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Adult Clinical Populations Flashcards

1
Q

what is ankylosing spondylitis?

A
  • inflammatory disease of spine and SI joints
  • early - chronic pain
  • late - new bone/spine segments fuse
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2
Q

what are the spinal changes in ankylosing spondylitis?

A
  • loss of lumbar lordosis
  • increased thoracic kyphosis
  • head protraction
  • loss of spinal flexibility in all planes
  • hip flexion
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3
Q

what is the resulting posture for patients with ankylosing spondylitis?

A
  • forward shift COM
  • lowering COG
  • accommodate knee flexion and PPT to maintain balance
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4
Q

what is the change in SSPC with ankylosing spondylitis?

A
  • COP net displacement greater than controls
  • frontal plane > sagittal plane (*sway more)
  • 50% increase w/ eyes closed (* somatosensory/vestibular issue)
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5
Q

what are the changes in anticipatory and compensatory postural control with ankylosing spondylitis?

A
  • limited postural control data available
  • some data reveals:
    – changes on static and dynamic clinical tools that worsens with disease severity
    – confirms worse performance w/ eyes closed
    – confirms higher incidence of dizziness vs controls
    – impact on dynamic activities such as gait
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6
Q

what are some peripheral and central vestibular disorders?

A

peripheral
- BPPV
- unilateral vestibular hypofunction
- bilateral vestibular hypofunction
central
- stroke
- multiple sclerosis
- brain injury

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7
Q

what are the changes in information processing in vestibular disorders?

A

inaccurate vestibular input
- need to learn to select accurate input and ignore inaccurate input
decreased vestibular input
- need to rely heavily on remaining inputs
– somatosensory
– vision

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8
Q

how do vestibular disorders affect SSPC?

A
  • screen for vestibular dysfunction using clinical test of sensory interaction and balance (CTSIB)
  • inc sway/loss of balance when altering visual and somatosensory input
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9
Q

how do vestibular disorders affect APC?

A
  • dec balance w/ dynamic movements that stimulate vestibular system
  • head turns, bending, turning around, scanning environment
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10
Q

how do vestibular disorders affect RPC?

A
  • use ankle strategy but not hip strategy even when hip strategy is required for postural stability
  • i.e. standing on one foot, narrow beam, or in a heel-toe stance
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11
Q

what is Alzheimer’s disease?

A
  • progressive disease process typically causing dementia
  • characterized by slow decline/change in:
    – memory
    – language
    – visuospatial skills
    – personality
    – cognition
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12
Q

what is the pathophysiology of Alzheimer’s disease?

A
  • breakdown in processes necessary to sustain brain cells
  • neuropathologic hallmarks
    – amyloid plaques
    – neurofibrally tangles
  • loss of neurons and synapses in cerebral cortex and subcortical regions –> atrophy
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13
Q

what are the changes in information processing in Alzheimer’s disease?

A
  • slower reaction times
  • impaired choice reaction time (dec focused attention)
  • dec ability to use advanced cues to anticipate
  • dec ability to inhibit non-regulatory stimuli
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14
Q

what are the changes in attention in Alzheimer’s disease?

A
  • poor selective and divided attention
  • dec performance on dual tasks
    – no training improvement
    – associated w/ risk of falls
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15
Q

what are the changes in SSPC and APC in Alzheimer’s disease?

A
  • SSPC
    – dec control of sway
  • dec performance w/ eyes closed
  • APC
    – reduced limits of stability and functional reach
    – postural instability associated w/ dual task activity
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16
Q

what are the changes in memory in Alzheimer’s disease?

A
  • early impairments in
    – working memory
    – episodic memory
    – semantic memory
  • relative sparing of
    – procedural memory
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17
Q

what are the appropriate strategies to use for motor learning for Alzheimer’s disease?

A

both implicit and explicit learning strategies can be used but reduced learning
- repeated practice (implicit)
- observational and guided learning (explicit)
– observational learning (demonstration) better than guided learning
– mental effort
– errorless learning (* learn mistakes if practiced, don’t learn from mistakes –> don’t correct)

practice should be constant, specific to task, and avoiding random with visual feedback being key

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18
Q

what is stroke?

A
  • disruption of blood flow to area of CNS
  • functional implications dependent upon brain regions involved:
    – sensation
    – motor
    – cognition
    – speech/language
    – vision
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19
Q

what are the changes in information processing with stroke?

A

decreased sensory input
- homonymous hemianopia
- vestibular (brainstem)
- somatosensory loss associated with loss of function/prognosis

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20
Q

what are the changes in attention in stroke?

