Week 5 (parts 1, 2 and 3)

Question 1

Part 1

Answer 1

stroke

Question 2

what is the brainstem

Answer 2

 Oldest part of the brain.
 Links the Cerebrum and the spinal cord.
 Comprises of the medulla, midbrain, and the pons.
 Connects to the Cerebellum.

Question 3

what is the cerebellum

Answer 3

 Attached to the brain stem via 3 peduncles
 Cortex is wrinkled and divided into lobes
 Has both grey and white matter
 Involved in maintaining balance and control

Question 4

what is the cerebrum

Answer 4

 Cortex of grey matter
 Deeper groups of white matter
 Include the Basal ganglia
 4 lobes, frontal, parietal, occipital, temporal
 Wrinkled with hillocks (gyri) and grooves (sulci)

Question 5

what is the motor homunculus

Answer 5

 This maps to the primary motor cortex in the frontal lobe

Question 6

what is the sensory homunculus

Answer 6

 This maps to the primary somatosensory cortex in the parietal lobe

Question 7

how is circulation controlled by the brain

Answer 7

 The brain is supplied with blood both anteriorly via the internal carotid arteries and posteriorly via the vertebral arteries
 To limit the possibility of loss of blood supply the brain has evolved a circular vascular anatomy which is called the Circle of Willis

Question 8

what is the role of the circle of willis

Answer 8

 Maintaining a blood supply to the brain and maintaining homeostasis are vital to maintaining life

Question 9

what are the 2 types of stroke

Answer 9

Infarcts:
* Due to blockage in the brain (85% of strokes)
* Embolic
* Thrombotic
* Due to blockage in the arterial supply to the brain usually (sometimes venous supply but rare)
Intracerebral Haemorrhage (ICH):
* Due to bleeding in or around the brain (haemorrhagic strokes)
* Bleeding into the brain tissue itself – different to bleeding into and around the meninges

Question 10

what are the causes of stroke

Answer 10

 A stroke can happen to anyone at any time – including children
 Age
 High Blood pressure (big risk for haemorrhages/bleeds)
 Diabetes
 Atrial Fibrillation
 High Cholesterol
 Family History
 Ethnicity
 Sickle Cell Disease

Question 11

what are the classifications of stroke

Answer 11

 TACS – Total Anterior Circulation Stroke
 PACS – Partial Anterior Circulation Stroke
 LACS – Lacunar Stroke
 POCS – Posterior Circulation Stroke

Question 12

what are the basic signs and symptoms of stroke

Answer 12

• Sudden onset weakness
• Sudden onset sensory loss
• Difficulty word finding or speaking
• Sudden blurred vision
• Sudden loss of sight
• Sudden memory loss
• Confusion

Question 13

what the main treatments for stroke

Answer 13

Ischaemic
 Thrombolysis
 Thrombectomy
 Antiplatelet v anticoagulant
 Cholesterol control
 BP control
 Smoking cessation
 Exercise
 Nutrition
 Rehabilitation

Haemorrhagic
 Cholesterol control
 BP control
 Smoking cessation
 Exercise
 Nutrition
 Rehabilitation

Question 14

Part 2

Answer 14

supporting structures of the CNS

Question 15

what are the supporting structures of the CNS

Answer 15

 The brain is an important structure so is protected from contusion and infection by:
 Glial Cells
 The meninges
 The cerebrospinal fluid (CSF)
 The skull

Question 16

what are Glial cells

Answer 16

 These are dispersed between the nerve cells and hold the neurons of the CNS in place. There are four main types:
 Oligodendrocytes – where did we discuss these before?
 Microglia
 Ependymal cells
 Astrocytes

Question 17

what are Meninges

Answer 17

 These are three layers of fibrous material that surround the brain and spinal cord to prevent it from injury and infection
 The meninges work together with the CSF to cushion the brain and prevent it moving too much with in the skull

Question 18

what is Pia Mater

Answer 18

 Very thin and lies directly on the surface of the brain
 Gives the brain its shiny look

Question 19

what is Arachnoid Mater

Answer 19

 Lies between the Dura and Pia Mater
 There is a space between the Arachnoid and Pia Mater called the Arachnoid space – this contains CSF (see below) and arterial blood supply to the outside of the brain
 The arachnoid layer is attached to the pia mater via fibrous strands - making it look like a spider – hence its name

Question 20

what is Dura Mater

Answer 20

 This is the tough outer layer of the meninges
 It is directly attached to the skull
 Except where it allows space for the venous supply

Question 21

what is Cerebro Spinal Fluid

Answer 21

 Straw coloured viscous fluid produced in the lateral ventricles
 Circulates around the brain and spinal cord in the subarachnoid space
 Approx 500ml produced per day. 125-150ml circulating at any time.

