L8 Neuroplasticity

Question 1

compensation in neuro rehab

Answer 1

optimize new skills with new methods of performing tasks to minimize loss of motor function; for neurodegenerative conditions
ex:
AFO for foot drop
adapting enviroment
adaptive equipment

Question 2

recovery and restoration in neuro rehab

Answer 2

restoring loss of motor skill/function
ex:
guillain barre
return gait speed to norms
neuroplasticity

Question 3

neuro rehab principles

Answer 3

specificity
repetition
intensity
time
salience

Question 4

experience expectant

Answer 4

neuroplasticity dependent on genetics and the developmental process
ex: vision, child needs to be exposed to stimulus for it to develop

Question 5

experience induced plasticity

Answer 5

occurs after neuro injury and induced by experiences such as:
motor learning
skilled motor activity
skill adaptation
as well as: diet, exercise type, enviro, stress, natural aging, neurotrophic factors, brain reserve

Question 6

why do we do early rehab in acute neuro events like stroke?

Answer 6

sensorimotor cortex recovery is associated with motor activity patterns normalizing
if pt is medically stable they should be mobilized after 24 hours in CVA

Question 7

long term potentiation

Answer 7

neuroplasticity at the cellular level
permanent change by persistent strengthening of synaptic connections from high frequency activity

Question 8

what cellular level changes occur in LTP?

Answer 8

presynaptic NTs: more NTs released
# of receptors postsynaptic: more receptors to receive NT signalling

Question 9

what types of exercise induce neurogenesis?

Answer 9

aerobic and resistive
enhance LTP by increasing O2 and GLC to brain, improve brain’s ability to adapt

Question 10

neuroplastic mechanisms that contribute to neural remodeling

Answer 10

modified gene expression
increased circulating neurotrophins: proteins that help w development, maintenance, and function of the NS
synaptic strengthening
cytogeensis
myelin plasticity
dendritic remodeling

Question 11

how does motor learning affect cellular neuroplasticity?

Answer 11

learning new skills increases dendritic spine density, survival of new spines in motor cortex, and connections to striatum/BG for selection of motor programs
neurons surviving better because they are being used

Question 12

what type of skill promotes neurogenesis in brain injury pts?

Answer 12

anticipatory postural control w activities like:
- ping pong
- ball rolling
- sticks

Question 13

learning new skills: CVA pts

Answer 13

need to relearn how to activities like transfers w hemiplegia
learning a previously known skill with now motor/sensory deficits is like learning a new skill
task based activities
STS w body mechanics, GRF, speed is all motor learning

Question 14

dosing neuroplasticity activities for CVA

Answer 14

wait 24 hours after or until medically stable
start w small doses frequently throughout the day
exercise larger amounts 2-3 months after
3+ hours of rehab has better outcomes

Question 15

what types of training target which part of the motor pathway?
strength, co contraction, and motor training

Answer 15

strength: spinal motor neuron and AHC excitability
co contraction: reduce muscle spindle transmission
motor training: brain plasticity

Question 16

why should we train multimodal exercise?

Answer 16

exercise including multiple sensory or motor activities in one
pts need working memory and attention to be successful at mulitsensory processing, cognitive abilities are dependent on ability to process multiple sensory inputs at once

Question 17

effects of training multisensory integration

Answer 17

enhanced speed, detection, localization, reaction in superior colliculus which integrates visual, auditory, somatosensory signals to enhance vigor of pt response

Question 18

aspects of multisensory training to incorporate

Answer 18

vision: salience increases motivation/attention
motivation: BG
attention: frontal lobe
auditory
somatosensory
postural control
varying speed, difficulty, cognitive load

Question 19

effect of multimodal stimulation in PD pts

Answer 19

reduces festination and improves turning by reducing steps taken

Question 20

gait training intensity in CVA

Answer 20

strong evidence for high intensity
70-85% HRmax

Question 21

results of high intensity gait training: variable vs forward

Answer 21

forward and variable showed much higher gains in step length and balance confidence than low intensity, forward may be superior to variable in these measures but variable showed more well rounded improvements and daily stepping for community ambulation