A
  • R hemisphere lesions (frontoparietal)
    – hemineglect/extinction
    – dec ability to sustain, divide, and shift attention
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21
Q

what are the changes in motor control associated with stroke?

A
  • tone – spasticity (UMN)
  • abnormal synergies
    – massed patterns of movement
    – unable to selectively activate individual muscles
    – results from increased recruitment of brainstem pathways
    – typically UE flx>ext, LE ext>flx
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22
Q

what are the issues in SSPC in stroke?

A
  • impairments in sitting and standing
  • asymmetrical alignment
  • increased and asymmetrical swag
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23
Q

what are the issues in APC in stroke?

A
  • lesions to many areas can impair APC
    – motor cortex, basal ganglia, cerebellum
  • delayed and reduced muscle activity in trunk on affected side
  • external trunk support can improve performance
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24
Q

what are the changes in RPC in stroke?

A
  • in-place strategies:
    – impaired sequencing, timing, and amplitude in paretic limb in response to perturbation
    – compensate for delays in distal muscles of paretic limb w/ early proximal activation of non-paretic limb
  • stepping strategies:
    – similar time to foot off paretic vs non-paretic, however different pattern based on asymmetrical load
    – delayed in non-paretic, but not paretic stepping are associated w/ falls
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25
Q

what are the changes in memory with stroke?

A
  • dependent upon lesion location
  • possible impairments:
    – dec STM
    – dec LTM
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26
Q

what are the changes in motor learning with stroke?

A
  • explicit learning impaired with medial temporal lobe damage
  • implicit learning distributed b/n brain structures so that no single lesion completely eliminates
  • ideal practice conditions depend upon type of stroke
    – MCA and basal ganglia stroke: explicit instruction dec learning
    – cerebellar stroke: explicit instruction inc learning
  • learned non-use
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27
Q

what is Parkinson’s disease?

A
  • progressive disorder of CNS
  • loss of dopamine producing neurons in substatia nigra of the basal ganglia
  • hypokinetic movement disorder
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28
Q

what are the changes in information processing in Parkinson’s disease?

A
  • difficulty adapting to sudden environmental changes
  • difficulty organizing and selecting sensory information
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29
Q

what are the changes in attention in Parkinson’s disease?

A
  • difficulty selecting what sensory cues to attend to
  • benefit from attentional curing
  • dec performance under dual task conditions relative to control subjects
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30
Q

what are the changes in motor control with Parkinson’s disease?

A
  • bradykinesia - slow movement time
  • hypokinesia - dec movement amplitude
  • akinesia - dec movement initiation
  • rigidity
    -tremor
  • secondary impairments:
    – dec ROM (flexors)
    – weakening (extensors)
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31
Q

what are the changes in SSPC with Parkinson’s disease?

A
  • alignment
    – stooped posture
  • swag
    – inc sway area and velocity
    – medication/DBS dec sway (conflicting evidence if meds induce dyskinesia)
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32
Q

what are the changes in APC in Parkinson’s disease?

A
  • smaller anticipatory adjustments
  • dec velocity
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33
Q

what are the changes in RPC in Parkinson’s disease?

A
  • in place responses
    – abnormal co-contraction of hip and knee musculature
    – dec adaptation of postural strategies to environmental and task demands
  • stepping strategies
    – dec weight shift prior to stepping
    – slower to initiate step
    – multiple small steps to recover balance
    – inc risk of falls
34
Q

what are the changes in memory in Parkinson’s disease?

A
  • working memory
    – dec relative to controls
    – worsens w/ disease progression
    – improves w/ dopamine
  • long term
    – dec encoding
    – dec retrieval
35
Q

what are the changes in motor learning with Parkinson’s disease?

A
  • slower rate of learning
  • worsens w/ disease progression
  • difficulty learning sequential tasks
  • blocked practice improved acquisition and retention
  • external focus of attention improves performance and motor learning
  • cueing (auditory or visual) can improve performance
36
Q

what are some causes of cerebellar pathology?

A
  • multiple sclerosis
  • stroke
  • tumor
  • brain injury
  • cerebral palsy
  • neurodegenerative conditions
  • genetic conditions
  • alcohol abuse
37
Q

what are the changes in information processing with cerebellar pathology?

A
  • dec ability to subconsciously compare sensory information to intended motor output
  • dec ability to subconsciously respond to sensory feedback
  • slower to respond to unexpected sensory info
38
Q

what are the changes in attention with cerebellar pathology?

A
  • must rely more on conscious, attention demanding pathways for movement adaptation
  • performance may deteriorate with demands on attention
    – dual task, fatigue, distraction
39
Q

what are the changes in motor control with cerebellar pathology?

