Recovery of Function and Adult Clinical Population Flashcards
(112 cards)
1
Q
What is ankylosing spondylitis? What are the general symptoms early and late?
A
- Ankylosing Spondylitis: Inflammatory disease of the spine & SI joint
- Early: chronic pain
- Late: new bone/spine segments fuse
2
Q
What are the spinal changes associated with ankylosing spondylitis?
A
- Loss of lumbar lordosis
- Increased thoracic kyphosis
- Head protraction
- Loss of spinal flexibility in all planes
- Hip flexion
3
Q
Describe the posture of a patient with ankylosing spondylitis and what accommodations do they make to maintain balance
A
Posture
- Forward shift COM
- Lowering COG
Accommodation to maintain balance
- Knee flexion
- Posterior pelvic tilt
4
Q
Describe steady state postural control in patients with ankylosing spondylitis
A
- COP net displacement greater than controls
- Frontal plane > sagittal plane
- 50% increase in sway with eyes closed
5
Q
Describe anticipatory & compensatory postural control ankylosing spondylitis
A
- Limited postural control data available in the literature
- Some clinical data reveals
1. Changes on static & dynamic clinical tools that worsen with disease severity
2. Confirms worse performance with eyes closed
3. Confirms higher incidence of dizziness vs controls
4. Impact on dynamic activities such as gait
6
Q
What are some peripheral vestibular disorders?
A
- BPPV
- Unilateral vestibular hypofunction
- Bilateral vestibular hypofunction
7
Q
What are some central vestibular disorders?
A
- Stroke
- Multiple Sclerosis
- Brain injury
8
Q
In regards to information processing what happens as a result of inaccurate vestibular input?
A
Need to learn to select accurate input & ignore inaccurate input
9
Q
In regards to information processing what happens as a result of decreased vestibular input?
A
Need to rely heavily on remaining inputs (somatosensory, vision)
10
Q
Describe the changes of Steady State Postural Control in vestibular disorders
A
Increase sway/loss of balance when alter visual & somatosensory inout
(Screen using Clinical Test of Sensory Interaction & Balance)
11
Q
Describe the changes of Anticipatory Postural Control in vestibular disorders
A
Decrease balance with dynamic movements that stimulate vestibular system
(Head turns, bending, turning around, scanning environment)
12
Q
Describe the changes of Reactive Postural Control in vestibular disorders
A
Use of ankle strategy but not the hip strategy, even when the hip strategy is required for postural stability
13
Q
What is Alzheimer’s Disease (AD)?
A
- Progressive disease process typically causing dementia
- Breakdown in processes necessary to sustain brain cells
14
Q
Alzheimer’s Disease is characterized by slow decline/change in?
A
- Memory
- Language
- Visuospatial skills
- Personality
- Cognition
15
Q
What are the neuropathological hallmarks of Alzheimer’s Disease?
A
- Amyloid plaques
- Neurofibrillary tangles
- Loss of neurons & synapses in cerebral cortex and subcortical regions causing atrophy
16
Q
How does a patient with Alzheimer’s Disease process information?
A
- Slower reaction times
- Impaired choice reaction time (decrease focused attention)
- Decreased ability to use advanced cues to anticipate
- Decreased ability to inhibit non-regulatory stimuli
17
Q
What is the attention like in a patient with Alzheimer’s Disease?
A
- Poor selective & divided attention
- Decreased performance on dual tasks (no training improvement, associated with risk of falls)
18
Q
How does steady state postural control change when a patient has Alzheimer’s Disease?
A
- Decrease control of sway
- Decrease performance with eyes closed
19
Q
How does anticipatory postural control change when a patient has Alzheimer’s Disease?
A
- Reduced limits of stability and functional reach
- Postural instability associated with dual task activity
20
Q
In Alzheimer’s Disease what are the early impairments on memory and what is there relative sparing of?
A
- Working memory
- Episodic memory
- Semantic memory
- Relative sparing of: procedural memory
21
Q
How do patients with Alzheimer’s Disease learn motor skills?
A
- Both implicit & explicit learning strategies can be used but reduced learning
- Repeated practice (implicit)
- Observation learning better than guided (explicit)
- Mental effort
- Errorless learning
22
Q
What practice conditions are best for patients with Alzheimer’s Disease when learning a new motor skill?
A
- Constant
- Specific to task
- Avoid random practice
- Visual feedback is key
23
Q
What is stroke?
A
Disruption of blood flow to area of CNS
24
Q
Within Stroke, what are the functional implications (dependent upon brain regions involved)?
