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To minimise the impact of cognitive overload during skill acquisition post rehabilitation breaking down the re-learning of skills using the 'Two Stage Model' might be beneficial by:

Fixation - practicing in a controlled environment eliminating the impact of negative peer opinions, creating/facilitating a supportive environment, reducing chances for the athlete to compare themselves to other athletes instead of comparing themselves to their progress made in their rehabilitation.

Diversification - once the athlete as acquired the skill gradually introducing tasks to cognitively load the athlete. For example, after an ankle injury to gradually load a soccer player after relearning to kick a ball into a goal from a variety of angles without a goalie introduce some team members to act as a noisy crowd.

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Total amount of mental effort being used in working memory

Intrinsic Cognitive Load - Topic specific (e.g. in sport this refers to actions controlled by the athlete)

Extraneous Cognitive Load - Presented information (e.g. in sport environmental cues such as a particularly part of music in a dance routine signalling for a specifically corresponding move.

High cognitive load has the potential to hinder balance, attention and focus

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What is COGNITIVE LOAD? What does COGNITIVE LOAD mean? COGNITIVE LOAD meaning & explanation

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Personal Thought for Expansion of Neurplasticity of Compulsive Worrying

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Personal Thought for Expansion of Neurplasticity of Compulsive Worrying

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Does personality characteristics/traits influence the degree of neuroplasticity in regards an individuals resilience to becoming a compulsive worrier

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When an injured athlete returns to sport they may have body image issues if they were absent from training for a multitude of reasons (e.g. multiple surgeries or experiencing negative affect). Thus changing how the athlete physically feels within themselves and their self-perception of how they look (e.g. might have lost all over muscle tone due to inactivity or inability to continue an intense training regime)

This could elicit compulsive worrying about what their peers will think of them in terms of their current skill abilities and how the athlete perceives others will see them physically. As there is typically a stigma around what makes an athlete. This is added pressure whilst trying to reacquire skills as they will be possibly combating the physical/neuropathic pain of the injury, the degrees of freedom problem and any reduced neurological representation of the movement having not undertaken that skill.

Athletes could be worried about re-injury as well as trying to understand how to re-acquire the skill especially if there has been any reconstructive surgery that may have resulted in reduced movement through having to surgically pin or plate the injury.

All of these would not only increase cognitive load reducing attentional focus (narrowing field of vision thus potentially missing environmental needed to acquire the skill but could eventually alter the brain structure engaging the neuroplastic process of strengthening the compulsive worrying. This could lead to the athlete becoming compulsive worrier inhibiting their ability to move through the the '3 Stages of Motor Learning' to achieve autonomous movement.

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The Brain That Changes Itself Chapter 6 Brain Lock Unlocked, Pg 117

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The Brain That Changes Itself Chapter 6 Brain Lock Unlocked, Pg 117

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worrying, post-traumatic stress disorders, phobias/fear, panic attacks and obsessive compulsive disorder.

Compulsive worrying can gradually alter the brain structure. Obsessively thinking something bad will happen.

Jeffery Schwartz developed plasticity based treatment to help those with OCD and those with everyday worries:

Acknowledge the issue through relabelling

Acknowledge that the anxiety/fear will not subside immediately and it will take time

Distinguish between worrisome thoughts/urges intruding conscious thought (form) and the reality of the issues (content). It is best to focus on form than the content

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The Brain That Changes Itself Chapter 7 Pain, Pg 133-135

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The Brain That Changes Itself Chapter 7 Pain, Pg 133-135

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Neurologist Vilayanur Ramachandran explores the potential of neuroplasticity and body image distortions.

pain/body image is created by the individuals brain and then projected onto the body

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If you like a little sports drama during the holiday season - and don't feel like watching another Rocky movie - then you may want to catch a showing of Concussion, due out Christmas Day. Starring Will Smith as Dr. Bennet Omalu, a Nigerian-born pathologist who brought the issue of brain damage in retired NFL players to the forefront, Concussion is the sort of underdog-stares-down-corporate-behemoth feature that reliably manages to stir up some awards buzz.

The true-life story began unfolding in September 2002 when Omalu, then with the Allegheny County coroner's office in Pittsburgh, Pennsylvania, was assigned to perform an autopsy on the body of Mike Webster. Known as "Iron Mike," Webster was a beloved former Pro Bowler with Pittsburgh Steelers, the anchor of a front line that helped the team win four Super Bowls. However, his mental health deteriorated to the point where he was ranting at strangers and zapping himself with a Taser gun, until his death from a heart attack at age 50.

