Evidence for Rehab Interventions for TBI

Question 1

Divisions of Movment

Answer 1

Planned vs Automatic

Question 2

Divisions of Movement:
Planned (Conscious)

Answer 2

Reaching
Pushing
Pulling
Lifting
Sorting
Kicking
Stairs
Inclines
Avoiding Objects / Maneuvers

Question 3

Divisions of Movement:
Automatic (Unconscious)

Answer 3

Visual or Auditory Orientation
Superior and Inferior Colliculus
Static Standing/Sitting
Balance Reactions and Falls
Sit to Stand
Gait (to some extent)

Question 4

Motor System Cortexes

Answer 4

1. Posterior Cortex
2. Prefrontal Cortex
3. Premotor Cortex
4. Motor Cortex

Question 5

Motor System:
1. Posterior Cortex

Answer 5

Provides Sensory informaiton to the Frontal Cortex

Question 6

Motor System:
2. Prefrontal Cortex

Answer 6

Plans movements

Question 7

Motor System:
3. Premotor Cortex

Answer 7

Organizes movement sequences

Question 8

Motor System:
4. Motor Cortex

Answer 8

Produces specific movements

Question 9

Motor System:
Corticospinal Tract

Answer 9

The final common pathway

No synapses occur until AHC

Question 10

Posterior Parietal Cortex

Answer 10

Sensory association area and intermodal integration of incoming sensory inforomation

Question 11

What is the Posterior Parietal Cortex used for?

Answer 11

The area for PLANNED movement

Question 12

Posterior Parietal Cortex:
Initiation

Answer 12

The initiation of planned movements comes from the Environment

Vision from Occiput to Front Eye Fields
Auditory Cortex
Somatosensory Cortex

Question 13

Where do you begin with a Severe TBI?

Answer 13

Begin with Visual Attention
(Superior Colliclulus)

Question 14

Superior Colliculus (TBI)

Answer 14

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

Question 15

What happens with a Superior Colliculus Injury?

Answer 15

Injury due to damage to the Axons (DAI)

Difficulty with scanning a scene
Impaired ability to quickly react
Spatial orientation is messed up

Question 16

Advancing Patients
(Automatic to Planned)

Answer 16

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

Question 17

Adding the Posterior Parietal Cortex in Treatment

Answer 17

Must have the ability to attend to certain stimuli while ingoring others to live in the community

(Visuospatial Attention)

Question 18

Visuospatial Attention

Answer 18

Selects the relevant visual and spatial input in the environment for the motor plan

Question 19

How to engage the Posterior Sensory Cortex

Answer 19

Posterior Sensory Cortex sends goals (Parietal Lobe)

Key to movement is being processed in the Sensory Cortex

Question 20

Preforntal Cortex

Answer 20

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

Question 21

Premotor Cortex:
Mirror Neurons

Answer 21

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

Question 22

Premotor Cortex:
Complex Movements

Answer 22

Mirror neurons discharge when an animal perforams a goal-directed action and also when it observes someone performing the same action

Question 23

Premotor Cortex:
Intention

Answer 23

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

Question 24

Mirror Therapy

Answer 24

Dosage:
50 tims a day for 7 days
Increase in active DF by 3 degrees

Question 25

Supplemental Motor Area (SMA)

Answer 25

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)

Question 26

Primary Motor Cortex

Answer 26

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

Question 27

Incorporating Concepts for Treatment

Answer 27

1. Choose activities that have meaning or let the patient choose 2. Demonstrate the task repeatedly (Mirror Neurons) 3. Provide a variety of sensory input (change the height, transfer angle, weight)

Question 28

Task Demand Circuitry

Answer 28

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

Question 29

Tilt Table Benefits

Answer 29

Engages vestibular, somatosensory, and postural responses -Prevention of contractures for PF and Hamstrings -Verticality -Weight Bearing -Increase loading for Bone Density -BP monitoring

Question 30

Task based Interventions

Answer 30

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