Week Three Flashcards
What are the current principles of treatment - dragon slide
Maximise neural plasticity
Commence rehab immediately
Collaborative goal setting - SMART
detailed assessment using OMs
Team approach
Promote recovery of normal movement patterns/techniques
Minimise use of aids early in recovery - otherwise they’ll rely on it
Prevent secondary changes
Maximise practise opportunities
Practise must be sufficiently challenging to promote learning
What is the role of the pons
Links the two sides of the cerebellar
What is the main goal of neurological rehab
Regain optimal motor performance
In order to start rehabilitation what does the patient need
MsK flexibility - don’t want contratcures as we won’t get very far
Some voluntary control
Sufficient medical stability and fitness to cope with treatment
Some degree of cognitive engagement and motivation
Appropriate training/practice plan
Appropriate environment - make environment more challenging to develop more brain mass
What did Paul Bach-y-Rita find
That the brain can recover to near normal function
His father lost ~90% of pathways and regained relatively normal brain function
Note: the homunculus can change quickly if learning a new skill
Adaptive plasticity is inevitable after an acute brain lesion, rehab can influence this positively or negatively
Following a brain injury there will be an immediate reparative phase (natural recovery)
What are the ten things which influence maximising neuroplasticity
- Use it or lose it - need to drive specific brain functions or else you’ll get degradation
- Use it and improve it - training can drive these specific brain functions
- Specificity - nature of training experience dictates the nature of plasticity
- Repetition matters - induction of plasticity requires repetition ~300 times
- Intensity matters - plasticity requires sufficient training plasticity
- Time matters - different forms of plasticity occur at different stages
- Salience matters - training experience must be sufficiently salient to induce plasticity - must be clear and not ambiguous
- Age matters - training-induced plasticity occurs more readily in younger brains
- Transference - plasticity in response to one training experience can enhance the acquisition of similar behaviours - practising tennis will partly help with squash, it’s better than doing nothing
- Interference - plasticity in response to one experience can influence with the acquisition of other behaviours
Why is it important to focus attention
There is improved learning if they understand the aim of the exercise
The task should be meaningful, worthwhile and challenging
Need appropriate environment, instruction and feedback
Important to focus attention in order to learn and remember
What the two types of feedback and why are they important
Intrinsic - important to consider tactile, visual and proprioception (most important)
Extrinsic - more effective that intrinsic,such as you can feel yourself touching the chair etc
- specific
- meaningful
- motivating
- augmented: video, timing and EMG
What is transferring a skill and why is it so important
Important part of learning
If patients want to go home, it’s important that they can transfer/incorporate their skills into their new environment
Why is practice so important
The task should be practiced in its entirety for the skill to be learned appropriately
Can practice subsets but need to make sure we put them altogether
Note: it’s important to use everyday functional tasks such as rolling, bridging and walking etc. Important to use this in rehab so that they can understand why they’re doing it
How can we make tasks more achievable
Reduce the difficulty
Lessen the range through which movement is required
Remove friction and/or gravity
Manual guidance
Improve stability by increasing BOS
Practice components but practice the whole
Can make tasks easier for them but need to remove this eventually
A Locomat holds them up in a hoist like structure to allow them to experience normal movement
What are some neurological impairments
Loss do voluntary control Loss of sensation Impaired perception and cognition (including a reduced conscious state) Impaired coordination Impaired vision Impaired speech Nana betrothed initiating movement
Strategies to address loss of voluntary control
Facilitation - hands on
Alter task/environment to promote normal patterns
High quality practice to give them the best chance of recovery
Functional tasks
Prevent use of compensations
Strategies to help with loss of sensation
Prevent soon cry changes
Provide normal movement and sensory experience
Train in different environments
Weight bearing tasks
Retraining of sensory recognition during specific tasks - Stereogenosis (getting them to show you which parts they can’t feel and facilitating that)
Sensory bombardment program
What is the sensory bombardment program
2 mins slapping 2 mins pinching 2 mins pounding through the long bones 2 mins vibration 2 mins icing 2 mins rubbing with a dry towel
No evidence for this, but some evidence for vibration, icing and towel rubbing
Used for Pts with decreased arousal and/or neglect
Should never be used where there is hyper-reflexia/spasticity