Omalu knew nothing about football but had heard about Webster's death on the news, and was curious as to what the ex-player's brain would reveal about his behavior. After taking the brain home and paying out of pocket to have it carefully dissected and stained, he discovered the presence of tau proteins, which impair moods and cognitive function upon accumulation. It was similar to findings in the brains of deceased boxers but clearly in a category of its own, so Omalu coined the condition "Chronic Traumatic Encephalopathy," or CTE. He submitted a paper, explaining his discovery and belief that Webster's troubles were the result of repeated head blows from his playing career, to the prestigious medical journal Neurosurgery.

Omalu naively believed that the NFL would be receptive to a study that revealed how the sport was endangering the mental health of its participants. Instead, after the paper appeared in the July 2005 issue of Neurosurgery, the response was a letter to the editor from three members of the NFL's Mild Traumatic Brain Injury committee (MTBI), which noted "serious flaws" in the study and demanded an official retraction.

Omalu pressed forward with examination of a second brain, of another retired football player named Terry Long. Like Webster, Long had exhibited distressing behavior after his retirement, eventually killing himself at age 45 by drinking antifreeze. Omalu discovered the same buildup of tau proteins - another case of CTE - and submitted a second paper to Neurosurgery.

By this point, the general press had caught wind of the concept of CTE, and the NFL's MTBI again responded by publicly vilifying Omalu and his research. However, examinations of more ex-football players confirmed his initial findings, and also drew the support of influential allies like Dr. Julian Bailes, chairman of neurosurgery at West Virginia University Hospitals and a former Steelers team doctor.

The tipping point came with an article by Jeanne Marie Laskas in a September 2009 issue of GQ, which detailed Omalu's discovery of CTE and the NFL's continued denial of its existence. Shortly afterward, the league revealed the results of a study that determined its former players were suffering from memory-related diseases at a higher rate than the normal population, its first public admission that maybe there was a problem.

NFL Commissioner Roger Goodell was subsequently hauled in to testify before a House Judiciary Committee in October 2009 about safety measures, and stricter guidelines were established in the pro game to limit head injuries. Still, dozens of former players embarked on legal action against the NFL in 2011, claiming that the league had failed to adequately warn and protect them. As of the summer of 2015, more than 5,000 former players were involved in a consolidated lawsuit, with a settlement figure of $765 million deemed insufficient by a judge.

In the meantime, Hollywood director and producer Ridley Scott enlisted former investigative journalist Peter Landesman to write and direct a movie based on Laskas's GQ article. He also recruited Smith, the sort of A-list star who would draw attention to the project. With Sony on board as the film's distributor, shooting began in October 2014.

In September 2015, a level of shadowy intrigue was added when a New York Times article cited emails from the previous year's Sony hack as evidence that the studio had bowed to the NFL's demands to soften the tone of the movie. Landesman steadfastly denied capitulating to the NFL, his stance backed by respected sportscaster Bob Costas, who issued a statement that read, "I have seen the movie. As one who has followed, and commented on, this issue, it doesn't appear to me many punches were pulled."

The NFL may never fully fess up to its culpability in the suffering of its former players, but with its continuing changes to concussion guidelines and mounting legal liabilities, it's undeniable that some progress has been made. Furthermore, it's clear that vindication has come for Omalu, now chief medical examiner of San Joaquin County, California, and a professor in the UC Davis Department of Medical Pathology and Laboratory Medicine. With the release of Concussion, viewers will learn more about his fight to be heard, more than 13 years after Mike Webster's brain changed the course of his life.

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If you like a little sports drama during the holiday season - and don't feel like watching another Rocky movie - then you may want to catch a showing of Concussion, due out Christmas Day.

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Raises the question if early intervention of combined motor skill acquisition, facilitation of neuroplasticity with psychological monitoring/intervention would be beneficial post contact sports career for the players mental health.
For example, instead of the athlete only undergoing a '48hr concussion watch' period also taking time off playing/training contact for a longer period of time (maybe 2 weeks) and focusing on rehabilitative training that involves no contact risking further head trauma.

Movie: Concussion

Based on a true story, neuropathologist Dr. Bennet Omalu, discovered link between Repeated head blows in contact sports and cognitive/emotional impairments

Developed the term Chronic Traumatic Encephalopathy (CTE)

Touches on lifespan development that under 18’s shouldn’t play contact sports

Memory-related diseases more prevalent in NFL players than the rest of the population.

