7] Neuro Interventions E2 Flashcards
Data from randomized trials with low false positive(alpha) and low false-negative (beta) errors
Level 1 evidence
Data from randomized trials with high false positive(alpha) or high false-negative (beta) errors
Level 2 evidence
Data from nonrandomized concurrentcohort studies
Level 3 evidence
Data from nonrandomized cohort studiesusing historical controls
Level 4 evidence
What is level 5 evidence?
Data from anecdotal case series
What is level 6 evidence?
Expert opinion
When tasks are repeated, the number of active regions in the
Brain are reduced
During the initial phases of motor learning, ? and ? regions of the brain are active.
Large and diffuse
When a motor task is learned, on ?, ? regions of the brain show an increased activity when performing the task
Small, distinct
Synapses are unused until injury occurs; Injuries to otherpathways causes their activation.
Unmasking
Brain capacity is dependent on the ? And NOT ?
of connections NOT # of neurons present
What interventions DO NOT promote neural reorganization?
Facilitation (PNF?)
Stretching
Strengthening
Functional reorganization of the cortex is ?
Skill and motor learning dependent; NOT USE
Brainstorm: flaccidity stage
1
The whole hemiparetic side is completely limp.The arm, the leg, the torso, the face including the mouth and tongue, the whole body on one side is flaccid or
limp.
Brun 1
Spasticity starts to creep in what stage of Brun?
2
Spasticity becomes severe in what Brun?
3
Spasticity is generally seen as a positive step because it signals the beginning of some sort of
messages getting through to the limbs. There may be some
small amount of voluntary synergistic movement available.
Brun 2
The good part is that voluntary controlof synergies develops
Brun 3
Spasticity begins to decline in this stage
Brun 4
Synergies continue to decline in this stage
Brun 5
Mvmts are near normal in this stage and no spasticity except when fatigued or doing fast mvmts
Brun 6
the stage where some movement outside of synergy ispossible.
Brun 4
able to have more voluntary control out of synergy and spasticity continues to decline.
Brun 5
Individual jointmovements become possible and coordination approaches
normal
Brun 6
What does Brun stages tell therapists?
Where the stroke survivor is in the recovery process
Environment drives motor development Utilization of the environment impacts
Behaviorist/cognitive theory
Spinal cord guru and Nobel Prize winnerRecriprocal lnnervation
Sherrington laws
Lead to Brun and NDT
Hierarchal model
Multiple systems interact to produce movement based on a specific taskThe “why” of movement
Individual + task within environment
Dynamic systems theory (mid 80s)
Three tenets to how the brain organizes and develops:
basic connections, Trial and Error, Expansion.
Brain is adaptable to change.
Neuronal group selection theory
Information to carry out the motor taskis contained in initial instructions; movements runs
w/o influence of peripheral feedback or error
detection processes
Open loop
Employs feedback and a reference for
correctness to compute error and initiate subsequent corrections relative to initial instructions issue
Closed loop
Based on principles and componentsof normal development and movement
Bobath (NDT)
In normal movement the brain registers the entire movementnot individual component parts
PNF
Uses diagonal movement pattern and core techniques
PNF
• Facilitate progress of movement from reflexive to volitional
Brun
Appropriate sensory stimulation can elicit specific motorresponses
Food
Degree of performance is dependent on theamount of practice
Motor learning
Includes MCIT and functional task oriented training
Motor learning
Normalize muscle tone
Inhibit primitive reflexes
Facilitate normal postural reactions
Treatment should be developmental
Principles of tx for NDT
Handling
Weight bearing over affected limb
Utilize positions that allow use of the affected limbsAvoidance of sensory input that affect muscle tone
NDT techniques
Mass muscle patterns that are spiral or diagonal in nature and mimic movement in functional activities
PNF
Multi-sensory approach (tactile, auditory and visual inputs
PNF
PNF patterns are named for the ? Joint when motion is completed
proximal
What’s more effective than PNF on gait?
Treadmill
What’s more effective than PNF on hand?
NMES
In what program is PNF effective?
Home structured program inclusive
When the CNS is injured, as in stroke, an individual goes through an “evolution in reverse”
Brun
Appropriate sensory stimulation can elicit specific motor responses
Food
- Normalized Tone is a prerequisite to movement
- Flexion and extension patterns affect one another
- Movement is directed toward functional goals
- Repetition Necessary for motor learning
Basic principles of rood
Passive in nature, short, unpredictable, NO evidence
Limits of Rood
Use random and variable practice within naturalcontexts in treatment
Motor learning
Provide decreasing amounts of physical guidanceand verbal feedback
Motor learning
Develop task analysis and problem-solving skills ofpatients so that they can find their own solutions
to problems in their environment
Motor learning
4 variables that affect the motor learning process
1 - stages of learning
2- sensory conditions
3- feedback
4 - practice schedule
Important factor in reinforcing motor-skill acquisition
Feedback
2 types of feedback
Intrinsic
Extrinsic
Info from sensory systems either during or after mvmt
Intrinsic feedback
Info from external source; supplements intrinsic
Extrinsic feedback
Establish normal motor development and function And or
Prevent contractures and deformities.
Initial goal of NDT
What kind of framework was used for NDT?
Normal developmental sequence
Given by therapist to provide information on how toimprove their subsequent performance
Transitional info
Provided as task is being performed
Concurrent feedback
6 timings of feedback
Concurrent Terminal Bandwidth Summary Delayed Faded
Given only when performance is outside range of error
Bandwidth feedback
Provided when task is completed
Terminal feedback
Given after a set # of trials
Summary feedback
Given very frequently at first then less
Faded feedback
Given after a time delay
Delayed feedback
2 types of practice sessions
Massed
Distributed
More practice, less rest; may lead to fatigue
Massed practice
session in which the
amount of rest between
trials equals or is greaterthan the amount of time for a trial
Distributed practice
beneficial: if decreased motivation - less attention span - less concentration or motor planning deficit (dyspraxia)
Distributed practice
2 types of practice
Constant
Variable
Practice organized around one task -performed repeatedly
Constant practice
Practice of several variations of the same task/same category of movements
Variable practice
3 types of task order
Blockers
Random
Serial
Repeated practice of a task
Blocked order
Non repeating and non predictable order
Random order
Predictable order of tasks in sequence
Serial order
2 types of tasks
Whole vs part
Practicing the task in its entirety
Whole task
Task broken down into its components and then practiced
Part task
skill can be demonstrated after a period of no practice; variety of intervals
Retention
acquired capability to adapt the skill to
permit performance of other similar related tasks
Generalizability
