Chapter 5: plasticity, recovery and neuropsychological rehabilitation

Question 1

Peri-infarct

Answer 1

A partly reversible perfusion abnormality in at least one segment in the territory of an infarct-related artery.

Question 2

Spontaneous recovery

Answer 2

Recovery form damage in the brain without active and targeted treatment in the first 12-14 weeks after the stroke.

Question 3

Penumbra

Answer 3

The area adjecent to the site of the stroke.

Question 4

Peperfusion

Answer 4

Improvement in blood flow in the penumbra.

Question 5

The process after a brain injury

Answer 5

After the injury the brain starts forming new synaptic connections and starts the structural and functional recovery of the brain tissue in the prenumbra. In the prenumbra there is reduced blood flow and potential damage to the neuron’s dedrites. Then reperfusion is set in motion via thrombolysis treatment (blood thinning medication).

Question 6

Function recovery

Answer 6

Recovery based on plastic changes in the brain.

Question 7

Functional recovery

Answer 7

Improved functioning due to behavioural compensation.

Question 8

The difference between function recovery and functional recovery

Answer 8

Can be clearly seen when someone breaks their leg. Walking with crutches promotes the function recovery of the leg fracture because it can heal, and it promotes the functional recovery because the crutches are used to compensate for the lost function of the one leg.

Question 9

2 mechanisms that enable recovery of neurons

Answer 9

1. Diffuse and redundant connectivity: some complex brain functions are distrubuted through the cortex, but are controlled by one side of the brain (contralateral). If there is damage in that brain area, the other side of the brain can take of that function (ipsilateral).
2. Remapping: the sensory and motor signals after damage in the brain run through a different cortical area than before.

Question 10

Transcranial magnetic stimulation (TMS)

Answer 10

Electromagnetic induction causes depolarization and hyperpolarization of neurons in specific cortical areas.

Question 11

Transcranial direct current stimulation (TDCS)

Answer 11

A weak direct current is conducted between a positive and a negative electrode in the skull. The positive electrode makes neurons in a specific area more sentitive and thus more active and the negative electrode actually causes less firing of the brain cells, resulting in less activity in the underlying area.

Question 12

Transcranial alternating current stimulation (TACS)

Answer 12

The direct current form TDCS is offered at a specific frequency that corresponds to the frequency of electrical activity in the brain intself.

Question 13

Cognitive rehabilitation

Answer 13

1. Use it or lose it
2. Use it and prove it
3. Specifity in training
4. Repetition
5. Intensity (not too easy)
6. Time (mostly in 3 months after the damage)
7. Salience (an experience must be relevant and important)
8. Age (children have a worse prognosis)
9. Transfer (plastic changes in one region can have supportive influence on other regions)
10. Interference (self-learned behaviour in response to the injury can lead tot non-desired plasticity, which reinforces the behaviour, like only using the unaffected limb).

Question 14

ICF model: the international classification of functioning, disability and health model

Answer 14

This model looks at human functioning from 3 levels:
1. The perspective of the human organism, divides into ‘functions’ and ‘anatomical properties’
2. The perspective of the human actions or daily life
3. The perspective of a person as a participant in social life and society

Question 15

The restorative model

Answer 15

This model is based on the assumption that affected cognitive function can be repaired/restored via training. These trainings make use of repeated computer-assisted training (games), but these tasks can be hard to transfer to real life so someone can be very well trained on the computer (near transfer), but cannot use their skills in daily life (far transfer).

Question 16

The compensatory model

Answer 16

Based on the learning of strategies to compensate for cognitive impairments. There are 3 types of compensation strategies:
1. Internal: learning techniques (like visualization) to support cognitive functions.
2. External: learning to use a tool to support cognitive functions (like a calendar).
3. Metacognitive: learning to reflect on one’s own thinking or cognitive dysfunctioning, (like a g-schema).

Question 17

Function training

Answer 17

The repeated training of a task to attempt to restore cognitive functioning.

Question 18

Skills training

Answer 18

A repeated training of a relevant daily activity. This does not attempt to restore the cognitive function, but to teach sub-skills of a specific activity.

Question 18

Strategy training

Answer 18

A form a training where the cognitive impairments are compensated via strategies.

Question 19

Environmental adaptation

Answer 19

Is used when the patients learning ability is extremely impaired. It can include route markings or contrasting colors to keep things seperated in the mind.