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I love watching football, especially the Green Bay Packers. So when I talked to someone who many had said "hated football," I was unsure how the conversation would go. What I found was this amazing man that not only surprised me, but humbled me at the same time. Dr. Bennet Omalu, the neuropathologist portrayed by Will Smith in the 2015 award-nominated film Concussion, may not understand one of our country's biggest athletic obsessions, but he understands what it is to be an American better than anyone I know. Omalu's new book released August 8, Truth Doesn't Have a Side, chronicles his journey from a war-torn Nigerian childhood to his quest to become an American citizen and live the American dream.

He describes America as a "country that (is) closest to what God wants us to be as sons and daughters, a place where you can be whatever you want, a place where you can be yourself." Omalu told me over and over during our interview, "America is not like any other country on the face of the earth. It is a great society because it encourages you to be yourself." Even Will Smith said, "[Omalu's] story could only happen in America."

In 2002, Omalu was working in the coroner's office in Allegheny County, Pennsylvania when he encountered NFL Hall of Fame player Mike Webster. Webster passed away at the age of 50, after years of depression, mood swings and bad financial decisions. The former football star had lived the last months of his once-amazing life in his truck and on drugs. Dr. Omalu was curious as to why a man so revered in our society could end up living such a sad existence and end up on the coroner's table at such an early age. He felt a kinship with Webster because the football star suffered from deep depression, just as Omalu had often struggled with. The young doctor wanted answers for Mike Webster and for himself.

Dr. Omalu in his lab. (Courtesy of UC Davis)

His discovery, which he would later call CTE (Chronic Traumatic Encephalopathy), thrust Dr. Bennet Omalu into the national spotlight where he was literally put under a microscope. His troubling findings were put under the most extreme peer review, his qualifications, research and even his character were questioned. Omalu faced the severest of criticism not only from the NFL, but from the general public as well. Dr. Omalu had opened what some would call the 'biggest can of worms in the history of football.' Not one to back down from the truth, Dr. Omalu kept pushing for the recognition of the dangers of contact sports, including rugby, ice hockey, wrestling and mixed martial arts. He did so not for attention or to make a name for himself, but because he truly cares about the cognitive and intellectual health of our nation's children.

A compassionate man of faith, Dr. Omalu continues to spread the word about CTE and the longterm damage repeated head traumas can cause. Even though Dr. Omalu has faced racial and societal prejudices to get his message out, it has not changed the way he feels about this country. Although his journey hasn't been easy and he has struggled against seemingly insurmountable odds, his passion for his discovery and his love for America has never wavered. Even when he had to decide to risk everything-his job, his new home, his relationships-Dr. Omalu pressed on to bring CTE to the attention of parents everywhere. I found out that Bennet Omalu doesn't "hate football," he just doesn't think anyone under the age of 18 should play. He thinks college and professional football can still be enjoyed, but only if the players are properly informed of the risks, so they can make their own decision about whether or not to play. Still, Dr. Omalu's message clashes horribly with the Friday Night Lights culture of small towns and cities across our great nation. How will it all play out? I do not know, but I have the feeling that with Dr. Omalu's new book, Truth Doesn't Have A Side, the dialogue will continue and hopefully, his message will reach parents who have children at risk.

Some are still wondering, years after CTE has come to light, who is this upstart doctor from Nigeria? Will Smith said it best in the forward he wrote for Truth Doesn't Have A Side. "If you want to understand Dr. Bennet Omalu, don't look at the acronyms that come after his name or read the papers he's authored; listen to his laugh. It's the laugh of someone who possesses the freedom that can only come when you know that you are doing exactly what you were destined to do." What a wonderful thing for any of us to find-our place; the place we were meant to be.

Will Smith, Dr. Bennet Omalu and Director Peter Landesman on the set of the movie Concussion. (Courtesy of Dr. B. Omalu)

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The Doctor Who Inspired The Movie Concussion - Truth Doesn't Have A Side

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I love watching football, especially the Green Bay Packers. So when I talked to someone who many had said "hated football," I was unsure how the conversation would go. What I found was this amazing man that not only surprised me, but humbled me at the same time.

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Although this article focuses on Stroke victims and the importance of early intervention to facilitate neuroplasticity to aid motor skill acquisition post injury. I feel it could be implemented into severe cases of Traumatic Brain Injuries occurring from sports (e.g. severe concussions from football tackles or in Boxing or head injuries obtained from other sporting incidents such as a cricket ball hitting a player or a diver hitting their head on the platform before entering the water where they'd be deprived of oxygen)

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The Brain That Changes Itself: Chapter 7 Pain, Pg 128

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The Brain That Changes Itself: Chapter 7 Pain, Pg 128

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Injuries can not only damage body tissues but also nerves which can then continually signal the brain that there still is something wrong with the injured part. Known as Neuropathic Pain.

