Neurological Rehabilitation

Question 1

Neurological rehabilitation

Answer 1

Self-management
Patient centred care
Teamwork
ICF
Functional movement re-eduction
Neural plasticity
Skill acquisition
Systems of model of sensory motor control

Question 2

Sensory motor control

Answer 2

Control of movement by the CNS and MSK system as well as the physical and social aspects of the environment
Requires intact - musculoskeletal system, sensory-motor control system, cognitive processes

Question 3

Skill acquisition

Answer 3

Motor skill learning
1. Early cognitive phase
2. Intermediate associative phase
3. Late autonomous phase

Question 4

Skill acquisition: 1. Early cognitive phase

Answer 4

Declarative phase
E.g. attempting to understand basic phase and moments of juggling

Question 5

Skill acquisition: 2. Intermediate associative phase

Answer 5

Implicit and explicit learning
E.g. often dropping balls but able to identify and correct the problem through trial and error by practicing

Question 6

Skill acquisition: 3. Late autonomous phase

Answer 6

Procedural learning
E.g. able to juggle automatically with few errors and able to focus on uni-cycling at the same time

Question 7

Motor learning

Answer 7

Learning new skills

Question 8

Motor re-learning

Answer 8

Improvements seen after stroke or damage
E.g. improvements in function

Question 9

Neural plasticity

Answer 9

Neuro - nerve cells
Plasticity - changeable
Any enduring changes in neurone structure or function, and occurs in everyone
Can be changes in the anatomy (structure) of the brain or changes in the physiology (function) of area of the brain

Question 10

Types of plasticity

Answer 10

Developmental plasticity
Functional plasticity
Adaptive plasticity
In neurological injury often combination of both functional and adaptive
Not always a positive thing

Question 11

Types of plasticity: developmental plasticity

Answer 11

Modification in structure and function of the CNS during embryonic growth and development

Question 12

Types of plasticity: functional plasticity

Answer 12

Changes in the adult CNS induced by the environment
Learning
E.g. professional violinists found to have greater cortical representation of left hand

Question 13

Types of plasticity: adaptive plasticity

Answer 13

Changes induced by injury or lesion to specific components of the CNS

Question 14

Damage induced changes to the CNS: stroke

Answer 14

Damage to nervous tissue at the site of the primary injury
Necrosis - core ischaemia, minutes
Penumbra - delayed cell death, hours to days
Diaschisis - remote secondary damage and dysfunction distal to the site of injury

Question 15

Recovery after stroke

Answer 15

Restoration
Reorganisation
Recruitment

Question 16

Recovery after stroke: restoration

Answer 16

Function within damaged area of the motor cortex restored with rehabilitation

Question 17

Recovery after stroke: reorganisation

Answer 17

Rehabilitation can drive residual neural tissue to reorganise to compensate for lost function

Question 18

Recovery after stroke: recruitment

Answer 18

When insufficient resources are found within the damage area, other areas mat take over or the contralateral motor cortex may be recruited

Question 19

Mechanisms of neural plasticity following motor training: long-term potentiation/ synaptic plasticity

Answer 19

Persistent strengthening of synapses based on recent patterns of activity
Produce a long-lasting increase in signal transmission between two neurones
More receptors on the postsynaptic neurone

Question 20

Mechanisms of neural plasticity following motor training: cortical reorganisation

Answer 20

Preserved brain tissue taking on a new functional role
Adapts and takes on the function that was lost due to the damage
Changes in cortical maps and functional organisation of brain regions

Question 21

Mechanisms of neural plasticity following motor training: neurogenesis

Answer 21

Individual neurones
Dendrite remodelling and atonal sprouting
Generation of new neurones in specific brain areas

Question 22

Mechanisms of neural plasticity following motor training: axonal sprouting

Answer 22

Formation of new connections or sprouting of existing axons
Corticospinal tract and other neural pathways involved

Question 23

Mechanisms of neural plasticity following motor training: dendritic remodelling

Answer 23

Structural changes in dendrites, including sprouting and arborisation
Affected and unaffected brain regions are involved

Question 24

Task specific functional practice

Answer 24

Best way to relearn a task is to practice the task
Involves repetitive practice of meaningful, real-life tasks with the intention of acquiring a skill
Challenging, progressively adapted, practiced within different contexts and environments
Aims towards reconstruction and mastery of the whole task

Question 25

Intensity/ time

Answer 25

Intensity - number of repetitions performed within treatment session and physiological effort exerted Should do lots of repetitions

Question 26

Types of practice

Answer 26

Direct supervision Semi-supervised practice Independent/ unsupervised practice

Question 27

Types of practice: direct supervision

Answer 27

One to one practice with a therapist

Question 28

Types of practice: semi-supervised practice

Answer 28

Takes place in the therapy area but not under the direct supervision of a therapist

Question 29

Types of practice: independent/ unsupervised practice

Answer 29

Takes place outside the of the therapy area, i.e. on the hospital ward or at home, and is not supervised by a therapist

Question 30

Late rehabilitation

Answer 30

Change faster early after injury/ disease Functional changes has been evident even when the rehab programme was initiated 20 years after the lesion Therefore, no absolute end to potential

Question 31

Key aims of Neuro physiotherapy

Answer 31

RAMP Restore Adapt Maintain Prevent

Question 32

Restore

Answer 32

Restore functional activities and increase participation as identified by patient led goals Aim your treatments at an activity level where possible The practice of motor skills needs to be both task and context specific

Question 33

Adapt

Answer 33

Viewed both negatively and positively Promote compensatory strategies that are necessary for function and discourage those that may be detrimental

Question 34

Maintain

Answer 34

Maintenance of function In progressive conditions such as MS physiotherapist can help maintain functional ability despite deteriorating impairments

Question 35

Prevent

Answer 35

Increased risk of developing secondary complications e.g. contracture, pressure area and reduced skin integrity, respiratory or urinary infections Need to work with the MDT to identify those most at risk and prevent the development of secondary complication