02 - Motor Pathologies and Principles of Motor Restoration

Question 1

Timeline post-injury

Answer 1

• 1m = acute
• 3m = subacute
• > 3m = chronic
• > 6m = impaired, disabled
• always = congenital, inherent

Question 2

Incidence def

Answer 2

nbr of new cases per pop° in a given time period (relative)

= risk of devpg a new cdt° w/i a specified time

Question 3

Prevalence def

Answer 3

total nbr of cases of a disease in a pop° at a given time (absolute)

Question 4

Paresis and related def

Answer 4

• paresis = weakness of voluntary movt
• paralysis = plegia = cplt loss of fct
• mono / di / tetra = quadri
• para = legs
• hemi = same side
• spastic paresis = exaggerated tendon reflexes and muscle hypertonia
• gastroparesis = impaired stomach emptying
• ophtalmo = impaired eye muscle

Question 5

Spasticity and related def

Answer 5

• increased muscle tone and unusual tightness of muscle (hypertonia)
• muscle tone = continuous and passive partial contraction of the muscle
• hypertonia = abnormal increase in muscle tension and decreased ability of a muscle to stretch

Question 6

Brain pathologies

Answer 6

• fcts involved: cognition, motion planning and ctl, emotions, pain…
• rehab methods: surgical intervention, movt therapy, neuroprosthesis, orthosis, cognitive training
• stroke (ischemic/hemorrhagic) => hemiplegia, neglect, etc.
• PD: idiopathic, neurodegenerative => hypokinesis, rigor, tremor, postural disturbances
• TBI
• MS (multiple sclerosis): neuron myelin attack by immune system => ataxia (lack of voluntary coordination of muscle movt), increased muscle tone, spasticity
• CP (cerebral palsy): during pregnancy or at birth, permanent, non-progressive => increased muscle tone, spasticity, motor dysfct, cognitive deficits

Question 7

Spinal pathologies

Answer 7

• fcts involved: stimulus generation and propagation
• rehab methods: neuroprosthesis, orthosis
• SCI: patient priorities = grasping, bladder/sexual, walking

Question 8

PNS pathologies

Answer 8

• fcts involved: stimulus propagation
• rehab methods: spontaneous healing, surgical intervention, othosis
• injuries, poliomyelitis

Question 9

MSK pathologies

Answer 9

• fcts involved: movt execution, body posture
• rehab methods: spontaneous healing, orthosis, robotic support, exoprosthesis
• MD (muscular distrophy, one is Duchenne): genetic, needed protein missing => weakening and skeletal breakdown with time
• amputation: traumatic, tumor, deformity

Question 10

Motion restoration

Answer 10

• natural
• – CNS: 3 recovery mechsm
• —– adaptation & compensation
• —– nerve growth & regeneration
• —– neuroplasticity = ability of the NS to respond to intrinsic or extrinsic stimuli by reorg^g its structure, fcts and connections
• – PNS: spontaneous, fast regeneration for weak nerve lesion / slow if full rupture but intact myelin / o/w surgical intervention
• technical: prosthesis, orthosis, neuroprosthesis, motion therapy

Question 11

Motor assessment - arm

Answer 11

• conventional = active/passive ROM
• qlttv clinical scores
• – GRASSP = graded redefined assessment of strength, sensibility & prehension
• – Fugl-Meyer: upper extremity in stroke - 0-66
• – Modified Ashworth Score: spasticity
• – MMT = manual muscle test - 0-5
• machine-supported: movt smoothness, jt torque/stiffness, EMG…
• arm/hand activity assessment
• – WMFT = wolf motor function test
• – box and block test
• – nine-hole-peg test

Question 12

Motor assessment - leg/gait

Answer 12

• conventional = active/passive ROM
• qlttv clinical scores
• – Fugl-Meyer: lower extremity in stroke - 0-34
• – Modified Ashworth Score: spasticity
• – TUG = time up and go
• – 6 min walking dist / 10 m walking time
• – single leg balance test
• – …
• machine-supported: movt smoothness, gait symmetry, jt torque/stiffness, EMG, ground reaction force

Question 13

Activity and participation assessment

Answer 13

• questionnaires
• – MAL = motor activity log
• – SIS = stroke impact scale
• – …
• GAS = goal attainment score