A
  • hypotonia
  • dec coordination/ataxia
    – impaired timing and grading of muscles contractions: dysmetria, dysdiadochokinesia, decomposition of movement, “rebound” phenomenon
  • intention tremor
  • improved control of isolated joint vs multipoint movement (not fluid; would move shoulder then elbow then wrist to pick up a cup for example)
40
Q

what are the changes in SSPC in cerebellar pathology?

A
  • inc postural sway
  • direction of sway linked to lesion location
  • wide BOS
    – sway inc as BOS dec
  • vision/somatosensory input dec sway
41
Q

what are the changes in APC with cerebellar pathology?

A
  • able to demonstrate anticipatory adjustments but:
    – abnormal timing
    – mismatched scaling
  • dec ability to develop new anticipatory postural adjustments for novel tasks
42
Q

what are the changes in RPC in cerebellar pathology?

A
  • in place responses
    – dec ability to grade force of output to match perturbation
    – hypermetric postural response (larger amplitude and longer duration)
  • excessive compensatory sway opposite direction (body oscillations)
  • stepping responses
    – able to demonstrate stepping responses
    – may require more than one step (* bc misplaced foot and are fixing it)
43
Q

what are the changes in memory with cerebellar pathology?

A
  • dec verbal working memory
  • dec flexibility in previously acquired procedural memories
  • dec consolidation of new procedural memories
44
Q

what are the changes in motor learning with cerebellar pathology?

A

-cerebellum plays essential role in error correction
– practice dependent motor adaptation and learning

damage to cerebellum
– dec extent and rate of -adaptation of movement
–dec error based learning
– declarative learning intact
– limited ability to consolidate new skills (dec automaticity)

45
Q

what practice and feedback strategies should be used for motor learning with cerebellar pathology

A

practice
- avoid trial and error learning
- stepwise movement repetition with verbal prompts to ensure conscious awareness
- require longer duration, inc repetitions, inc intensity
- massed
- less retention

feedback
- respond well to verbal cues to direct attention
- teach pts to consciously attend to movement
- providing KP and/or KR assists w/ error detection
- intermittent better than constant

46
Q

what is Huntingtons disease?

A
  • hyperkinetic disorder of the basal ganglia
  • clinical sx:
    – progressive movement disorder
    – cognitive deficits
    – behavioral changes
47
Q

what are the changes in information processing with Huntingtons disease?

A
  • slow response times
  • difficulty selecting between relevant and irrelevant stimuli
  • problems w/ visuospatial awareness
  • difficulty inhibiting inappropriate responses
  • difficulty anticipating due to overestimating abilities
48
Q

what are the changes to memory in Huntingtons disease?

A
  • dec ability to shift attention
  • dec ability to concentrate on more than one task
49
Q

what are the changes in motor control with Huntingtons disease?

A
  • hypotonia
  • chorea
    – irregular, rapid, jerky, involuntary movements
  • overtime
    – weakness
    – decreased ROM
  • step length discrepancies and inconstancies
50
Q

what are the changes in APC in Huntingtons disease?

A
  • 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
  • may score very low on balance measures, but do not experience falls at as high a rate as typical older adults w/ similar scores
51
Q

what are the memory changes in Huntingtons disease?

A
  • difficulty retrieving memories
    – applies to both distant and recent memories
52
Q

what are the changes in motor learning in Huntingtons disease?

A
  • better w/ part practice
  • need inc guidance to put the [arts together
  • avoid distractions and dual task
53
Q

what are spinal cord injuries?

A
  • can be categorized as
    – traumatic v nontraumatic
    – complete vs incomplete
    – tetraplegia vs paraplegia
  • results in:
    – reduced or absent sensory info from below the level of lesion
  • reduced or absent motor signals to the muscles activated below the level of the lesion
54
Q

what are the changes in motor control in spinal cord injury and how do compensatory movements come into play?

A
  • motor control
    – motor impairments
    – spasticity
    – sensory impairments
    – multiple systems impacted (respiratory, cardiovascular)
  • compensatory movements
    – skills are achieved using very different motor control strategies
    – use head to move hips instead of core
    – rely on momentum
    – muscle substitution
    – task modification
55
Q

what are the changes in SSPC with spinal cord injury?

A
  • inc sway in sitting
  • higher lesions demonstrate more and faster sway
  • unsupported sitting was motor unstable in comparison to supported sitting posture, especially in the A-P direction
56
Q

what are the changes in APC in spinal cord injury?

A
  • compensatory strategies
    – lack core muscle activation
    – counterbalance to maintain COM within BOS
  • dec LOS
57
Q

what are the changes in RPC with spinal cord injury?

