Evidence for Rehab Interventions for TBI Flashcards
Divisions of Movment
Planned vs Automatic
Divisions of Movement:
Planned (Conscious)
Reaching
Pushing
Pulling
Lifting
Sorting
Kicking
Stairs
Inclines
Avoiding Objects / Maneuvers
Divisions of Movement:
Automatic (Unconscious)
Visual or Auditory Orientation
Superior and Inferior Colliculus
Static Standing/Sitting
Balance Reactions and Falls
Sit to Stand
Gait (to some extent)
Motor System Cortexes
- Posterior Cortex
- Prefrontal Cortex
- Premotor Cortex
- Motor Cortex
Motor System:
1. Posterior Cortex
Provides Sensory informaiton to the Frontal Cortex
Motor System:
2. Prefrontal Cortex
Plans movements
Motor System:
3. Premotor Cortex
Organizes movement sequences
Motor System:
4. Motor Cortex
Produces specific movements
Motor System:
Corticospinal Tract
The final common pathway
No synapses occur until AHC
Posterior Parietal Cortex
Sensory association area and intermodal integration of incoming sensory inforomation
What is the Posterior Parietal Cortex used for?
The area for PLANNED movement
Posterior Parietal Cortex:
Initiation
The initiation of planned movements comes from the Environment
Vision from Occiput to Front Eye Fields
Auditory Cortex
Somatosensory Cortex
Where do you begin with a Severe TBI?
Begin with Visual Attention
(Superior Colliclulus)
Superior Colliculus (TBI)
Superior Colliculus is in the Brain Stem and helps the brian respond to environmental stimulation
It makes motor responses to turn towards stimuli
Mediates conscious awareness
Decision making
What happens with a Superior Colliculus Injury?
Injury due to damage to the Axons (DAI)
Difficulty with scanning a scene
Impaired ability to quickly react
Spatial orientation is messed up
Advancing Patients
(Automatic to Planned)
Sitting patient up as 1st role in PT (Auto)
-Endurance
-Head/Trunk Righting
-Visual Tracking
-Gestures to guide
Progress into finding objects
-Object recall
-Advance to 2/3 step
Adding the Posterior Parietal Cortex in Treatment
Must have the ability to attend to certain stimuli while ingoring others to live in the community
(Visuospatial Attention)
Visuospatial Attention
Selects the relevant visual and spatial input in the environment for the motor plan
How to engage the Posterior Sensory Cortex
Posterior Sensory Cortex sends goals (Parietal Lobe)
Key to movement is being processed in the Sensory Cortex
Preforntal Cortex
Planning of Movement (Non-Auto)
Goal Orientation and Long Term Consequences
-Sit to stand to perform activity
-Tranfers on different heights and surfaces
-Reaching for different shapes, weights, and sizes
-Presetting hands for efficient grasp
Premotor Cortex:
Mirror Neurons
See a person perform an action is the same as performing the action (neuron fires)
Selection and preparation of the Motor Plan: plans the correct movement
Premotor Cortex:
Complex Movements
Mirror neurons discharge when an animal perforams a goal-directed action and also when it observes someone performing the same action
Premotor Cortex:
Intention
Tuned to activate at the appearance of a cue, before reaching for the object
Learns to select a set of motions based on external stimuli
Mirror Therapy
Dosage:
50 tims a day for 7 days
Increase in active DF by 3 degrees
Supplemental Motor Area (SMA)
10% of Corticospinal tracts originate from the SMA
-Deeply connected to the primary motor cortex
-Connects to the thalamus, cerebellum and basal ganglia
-Complex sequence of movements (bilateral and in-mental rehearsal)
Primary Motor Cortex
Activates 5-100 ms before initiation of the movement
-Encodes the force of the movement
-Encodes the direction of the movement
-Encodes the extent of the movement
-Encodes the speed of the movement
Incorporating Concepts for Treatment
- Choose activities that have meaning or let the patient choose
- Demonstrate the task repeatedly (Mirror Neurons)
- Provide a variety of sensory input (change the height, transfer angle, weight)
Task Demand Circuitry
Activation sends to Premotor Cortex to Primary Motor C
-Corticospinal Tract activated
-Motor Program achieved
-Via muscle spindle to cerebellum
-Cerebellum to Somatosensory Cortex on to the Red Nucelus
Tilt Table Benefits
Engages vestibular, somatosensory, and postural responses
-Prevention of contractures for PF and Hamstrings
-Verticality
-Weight Bearing
-Increase loading for Bone Density
-BP monitoring
Task based Interventions
Gradual Progression (KEY to neuroplasticity)
-Tasks are progressively made more challenging by changing the environment, adding resistance, or increasing the complexity of the movement to match the patient’s progress
Client-Centered Approach
-The specific tasks chosen should be relevant to the patient’s lifestyle and goal