Typically seen/reported in amputees but can also be seen in cases of labour pains or large ulcers.

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Skill learning is practice dependent of synaptic structural/functional reorganisation of Motor Cortex.

Experience Expectant Plasticity – experience of brain development during early sensitive periods.

Competitive environment - effectively activated neural connections are maintained/strengthened and less activated are eliminated (Long-term potentiation vs Long-term depression as mentioned in 'Neuroplastic Process'; competition for brain representation mentioned in 'Principles of Rehabilitation and Neuroplasticity')

Rehabilitative Treatments initiate within one week increases the chances that the affected area keeps its representation in the motor cortex compared to when rehabilitation is delayed for 30 days after injury.

When initiated earlier rehabilitative treatments are typically shorter resulting in greater functional improvements compared to delayed treatments. Constraint Induced treatments increased performance of fine motor skills if started 3-9months post injury.

Forced Constraint Induced Therapy for two weeks is potentially be detrimental if done to early immediately following injury; However, is not detrimental if delayed by 7 days.

Vouluntary exercise can improve cognitive performance after 0-6 days post injury; However, can lead to impaired cognitive performance if exercise is conducted within this period.

Skill training of uninjured limb increases dendrite growth in Contraslesional Cortext which is detrimental to injured limb.

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Use it and or Lose it - Expereince Effects. on Brain Remodeling Across Time After Stroke - Allred YoungKim and Jones 2014pdf

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Pain may also cause fear, worry, reduced self-competence and self-confidence.

As humans either engage in avoidance or engagement behaviours. Pain will typically promotes avoidance of anything that causes something to hurt. Thus, an injured limb would typically promote the individual to restrict or completely stop movement altogether. This would most likely lead to unfavourable neuroplastic changes as the restricted limb would begin to weaken its neural connection and lose its representation in the primary motor cortex whilst the uninjured limb would potentially strengthen its connection and representation (suggested in 'Use It or Lose It - Stroke Example'). This could be problematic if the injury is long term without movement.

As the athlete begins to engage in skill acquisition post rehabilitation they could experience the degrees of freedom problem presented in the dynamic systems stages of learning. In which the cognitive components of fear of re-injury, worry, reduced competence and confidence (dependent on how traumatic the original event of the injury) may cause the individual to restrict movement in an attempt to protect the previously injured site; Thus, potentially restarting the process of developing new 'mistake' neural pathways before the learning moves through the stages of releasing and eventually exploiting again. However, they not only may they not return to their post injury skill level they could strengthen a neural pathway out of avoidance of the injury leading to incorrect technique, possibly affecting the kinetic chain increasing the risk of a different injury.

With regards to 'The Brain That Changes Itself: Chapter 7 Pain, Pg 128' there is Reason to believe that this neuropathic pain could extend into the field of sporting injuries and rehabilitation process for skill acquisition post rehabilitation. Which is why it is important to understand neuroplasticity's underlying involvement with skill acquisition. As chronic pain could potentially be neuropathic which in turn could lead to longer rehabilitative training and reinforcement of physical compensation (accounting for the movements that prompt pain) whilst re-acquiring a skill. Possibly increasing the risk of other injuries due to potentially detrimental changes in the kinetic chain of movement

Starting early with novel tasks at low repetition to avoid fatigue and pain before gradually increasing skill complexity as suggested in Boudrea, Farina and Falla (2010) may potentially reduce the chance an athlete will experience the degrees of freedom problem again.

Cognitive Distortions (e.g. negative self talk of their incapability leading to further psychological issues) after severe injuries may need the use of Cognitive Restructuring to aid neuroplastic changes. As negative affect as the potential to slow down the bodies ability heal itself (e.g. injured athlete may become depressed not being able to perform optimally which may lead to reduced appetite that may lead to a decrease in required essential nutrients to heal).

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Experimental/chronic pain often results in unfavourable neuroplastic changes leading to decreased performance

Motor rehab focused at re-establishing normal motor strategies

Neuroplastic changes underlie functional recovery

Musculoskeletal pain management involves isolation training: activating of delayed/inhibited muscle with repeatedly with voluntary contractions. Skilled/precise actions facilitate cortical neuroplastic change

Acute pain suppresses rapid increase in cortical excitability hindering performance improvements

Experiemental pain interferes with nueroplastic change underlying simple instrumental learning (condition and response)

Pain is associated with: increased stress, reduced cognitive performance, reduced sleep and attention/focus deficits.