A
  • use different reactive strategies
  • protective reaching vs stepping
58
Q

what are the changes in information processing with spinal cord injury?

A
  • limited somatosensory input
  • must rely more heavily on vision and vestibular inputs
59
Q

what are the changes in attention in spinal cord injury?

A
  • require more attention to maintain postural control
  • negatively impacts dual task ability
  • potential to improve with practice
60
Q

what are the changes in motor learning with spinal cord injury?

A
  • early extrinsic feedback progressing to faded
  • later intrinsic feedback to facilitate independence
  • part to whole practice
  • variability enhances adaptability of skills
  • random practice beneficial to learning
61
Q

what are the changes in memory with spinal cord injury?

A
  • may co-exist with brain injury due to trauma, but no direct memory impairment due to SCI
62
Q

what is concussion?

A

mild TBIs that can result in difficulties related to:
- headaches
- concentration
- memory
- balance
- coordination

63
Q

what are the changes in information processing with concussion?

A
  • sx post concussion may include
    – dizziness
    – noise/light sensitivity
    – blurred/double vision
  • impaired sensory integration
  • delayed speed of info processing
64
Q

what are the changes in postural control and what tools can be used to measure them?

A
  • SSPC
    – acute inc sway
    – related to sensory integration problems (visual, vestibular)
  • APC
    – dec anticipatory postural adjustments prior to gait initiation
  • RPC
    – inc latency of reactive balance responses
  • measurement tools
    – balance error scoring system (BESS)
    – sensory organization test (SOT)
  • instrumentation
65
Q

what is the BESS?

A
  • count # of errors in each 20 sec trial
  • error:
    – 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
  • max 10 errors per condition
66
Q

what are the changes in attention with concussion?

A
  • difficulty dividing attention
  • deficits persist for up to 2 months post injury
67
Q

what are the changes in memory with concussion?

A
  • working memory
    – dec accuracy
    – dec verbal fluency
68
Q

what are the changes in motor learning with concussion?

A
  • both recall and new task acquisition
  • attempts at learning can prolong recovery
    – cognitive rest
69
Q

how can traumatic brain injury present?

A

motor, sensory, cognitive behavioral, communication

70
Q

what are the changes in motor control in traumatic brain injury?

A
  • weakness (UMN)
    – spasticity
  • ataxia
  • CN function
  • ROM
  • motor planning deficits
71
Q

what are the changes in postural control with traumatic brain injury?

A
  • SSPC
    – inc sway
    – asymmetrical WBing
  • APC
    – high incidence of vestibular dysfunction
  • RPC
    – studies limited
72
Q

what are the changes in information processing with traumatic brain injury?

A
  • may have reduced sensory input
  • dec executive functions (prefrontal cortex)
  • large dec in processing speed –> rxn time
73
Q

what are the changes in attention with traumatic brain injury?

A
  • deficits in:
    – selective attention
    – sustained attention
74
Q

what are the changes in memory with traumatic brain injury?

A
  • post-traumatic amnesia is common
    – ranges from minutes to weeks (in rare cases months)
  • deficits in working memory associated with:
    – frontal lobe damage
    – impaired executive functions
    – impaired info processing
75
Q

what are the strategies for practice and feedback for traumatic brain injury?

A
  • practice
    – distributed with frequent rests to avoid mental fatigue
    – blocked for initial learning progressing to random
  • feedback
    – explicit/augmented feedback may be beneficial early due to sensory, perceptual, and cognitive impairments
    – avoid overwhelming w/ feedback
  • evidence supports both video self-modeling and self-generation may support learning
76
Q

what is multiple sclerosis?

A
  • immune-mediated disease that causes demyelination and degeneration within the CNS
  • lesions in multiple areas at multiple times
  • sx can vary by lesion location and can include sensory, cognitive, and motor
77
Q

what are the changes in motor control with multiple sclerosis?

A
  • may present with any or all of the following:
    – weakness/paralysis
    – spasticity
    – incoordination/ataxia
    – loss of ROM
78
Q

what are the changes in postural control with multiple sclerosis?

A
  • reduced LOS
  • slow activation of postural muscles
    – slow conduction (sensory and motor)
    – slow initiation of anticipatory postural adjustments
    – slow RPC
  • difficulty under varying/reduced sensory conditions
79
Q

what are the changes in information processing with multiple sclerosis?

A
  • sensory deficits are common
  • slow conduction speeds may increase response time
80
Q

what are the changes in attention, memory, and motor learning in multiple sclerosis?

A

deficits highly dependent on lesion location

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