First, I will acknowledge that some learning is innate and a function of nature, prior to any nurture. Nursing might be the best example of this, coded as a sensory-motor reflex, rather than an instinct. Second, I will acknowledge that some learning is truly by instinct, with no observable sensory to motor connection, but rather a natural affinity or fear that is present without experience or education/communication. With these points made, I will suggest that a fully comprehensive categorization of stimuli leading to new learning, and a neuroplastic change, requires only three elements:
- Constraints – Forced behavior in thought or action that is guided through restrictions imposed for the sake of learning. (an armsling on an unimpaired arm, patching a more functional eye, placing the unimpaired foot further out in front of a patient on sit to stand, etc).
- Incentives – Numbers to beat, rewards in the form of food, protecting finances, free time, praise, etc.
- Avoidances – Removal of a negative: fall, pain, fear, injury, embarrassment.
When we structure rehabilitative care or participate in our own new learning, we are intentionally pushing for neuroplasticity – recall these three: constraints, incentives, avoidances. In so doing, offer a practice environment that is variable, yet provides for each, in keeping with the personal preferences of a patient.