Novel motor skill training implemented with initial pain symptoms reduced risk of unfavourable neuroplastic changes as a result of pain

gradually making novel motor skill training more complex throughout rehabilitation may encourage cognitive effort enhancing cortical changes

Maximising cortical nueroplastic changes facilitate greater potential for rehab success.

Low task repetition to avoid fatigue and pain to optimise musculoskeletal pain

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The Role of Motor Learning and Neuroplasticity in Designing Rehabilitation Approaches for Musculoskeletal Pain Disorders - Boudreau Farina and Falla 2010

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Improving Hand Function in Chronic Stroke - Muellbacher et al 2002

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Principles of Rehabilitation and Neuroplasticity

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Principles of Rehabilitation and Neuroplasticity

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Competition for representation in the brain. movements used more often have a stronger/large area of the motor cortex devoted to their function than lesser used areas.

Thepremotor Cortex can substitute the Primary Motor Cortex

Contralesional Hemisphere can replace the Thepremotor Cortex and the Primary Motor Cortex as a last resort.

Neuroplasticity can be facilitated:

Focused Physical Therapy/ Constraint-Induced Therapy

Combination of drug therapy (amphetamine) and physical therapy.

use of local anaesthesia of proximal muscles to help lower muscles strengthen their representation

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Remodelling occurs in individual cells; groups of neurons and functions adapt to change behaviour

Persistent early change more likely to be permanent

long-term potentiation (increases synaptic strength) and long-term depression (decreases synaptic strength)

remodelling of Neuron's dendritic spines and connectivity

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Dynamic Systems and Stages of Learning (Bernstein, 1967)

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Dynamic Systems and Stages of Learning (Bernstein, 1967)

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Skill learning is based on solving degrees of freedom problem that is gradually releasing movement from ridged to relaxed and fluid.
Freezing the Degrees of Freedom: reduction of independently moving body parts required for movement (i.e. athlete is tense and rigid at first using more muscles than required), thus control and coordination is hindered. For example, when teaching a child to skip they will typically engage in full circumduction of the arms to rotate the rope.
Releasing:  the more the movement is practiced the learner will begin to release more degrees of freedom (i.e. relaxing the muscles not required for that movement). For example, as the child gets better they will release the wrist joints to do the rotation thus the arms will remain by their sides.
Exploiting: exploring and experimenting with the movement's passive and reactive forces in the body /environment to achieve the most energy efficient movement. Example, jumping with two feet on a ratio of 1:1 (1 skip: 1 jump) is more energy efficient then jumping 1:2 ratio at the same pace.

Spittle, M. (2013) Motor learning and skill acquisition: Applications for physical education and sport. South Yarra, Australia: Palgrave Macmillan.

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Initial Stage: understanding and acquiring basic movement with the ability to distinguish non-regulatory conditions and  regulatory conditions.
Later Stage: increasing the consistency and adaption of the skill by practising:

Fixation: Closed skills in stable and predictable environments to improve consistency

Diversification: Open skills that require the athlete to react and adapt to changing conditions in the environment outside of the athletes control (e.g. loud crowd)

Spittle, M. (2013) Motor learning and skill acquisition: Applications for physical education and sport. South Yarra, Australia: Palgrave Macmillan.

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Cognitive Stage: Gaining an understanding of the basic movement pattern through: breaking the skill down into parts, Conscious movement (high cognitive load and focus required during this stage of learning) and trial and error.

Associative Stage: Less cognition is required as the athlete understands the movement pattern becoming more fluid and begins deliberate practice of the skill.

Autonomous Stage: Minimal cognitive effort required as the athlete has put many hours of deliberate practice that the skill becomes 'over learned' with minimal performance variance in which they can broaden their attentional focus to other performance factors.

Influenced by:

Individual differences, Skill Complexity and Pressure

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Neuroplasticity subserving Athlete's Skill Acquisition Post Injury Rehabilitation

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Neuroplasticity subserving Athlete's Skill Acquisition Post Injury Rehabilitation

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It is important to understand neuroplastic involvement in motor learning to assist in skill acquisition post injury rehabilitation.

Injuries affect an individual psychologically, physiologically and neurologically.

It is important to understand when and how to implement rehabilitative treatments and its impact on neurological organisation of the brain (e.g. the more you engage in an activity the stronger the neural path)

Understanding the concept of neuropathic pain how it interacts with an individuals attentional focus for learning

Understanding that neuroplasticity plays a role in compulsive worry and potentially fear of re-injury