A
- Sensation
- Motor
- Cognition
- Speech/language
- Vision
25
In regards to information processing of stroke there is a decrease sensory input which can cause what?
- Homonymous hemianopia
- Vestibular (brainstem)
- Somatosensory loss associated with loss of function/prognosis
26
A stroke involving a right hemisphere lesion what can symptoms can this cause?
- Hemineglect/ extinction
- Decreased ability to sustain, shift & divide attention
27
After stroke what happens to tone?
Spasticity (UMN)
28
What are the abnormal synergies of stroke?
- Massed patterns of movement
- Unable to selectively activate individual muscles
- Results from increased recruitment of brainstem pathways
- UE: Flexor > Extensor
- LE: Extensor > Flexor
29
What are the changes in steady state postural control in a patient after stroke?
- Impairments in both sitting & standing
- Asymmetrical alignment
- Increased & asymmetrical sway
30
What are the changes in anticipatory postural control in a patient after stroke?
- Lesions to many areas can impair APC (motor cortex, basal ganglia, cerebellum)
- Delayed & reduced muscle activity in trunk on affected side
- External trunk support can improve performance
31
Describe the reactive postural control in place strategies that is observed in patients after stroke
- Impaired sequencing, timing & amplitude in paretic limb in response to perturbation
- Compensate for delays in distal muscles of paretic limb with early proximal activation of non-paretic limb
32
Describe the reactive postural control stepping strategies that is observed in patients after stroke
- Similar time to foot off paretic vs non-paretic however different pattern based on asymmetrical load
- Delays in non-paretic, but not paretic stepping are associated with falls
33
Loss of memory in patients after stroke is dependent upon lesion locations. What are some possible impairments?
- Decreased short term memory
- Decreased long term memory
34
What impact does stroke have on implicit and explicit learning?
- Explicit learning is impaired with medial temporal lobe damage
- While implicit learning distributed between brain structures so that no single lesion completely eliminates
35
What are the ideal learning for a patient after MCA & basal ganglia strokes?
Explicit instructions, decrease learning
36
What are the ideal learning for a patient after cerebellar stroke?
Explicit instructions, increase learning
37
What is Parkinson's Disease?
- PD is a progressive disorder of CNS
- Loss of dopamine producing neurons in substantia nigra of the basal ganglia
- Hypokinetic movement disorder
38
What are some challenges patients with Parkinson disease face when it comes to information processing?
- Difficulty adapting to sudden environmental changes
- Difficulty organizing and selecting sensory information
39
What do patients with PD have a difficulty with in regards to attention?
- Difficulty selecting what sensory cues to attend to
- Decreased performance under dual task conditions relative to control subjects
40
Patients with PD can benefit from (BLANK) cueing
attentional
41
Describe the motor control of patients with PD
- Bradykinesia
- Hypokinesia
- Akinesia
- Rigidity
- Tremor
42
What are some secondary impairments that occur on the motor control system as a result of PD?
- Decreased ROM (flexors)
- Weakening (extensors)
43
What is the postural alignment of a patient with PD?
Stooped posture
44
In a patient with PD describe the sway observed in steady state postural control
- Increased sway area & velocity
- Meds decrease sway
45
In a patient with PD what are the changes in anticipatory postural control?
- Smaller anticipatory adjustments
- Decreased velocity
46
In a patient with PD describe their reactive postural control in place response
- Abnormal co-contraction of hip & knee musculature
- Decreased adaptation of postural strategies to environmental & task demands
47
In a patient with PD describe their stepping strategy
- Decrease weight shift prior to stepping
- Slower to initiate step
- Multiple small steps to recover balance
- Increased risk of falls
48
In patients with PD what changes occur to their working memory?
- Decreased relative to controls
- Worsens with disease progression
- Improves with dopamine
49
In patients with PD what changes occur to their long term memory?
- Decreased encoding
- Decreased retrieval
50
In patients with PD, they have (Slower or faster) rate of learning and it (improves or worsens) with disease progression
- Slower
- Worsens
51
Patients with PD have difficulty learning sequential task so what practice improves acquisition & renting?
Blocked practice
52
In patients with PD what does external focus of attention improve?
Performance & motor learning
53
Patients with PD what can improve performance?
Cueing (auditory or visual)
54
What are the changes in a patient's information processing with Cerebellar Pathology?
