L10 - Neurological rehab Flashcards Preview

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Flashcards in L10 - Neurological rehab Deck (28):

Experiences are needed to complete development of maps - which also involves...

changes in synaptic strength


What are experience-expectant processes?

shape developing sensory and motor systems

musicians = hand


What are experience-dependent processes?

experiences which differ in both timing and character and that are unique to the individual


true or false

movements, not muscles, are represented in the brain



What have reorganisation follow brain lesion studies in monkeys shown us?

map of brain done with microstimulation

Injuries that caused a paralysed hand, if they were exposed to training involving shaping behavioural experiences with moments, had more plasticity


true or false

The residual corticospinal projects after spinal hemisection (cut) contribute after the recovery?


recovered upper limb function but couldn't move dextrously


Give a description of motor control of the hand, from the brain

corticospinal tract

- the only direct link between the brain and the spinal cord
- provides direct connections with motorneurons
- critical for skilled voluntary movement, esp of hand


true or false

alll neurons in the corticospinal tract terminate on motor neurons


not all will but some do


How is upper limb function affected after stroke?

30-60% of stroke survivors fail to regain functional use of their arm and hand

reduced upper limb function after stroke is associated with poor QOL and carer burden

dissatisfaction with inadequate training possibilities after discharge from hospital


what are the issues with upper limb rehabilitation?

low expectations, lower priority given

insufficient time spent on upper limb activities during rehab

current dose of interventions inadequate to drive neural reorganisation


what is the evidence-practice gap?

clinical guidelines for rehabilitation after stroke recommend early, intenstive, repetitive, task oriented activity

current dose of interventions inadequate to drive neural reorganisation


What are the technological devices used in upper limb rehab?

robotic devices, have algorithms to assist - very expensive

coaching devices - don't assist movement but track progress (computer games). An example is Hand Hub


What have been the key outcomes of technological devices used in upper limb rehab?

Increased opportunities for upper limb rehab

significant improvements in arm function and QOL

games are cognitively engaging - improvements in attention, memory and visual perception


Spinal cord injury is an extreme example of forced inacitivty

How is the patient effected?

immediate and severe loss of sensory and motor function leads to ''metabolic chaos''

Disruption of Ca and Phosphate metabolism: loss of bone

Immunosuppression: vulnerability to infections

muscle atrophy - causes falls and breaks

poor circulation

exacerbation of neuro dysfunction due to inactivity - retraining effects initiated later are limited

secondary complications: pressure ulcers and fractures


Without descending input what happens to the distal neurons?

they shrink and die - major problem

they need to be maintained for any hope of return of function if the SC is repaired


SCIPA Switch-on?

Early exercise to prevent musculoskeletal atrophy


50% of people living with Sc injury engaged in leisure time physical activity for an average of only ___ min per day



What are the barriers to physical activity after SC injury?

Physical health

Psychological factors - depression

Accessiblity - equipment/facilities

Financial cost

Lack of knowledge and awareness about availability and appropriate exercises

Experts not discussing its importance enough


What are the facilitators to physical activity after SC injury?

Action planning, goal setting

support from advocacy organisation

counselling services

building codes - accessibility

awareness of local resources: gyms


What are the physical activity guidelines after SC injury?

Aerobic - twice weekly, moderate to vigorous, 20min duration

Strength - 3 set of 8-12 reps, two times a week


programs exist to help Sc injury patients with phtysical exercise - what are they and do they work?

customised/evidence based guidelines

8-12 weeks, 2-3 times a week

exercise levels remained above baseline after the program was initiated


What are the downsides of the rehab environment?

very hospital-like

cognitive deterioration while in hospital makes active capacity to cope and improve more difficult


Animal studies: what are the effects of environmental enrichment on the brain?

changes in neurochemistry and physiology

enhancement of synaptogenesis

increase in cortical thickness

strengthens plasticity and survival of neural networks


Human studies:what are the effects of environmental enrichment on the brain?

promotes improved forelimb motor function after brain injury

cognitive or social activity enhances cognitive recovery


true or false

survivors of stroke and TBI may be vulnerable to reversal of gains when transitioning from rehab to home



Rehab is often a isolated experience, how can environmental enrichment in the rehab setting help?

significant improvements at discharge in depression, anxiety, cognitive function compared to routine ward activity


What is the basic principle underlying neurological rehab?

to harness neural plasticity

''use it or lose it!''


True or false

exercise helps to maintain the NS