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experience dependent neuroplasticity Flashcards

1
Q

What are principles of neuroplasticity?

A
  1. use it or lose it
  2. use it and improve it
  3. specificity
  4. repetition
  5. intensity
  6. salience/meaningfulness
  7. time since onset: 1st year after TBI/3mo-1yr post stroke
  8. age: younger=more
  9. transference
  10. interference
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2
Q

Ways to grade functional tasks for LE (gait)

A
  1. speed
  2. load
  3. assistance
  4. intensity
  5. error
  6. UE support/assistive devices
  7. cardiovasc. factors
  8. accuracy
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3
Q

ways to grade functional tasks for UE

A
  1. position of patient
  2. objects (position/weight/size)
  3. adaptive devices
  4. time constraints
  5. unilateral vs bilateral
  6. accuracy
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4
Q

studies with _____ during locomotor training facilitated walking ability

A

enhanced errors
ex. split belt treadmill (running belts at diff speeds, forwards/backwards)

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5
Q

variability is ____ for learning

A

good! more like real life

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6
Q

when is there too much variability in practice? When our patient exhibits signs of…

A

learned helplessness
demoralization
decreased motivation to not fail

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7
Q

what happens when we sleep?

A

plasticity
(downsizing of dendrites/spines of unnecessary inputs)
-facilitates storage, consolidation of earlier day’s learning

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8
Q

depression results in

A

smaller hippocampus
neuronal loss
decreased neurogenesis
deficits in concentration/memory

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9
Q

what happens during increased stress

A

mild stress enhances learning/memory but chronic stress causes NEURONAL LOSS IN HIPPOCAMPUS
-deficits in concentration/memory

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10
Q

regular exercise in mid/late life decreases risk of

A

dementia!
CARDIORESPIRATORY/AEROBIC EXERCISE

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11
Q

aerobic exercise causes

A
  1. better cognition
  2. better neurogenesis
  3. more dendritic spine density
  4. more angiogenesis
  5. more long term potentiation
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12
Q

_% of people are able to walk post stroke

A

80% (doesn’t include quality of walking)

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13
Q

_% independently walked at 6 months IF
1.
2.

A

98% independ. walk at 6 months IF
1. indep sitting balance in first 3 days
AND
2. LE strength of at least 1/5 hip flexors, knee extensors, ankle DFs in first 3 days

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14
Q

27% walked if criteria unmet at ___ days post stroke

A

27% walked if criteria unmet in 3 days

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15
Q

___% walked if criteria unmet at 9 days post stroke

A

10% walked if criteria unmet at 9 days

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16
Q

what 2 measures accurately predicted who will be homebound 92% of the time?

A
  1. BERG BALANCE SCALE
  2. FIM-LOCOMOTOR
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17
Q

upon admission to inpatient rehab facility, if BBS was less than ___ and FIM-L ____, then
20x more likely to achieve household ambulation by dc.

A

BBS below 20
FIM-L 1-2

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18
Q

what is a predictor of UE functional recovery post stroke?

A

AROM of shoulder and mid finger predicted 71% of variance in UE function at 3 months

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19
Q

What were the results of AVERT study?

A

no significant diff in deaths, falls, adverse events BUT
better with time in PT, time to first mobilization,
*DECREASED COST OF CARE AT 3 MONTHS
*BETTER MODIFIED RANKIN SCALE AT 3, 12 MONTHS
*ABILITY TO WALK UNASSISTED AT 3, 6 MONTHS