- Decreased ability to subconsciously compare sensory info to intended motor output
- Decreased ability to subconsciously respond to sensory feedback
- Slower to respond to unexpected sensory info
55
Patients with Cerebellar Pathology must rely on what for movement adaption?
Rely more on conscious, attention demanding pathways
56
In patients with Cerebellar Pathology when may performance deteriorate?
Other demands on attention (dual task, fatigue, distraction)
57
Patients with Cerebellar Pathology struggle with timing & grading of muscle contractions which causes what?
- Dysmetria
- Dysdiadochokinesia
- Decomposition of movement
- Rebound phenomenon
58
Describe the motor control of a patient with a cerebellar pathology
- Hypotonia
- Decreased coordination/ataxia
- Intention tremor
- Improved control of isolated joint vs multipoint movement
59
What is the change in steady state postural control for a patient with a cerebellar pathology?
- Increased postural sway
- Direction of sway linked to lesion location
- Wide BOS (sway increase as BOS increases)
- vision/ somatosensory input decrease sway
60
What is the change of anticipatory postural control in patients with a cerebellar pathology?
- Able to demonstrate anticipatory adjustments (w/ abnormal timing. mismatched scaling)
- Decreased ability to develop new anticipatory postural adjustment for novel tasks
61
What is the in place reactive postural control responses in a patient with cerebellar pathology?
- Decreased ability to grade force of output to match perturbation
- Hypermetric postural response (larger amplitude & duration)
- Excessive compensatory sway opposite direction (body oscillations)
62
What is the stepping responses in a patient with cerebellar pathology?
- Able to demonstrate stepping response
- May require more then one step
63
What are the changes in memory for a patient with a cerebellar pathology?
- Decrease verbal working memory
- Decrease flexibility in previously acquired procedural memories
- Decrease consolidation of new procedural memories
64
In regards to motor learning what does the cerebellum play an essential role in?
Error correction (practice dependent motor adaption & learning)
65
In regards to motor learning damage to the cerebellum cause what?
- Decreased extent & rate of adaption of movement
- Decreased error based learning
- Declarative learning intact
- Limited ability to consolidate new skills (decreased automaticity)
66
What practice conditions are best for patients with a cerebellar pathology?
- Avoid trial & error learning
- Stepwise movement repetition with verbal prompts to ensure conscious awareness
- Require longer duration, increase reps, increase intensity
- Massed
- Less retention
67
What feedback is best for patients with cerebellar pathology?
- Respond well to verbal cues to direct attention
- Teach patients to consciously attend to movement
- Providing KP and/or KR assists with error detection
- Intermittent better than constant
68
What is Huntington's Disease and what are the clinical symptoms?
- Hyperkinetic disorder of basal ganglia
Clinical symptoms
- Progressive movement disorder
- Cognitive deficits
- Behavioral changes
69
Describe the changes in information processing for a patient with Huntington's Disease
- Slow response times
- Difficulty selecting b/w relevant & irrelevant stimuli
- Problems w/ visuospatial awareness
- Difficulty inhibiting inappropriate responses
- Difficulty anticipating due to overestimating abilities
70
Describe the changes in attention for a patient with Huntington's Disease
- Decreased ability to shift attention
- Decreased ability to concentrate on more than one task
71
What is motor control of patients with Huntington's Disease?
- Hypotonia
- Chorea
- Overtime (weakness, decreased ROM)
72
Describe the anticipatory postural control of a patient with Huntington's Disease
- Reduced limits of stability even in pre-manifest HD
- Limb movements deviate significantly from planned trajectories
- Difficult to anticipate (end up relying on reactive postural control)
73
Patients with Huntington's Disease struggle with what memory?
Difficulty retrieving memories (applies to both distant & recent memories)
74
How do patients with Huntington's Disease learn motor skills best?
- Better with part practice
- Need increased guidance to put the parts together
- avoid distractions & dual task
75
Spinal Cord Injury results in what?
- Reduced or absent sensory info from below level of lesion
- Reduced or absent motor signals to the muscles activated below the level of lesion
76
what is the motor control of patients with spinal cord injury?
- Motor impairments
- Spasticity
- Sensory impairments
- Multiple systems impacted (respiratory & cardiovascular)
77
What are some compensatory movements in patients with a spinal cord injury?
- Skills are achieved using very different motor control strategies
- Use head to move hips instead of core
- Rely on momentum
- Muscle substitution
- Task modification
78
what is the steady state postural control in patients with SCI?
Increase sway in sitting
79
Higher lesions of SCI result in what in regards to steady state postural control?