Question 22

benefits of variable activity and neuroplasticity for CVA pts

Answer 22

increase strength of paretic leg: stairs, leg weights
increase balance: perturbations while walking
walk multiple directions
avoid/over obstacles

Question 23

TENS as spasticity management in stroke

Answer 23

NMES, FES, or TENS for focal spasticity
temporarily reduces spasticity
could reduce permanently over time with repeated treatments or being combined with activity
resets muscle spindle

Question 24

dosing TENS for spasticity management in stroke

Answer 24

30 min better than 60, both effective
used at sensory level

Question 25

how is TENS used in SCI?

Answer 25

assist in voluntary oscillation of limbs allows greater amplitude even after stimulation is removed in short term creates constant muscle stimulation

Question 26

TENS and neuropathic pain

Answer 26

stimulates at the source of the pain can weaken pain synapses and strengthen sensory ones if performed consistently over time treat pt even if not curing source modulates pain at the dorsal horn

Question 27

negative neuroplasticity in neuropathic pain

Answer 27

pain synapses are being stimulated frequently increasing: spine density, mature spines, redistribution of spines close to cell body, receptor clustering/activation, hyperexcitability all results in better pain transmission

Question 28

PD and neuroplasticity: which types of training show best improvements

Answer 28

goal based and aerobic activity imprive cognitive and automatic motor control with experience dependent neuroplasticity TASK BASED

Question 29

MS and neuroplasticity

Answer 29

TASK BASED increases white and gray matter from neuroplasticity over 2 months training types include: exercise w visual feedback, resistive, balance, running

Question 30

MS resistive training improves what?

Answer 30

corticospinal connectivity, synapses, AHC activation, reduces tau protein

Question 31

motor priming

Answer 31

prepares NS for performing a task ex) CV task primes neural circuits with plasticity to work on another task like step length happens bc aerobic activity produces lactate and BDNF altering cortical excitabiltiy and reducing GABA inhibition

Question 32

when does motor learning occur across one/multiple sessions?

Answer 32

can increase rapidly in one session, then start higher at next session will eventually plateau

Question 33

dosage for neuro rehab

Answer 33

high dose rehan with extended training hours induce strutural, neuroplastic changes and reorganize neural networks to improve motor function

Question 34

neuro rehab principles modofy what parts of the brain?

Answer 34

some modify specific brain areas like motor areas of cortex - mass practice, task based, multisensory some modifiy brain networks - goal oriented, diffiulty, observation, motor imagery, mirror, rhythmic cuing both should be incorporated

Question 35

how to set up a program: dosage

Answer 35

training more than 5 hours a week can speed functional recovery

Question 36

how to set up a program: structured practice

Answer 36

frequent training with longer breaks leads to better retention than massed practice

Question 37

how to set up a program: task specific practice

Answer 37

movements that are relevant to ADLs and goal oriented results in maximal learning

Question 38

how to set up a program: variable practice

Answer 38

incorporate several tasks requiring different movements for better retention and generalized rehab

Question 39

how to set up a program: multisensory stim

Answer 39

provide feedback through mutliple senses to restore sensorimotor contingencies

Question 40

how to set up a program: increasing difficulty

Answer 40

progressively increase task difficulty to augment use of impaired limb

Question 41

how to set up a program: explicit feedback

Answer 41

knowledge of results (success/failure/outcome) leads to retention of adapted movement

Question 42

how to set up a program: implicit feedback

Answer 42

knowledge of performance obtained from tracking, analyzing, visualizing kinematic movement data reduces sensorimotor prediction error and promotes learning

Question 43

how can VR help with walking?

Answer 43

coupling VR and walking allows carryover of locomotor tasks to many contexts otherwise not available in clinic or hospital (task based) generalizes task

Question 44

which interventions are not very effective for improving locomotor function?

Answer 44

static/dynamic balance, BW supported treadmill training, robotic training, strength training, cycling