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20
Q

gait speed for unlimited household ambulation

A

0.27 m/sec

21
Q

gait speed for limited community ambulation

A

0.58 m/sec

22
Q

unlimited community ambulation gait speed

23
Q

gait speed needed to cross commercial street

24
Q

community ambulation for adults without stroke

25
Von Schroeder et al. reported that normal 64 y/o were able to ambulate with a speed of _____ while chronic stroke survivors of similar age walked at ____
normal: 1.07 m/sec chronic stroke survivors of similar age walked at 0.8 m/sec
26
what is the 6th vital sign?
gait speed 0.8 m/sec
27
What are essential neuroanatomy for walking?
SPGs (spinal cord pattern generators) mm and peripheral nerves 3. ventrolateral and ventromedial spinal cord pathways 4. medullary reticular formation 5. mesencephalic locomotor region 6. subthalamic locomotor region
28
what are spinal cord CPGs?
Intrinsic circuits located in the ventral and intermediate gray matter that produces and repeats a functional behavior For walking, it switches between flexors and extensors (extensors more peripheral)
29
properties of CPGs
1. They are involved in intra- and inter- limb coordination (involving many joints). 2. They can react appropriately to sensory inputs. 3. They can recover. 4. They can learn.
30
medial medullary reticular formation
Final integrative center for locomotion before the cord “Driving” center for locomotion in all animals Decision to walk is made here. Source of pathway that descends in V-L cord to provide the tonic drive to CPG in spinal cord Involved in inter-limb coordination via feedback loops that detect symmetry or asymmetry of limb movement
31
Why PT’s can influence gait at the level of the Medial Medullary Reticular Formation:
However, in supported treadmill training, limbs can be moved symmetrically, so that feedback goes into the reticular system and the medial medullary RF can begin to develop a better “driver” for the CPG’s. Gait speed is important, since it will control level of feedback provided to cerebellum via stretch-sensitive muscle receptors.
32
mesencephalic locomotor region
When this region of midbrain is stimulated with E-stim (in cats) locomotion is initiated with the speed of movement consistent with the intensity of the E-stim. Thus, this area may help modulate speed of walking. May be involved in exploratory locomotion
33
Responsible for spontaneous goal-directed locomotion
subthalamic locomotor region
34
important but not essential neuroanatomy
Sensation Dorsolateral spinal cord pathways Pontomedullary locomotor strip Cerebellum (vermal) Red nucleus Lateral vestibular nuclei Substantia nigra Globus pallidus, internal segment Nucleus accumbens Limbic cortex
35
where can you identify motivation to walk?
hippocampus! fear can shut down system
36
important neuroanatomy interact with essential regions to control locomotion indirectly by:
Timing of swing versus stance phases of gait Detection of sensory gains during walking (especially if sensations are atypical) Coordination of walking Motivation to walk*
37
accessory regions involved in walking
1. motor cerebral cortex 2. pyramidal tracts
38
what is the cerebral cortex involved in?
May influence initiation, timing, the transition from stance to swing, and the precise positioning of the foot However, cortex may interfere with walking if attention is required for a task
39
what are 3 key sensory inputs for CPG
1. Stretch of hip flexors* – resets the CPG 2. Unweighting of triceps surae – gives leg “permission” to take a step 3. Weight bearing to facilitate extensor tone in stance limb (muscle receptors in triceps surae, pressure receptors in foot, and joint receptors)
40
Hip extension during ______(Key phase of gait) triggers swing of the limb via activation of the velocity and amplitude dependent muscle spindles.
Mid-stance to Heel off
41
key spinal cord segments involved in "stretch of hip flexors"
L2, 3, 4 *if hip is kept from extending, then walking STOPS
42
For therapeutic benefit, therefore, PT should stretch the_____during key phase of gait and let the leg swing through.
iliopsoas during midstance to heel off
43
Avoid working on ______, if walking is the goal
static position control (COM is outside the base of support 80% of the time when walking normally)
44
learned non-use...
Can occur with overuse of other UE and compensations May start with decreased sensation and/or motor abilities initially post-stroke
45
forced use: constraint induced movement therapy
1. ability to extend wrist 10-20 degrees (from any position) and slightly extend 2 fingers AT LEAST 2. ability to understand and follow directions! *other criteria (raise arm 45 deg, extend elbow 20 deg with shoulder flexed to 90, stand 2 min, B&B, extend/abduct thumb 10 degrees, medically stable, highly motivated)
46
CIMT: Adherence-Enhancing Behavioral Strategies (Transfer Package)
Behavioral contract Home diary Home skill assignment Daily administration of Motor Activity Log Home practice
47
EXCITE trial results
CIMT stroke survivors! wolf motor function test, motor activity log, SIS (all improved! *improvements kept up at 12 and 24 months *total of 70 participants
48

FALL2 NEURO (8 decks)

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