimuli that, through experience, are associated with expected behavior. External and contextually relevant primes have been theorized to guide internally the cognitive functions necessary for ADL and IADL performances (Gage and Storey 2004; Praamstra et al. 1998). Neurologic and motor control research has shown that the brain goes through cognitive programming or ideation before making any action or movement. Priming of this cognitive programming is possible through external priming via semantically related language (Gentilucci et al. 2000; Gentilucci and Volta 2008; Maitra and Telage 2004; Maitra et al. 2003; Maitra and Dasgupta 2005; Maitra 2007).
For example, participants performed reaching and grasping tasks with a wooden block while they silently read the words near, far, small, and large written on the block. Results of this study showed that the participants reached faster when they reach for a block with the word far written on it compared to reaching for a block with word near written on it. Similarly, the grasping aperture was larger when the participant grasped a block with the word large written on it than when the word small was written on it. The conclusion was that the participants automatically associated the meaning of the word with the planning of the action (Gentilucci et al. 2000).
Studying clients with PD and stroke (Maitra et al. 2006), researchers showed that pre-reading of a word that is semantically related to the expected motor performance, positively influenced the performance. Speed and smoothness of the reaching or grasping task (n = 24) were significantly facilitated when the words REACH or GRASP were pre-read (Grossi et al. 2007). The word-based contextual primes have to be in congruency with the movement performances. For example, a reaching performance is not influenced by an unrelated action word such as RETURN or nonsense word such as GA(Miller et al. 2005).
Pulvermüller et al. (2005) explained the mechanism by which action words can prime and facilitate a motor performance. He proposed that words are represented in the brain by a neuronal network (or cell assemblies). The network is formed by neurons that represent a word’s meaning (sensory perception) as well as the neurons that represent the word’s content (motor action). Thus, for example, visually seeing the word REACH (perception), or saying the word REACH, may stimulate the neural network governing the reach action, a phenomenon which can be investigated by functional magnetic resonance imaging (fMRI) data of the brain. For example, when the subjects read the words lick, pick, and kick, the brain showed activation in the sensory association areas of the mouth (for lick), hand (for pick), and leg (for kick) for interpretation of the meaning of the word. The fMRI also showed simultaneous activation of the motor areas of the mouth, hand, and leg responsible for licking, picking, and kicking actions (Pulvermüller et al. 2005). These studies provide a strong rationale for the present protocol.
RehabSelfPrime-Speech intervention technique with semantically related action words to action is a simple but evidence-based interventions that can be implemented and incorporated into a regular neuromuscular intervention plan. Additionally, these interventions can be implemented and practiced in multiple settings, including home. There is evidence that adherence to a program is greater when implemented in the home (Ashworth et al. 2005). Because PD is a progressive degenerative disease, it is unrealistic to expect that therapeutic interventions can be sustained over long periods of time. The priming method can be continued by the patient; empowering them to self-manage their symptoms as much as possible (Allen et al. 2012).
The evidence for the RehabSelfPrime-Speech intervention is supported by studies with people suffering from stroke (Maitra et al. 2006) or PD (Maitra 2007), and several empirical studies with older adults provided sufficient rationale to use the protocol in practice (Grossi et al. 2007; Maitra and Telage 2004; Maitra et al. 2003).
The Case Study of Mr. W—The Use of Priming to Improve Function
Activities of daily living, Parkinson’s disease, priming movement initiation
The theme of this case study is based on the RehabSelfPrime-Speech intervention technique.
The students’ tasks include:
Demonstrate an understanding of Parkinson’s disease (PD).
Determine how symptoms of PD interferes with occupational performance.
Understand how semantic priming can be used to facilitate movement initiation.
Apply this understanding to a case example, creating a priming intervention.
Evaluate possible outcomes and revise the intervention, if necessary.
As a starting point, students should use the following references to gather background information. Links to the article and/or abstract are provided.
Allen NE, Sherrington C, Suriyarachchi GD, Paul SS, Song J, Canning CG (2012) Exercise and motor training in people with Parkinson’s disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials. Parkinson’s Disease, 1–15. www.hindawi.com/journals/pd/2012/854328/
This article is a summary of evidence from 53 relevant randomized controlled trials (RCT) and 90 interventions on the use of exercise and motor training with patients with PD.
Grossi JA, Maitra KK, and Rice MS (2007) Semantic priming of motor task performance in young adults: implications for occupational therapy. Amer J Occup Ther 61(3):311–320. ajot.aotapress.net/content/61/3/311.full.pdf
This study investigated the use of priming, using performance-related words and its impact on motor performance in young adults (N = 24).
Lim I, Van Wegen E, De Goede C, Deutekom M, Nieuwboer A, Willems A, Kwakkel G et al (2005) Effects of external rhythmical cueing on gait in patients with Parkinson’s disease: a systematic review. Clin Rehabil 19(7):695–713. cre.sagepub.com/content/19/7/695.long
A review of 24 studies (two were RCT) focusing on the effects of external rhythmical cueing.
Maitra KK (2007) Enhancement of reaching performance via self-speech in people with Parkinson’s disease. Clin Rehabil 21(5):418–424. cre.sagepub.com/content/21/5/418.long
Participants with PD took significantly shorter time when using self-speech to complete a movement task (reaching for, grasping, and placing a water bottle) than in the control or other conditions.
The major goal of the priming motor initiation intervention is to enable the patient with PD to identify action words associated with completing an activity of daily living (ADL) or instrumental activity of daily living (IADL) that they identify as important and use those words to facilitate initiation (priming) in order to improve functional performance.
Using the case study, the student will be able to:
Identify motor control problems and risks for this patient with PD
Develop client-centered treatment goals to address motor performance
Create an intervention using a semantic priming example
Choose an activity and give examples of the semantic primes that could be used to help initiate movement
Evaluate the efficacy of the treatment intervention based on current available research evidence
Medical Diagnoses and Prognoses:
Mr. W. is a 63-year-old male, diagnosed 15 years ago with early-onset Parkinson’s disease. He has experienced periods of slow decline in motor performance, but has recently changed medications that have helped decrease involuntary muscle movement and improved his quality of movement. The patient’s wife reports some cognitive decline—forgetfulness and a decreased attention span. Mr. W. hopes to continue to be as independent as possible, but also knows that the progression of the disease will make participation in everyday activities more difficult in the future.