Question 22

how is the brain provided for via circulation

Answer 22

 The brain is supplied with blood both anteriorly via the internal carotid arteries and posteriorly via the vertebral arteries
 To limit the possibility of loss of blood supply the brain has evolved a circular vascular anatomy which is called the Circle of Willis

Question 23

what is the function of the circle of Willis

Answer 23

 Maintaining a blood supply to the brain and maintaining homeostasis are vital to maintaining life

Question 24

what brain lobes do the arteries supply

Answer 24

 Can you guess/tell me which lobes or areas of the brain the following arteries supply AND what your signs and symptoms would be if you had loss of blood supply to that area??
 Middle cerebral artery (MCA)?
 Posterior cerebral artery (PCA)?
 Anterior cerebral artery (ACA)?
 Posterior inferior cerebellar artery?

Question 25

what is the function of the Venous system

Answer 25

 Blood drains away from the brain via a complicated series of veins.  Some of these veins are called sinuses  There are deep and superficial veins  They empty into the dural venous sinus before flowing via the jugular vein back to the heart

Question 26

Part 3

Answer 26

Training of the Lower Limb

Question 27

what is Movement Analysis

Answer 27

 The systematic study of human movement  We need to be able to study and recognise normal in order to observe and highlight deviations that are due to neurological conditions  If we understand and can reproduce movement patterns, then we can use these as part of our rehabilitation e.g., if a patient cannot sit to stand, we can prescribe them an exercise or assist them to practise sit to stand  Understanding of kinetics (motion and its causes) and kinematics (movement but not forces) assists with movement analysis.  We looked at observation of static postures and movement earlier in the module  All the treatment principles still remain the same: salience, task specific, functional, intensity, reps!!

Question 28

what is involved in therapeutic handling

Answer 28

 Therapeutic handling includes:  guiding, facilitating, manipulating or providing resistance. It may also be defined as any treatment where force is applied through any part of the therapist's body to any part of the patient's body” (CSP, 2014)

Question 29

what are the 2 'different schools of thought'

Answer 29

 Bobath Approach (Neuro Developmental Therapy)  Central Key Points (CKP)  Peripheral Key Points (PKP)  Provision of support to undertake normal movement patterns and functional tasks  Research has shown that PKP at elbow into ext. rotation can increase cervical and thoracic extensor EMG activity  Motor Relearning  Manual guidance of movement  Supportive practice of missing components of motor programme  Feedback within handling to support them in activating components  Elimination of unnecessary muscle activity

Question 30

why do we use therapeutic handling

Answer 30

 To facilitate normal movement patterns  To reduce compensation strategies  To support stabilisation and activation of anticipatory postural adjustments  To provide de-weighting support  To increase sensory feedback  To increase motor control (i.e. hyper-extending knee)

Question 31

what's the difference between manual and therapeutic handing

Answer 31

 Manual Handling is about moving loads, including patients. It is a legal framework to ensure staff and patients are protected.  Therapeutic handling is a developed skill that is used to facilitate the return of ‘normal’ movement.  There is a need to balance up the benefit to the patient versus risk to therapists.  You still need to maintain and consider safe practice and set realistic goals for treatment when using therapeutic handling.

Question 32

what are the sit to stand phases

Answer 32

 Flexion Momentum  Momentum transfer  Extension  Stabilisation

Question 33

what are some training tips for sit to stand

Answer 33

 Intensive  Repetitive  Constant v variable  Random v block  Massed v distributed  Task Specific  Salient  Transferable  Whole v part training  Feedback  Knowledge of performance v knowledge of results

Question 34

what are the phases of swing phase

Answer 34

 Toe off  Initial swing  Mid swing  Terminal swing

Question 35

what are the phases of stance phase

Answer 35

 Heel strike  Loading response  Mid stance  Terminal stance

Question 36

what are the parts of neuroplasticity

Answer 36

 Cortical Remapping  Collateral sprouting  Axonal regeneration  Do not forget general activity and fitness as per ACSM guidelines

Question 37

what is motor skill learning

Answer 37

* Repeated task specific practice * Needs cognition AND some motor output * Instructive motor learning * Knowledge of performance * Change achieved through intentional movement strategies * Change in response to explicit feedback * Needs cognition