- More sway
- Faster sway
80
What is the anticipatory postural control of a patent with a SCI?
- Compensatory strategies (lack core muscle activation & counterbalance to maintain COM within BOS)
- Decreased LOS
81
What is the reactive postural control of a patient with a SCI?
- Use different reactive strategies
- Protective reaching vs stepping
82
How does a patient with SCI process information?
- Limited somatosensory input
- Must rely more heavily on vision & vestibular inputs
83
What are the changes of attention in SCI?
- Require more attention to maintain postural control
- Negatively impacts dual task ability
- Potential to improve with practice
84
What practice conditions are best for a patient with a SCI to learn a new motor task?
- Part to whole
- Variability enhances adaptability of skills
- Random practice beneficial to learning
85
What feedback is best for a patient with a SCI learning a new motor skill?
- Early extrinsic feedback (faded)
- Later intrinsic feedback to facilitate independence
86
Is there a direct memory impairment due to SCI?
No, may co-exist with brain injury due to trauma
87
What is a concussion?
Mild traumatic brain injuries that can result in difficulties related to headaches, concentration, memory, balance & coordination
88
What are some post concussion symptoms?
- Dizziness
- Noise/light sensitivity
- Blurred/ double vision
89
What are the changes in information processing for a patient with a concussion?
- Impaired sensory integration
- Delayed speed of information processing
90
What is the steady state postural control in a patient with a concussion?
- Acute increase sway
- Related to sensory integration problems (visual, vestibular)
91
What is the anticipatory postural control in a patient with a concussion?
Decreased anticipatory postural adjustments prior to gait initiation
92
What is the reactive postural control in a patient with a concussion?
Increase latency of reactive balance responses
93
What are the postural measurement tools for someone post concussion?
- Balance Error Scoring System (BESS)
- Sensory Organization Test (SOT)
- Instrumentation
94
How is the BESS test performed and what diagnosis is it used for?
- Count # of errors in each 20 second trials
- Max 10 errors per condition
- Concussion
95
What counts as an error in BESS?
- Move hand off iliac crest
- Open eyes
- Step stumble or fall
- ABD or flex hip >30
- Lift forefoot or heel off testing surface
- Remain out of test position > 5 sec
96
What is the attention of someone after a concussion?
- Difficulty dividing attention
- Deficits persist for up to 2 months post injury
97
What are the changes in memory in someone after a concussion?
Working memory
- Decreased accuracy
- Decreased verbal fluency
98
How does a patient after a concussion learn motor skills?
- Both recall & new task acquisition
- Attempts at learning can prolong recovery (cognitive rest)
99
Describe the motor control of a patient with TBI
- Weakness (UMN)
- Ataxia
- CN function
- ROM
- Motor planning deficits
100
What is the steady state postural control in a patient with a concussion?
- Increase sway
- Asymmetrical WB
101
What is the anticipatory postural control in a patient with a concussion?
High incidence of vestibular dysfunction
102
Describe how patients with a TBI process information
- May have reduced sensory input
- Decreased executive functions (prefrontal cortex)
- Large decrease in processing speed (increase in reaction time)
103
In a patient with TBI in regards to attention what are the deficits?
- Selective attention
- Sustained attention
104
In regards to memory after TBI what occurs?
Post traumatic amnesia is common ranging from minutes to weeks
105
After TBI deficits in working memory are associated with?
- Frontal lobe damage
- Impaired executive functions
- Impaired information processing
106
What practice condition is best for motor learning in patients with TBI?
- Distributed with frequent rests to avoid mental fatigue
- Blocked for initial learning progressing to random
107
What feedback is best for motor learning in patients with TBI?
- Explicit/augmented feedback may be beneficial early due to sensory, perceptual & cognitive impairments
- Avoid overwhelming with feedback
108
What is multiple sclerosis?
Immune mediated disease that causes demyelination & degeneration within the central nervous system
109
Symptoms of MS vary by location and can include?
- Sensory
- Cognitive
- Motor
110
What symptoms of motor control do patients with MS present with?
- Weakness/ paralysis
- Spasticity
- Incoordination/ataxia
- Loss or ROM
111
Describe the changes in postural control for a patient with MS
- Reduced LOS
- Slow activation of postural muscles (slow conduction, slow initiation of anticipatory postural adjustments, slow reactive postural control)
- Difficulty under varying/reduced sensory condition
112
How do patients with MS process information?
- Sensory deficits are common
- Slow conduction speeds may increase response time
