Exam 1 Flashcards
1
Q
What is neuroplasticity?
A
The brains ability to reorganize itself by forming new neural connections
-in response to training and practice
-to compensate for injury or disease
2
Q
What are four ways the brain can create neuroplasticity?
A
-Neurogenesis
-New synapses
-Strengthened synapses
-Weakened synapses (negative neuroplasticity)
3
Q
What is neurogenesis?
A
The continuous generation of new neurons in certain brain regions
4
Q
What creates new synapses?
A
New skills and experiences create new neural connections
5
Q
How are synapses strengthened?
A
Repetition and practice strengthens neural connections
6
Q
How are synapses weakened?
A
Connections in the brain that are not used become weak
7
Q
When can neuroplasticity take place?
A
When changes occur in:
-Characteristics of dendritic spines
-Properties of membrane and ion channels
-Hormonal activity
-Microglia activity
-DNA regulation and transcription
-Neurotransmitters
8
Q
What does neuroplasticity based motor learning include?
A
-Repetition
-Neuroadaptive: task parameters continuously modified
-Attentionally engaging: task difficulty continuously adjusted
-Rewarding
9
Q
What are the principles of task specific intervention?
A
-Requires extensive practice of a specific task
-Emphasizes functional mobility tasks
-Practice
-Adapt treatments by changing the task and environmental conditions
-Vary the level of difficulty
10
Q
What are examples of task specific training?
A
-Sit to stand
-Opening a door
-Kicking a ball
11
Q
What is motor control?
A
It is defined as the ability to regulate the mechanisms essential to movement
12
Q
What is a motor skill?
A
Skills that require body, head, and limb movements to achieve a goal
13
Q
What is performance?
A
Behavioral act of executing a skill at a specific time and in a specific situation
14
Q
What is motor learning?
A
Motor learning is the acquisition of skills necessary to plan and execute a desired movement pattern for a given task
15
Q
What is open loop movement instructions?
A
-Does not use feedback
-Control center provides all the information for effectors to carry out movement
-Does not use feedback to continue and terminate movement
16
Q
What is closed loop movement instructions?
A
-Uses feedback
-Control center issues information to effectors sufficient only to initiate movement
-Relies on feedback to continue and terminate movement
17
Q
What are the three stages of motor learning?
A
-Cognitive stage
-Associative stage
-Autonomous stage
18
Q
What is the cognitive stage of motor learning?
A
-“What to do”
-Understanding the task and developing strategies
-large amount of attention
19
Q
What is the associative stage of motor learning?
A
-“How to do”
-Selected the best strategy for the task and refines skill
-Some attention still required
20
Q
What is the autonomous stage of motor learning?
A
-“How to succeed”
-Automaticity in the skill
-Low degree of attention required
21
Q
What are the characteristics for promoting motor learning and transfer?
A
-Individual
-Task
-Environment
22
Q
What are different aspects of task in motor learning and transfer?
A
-Elements
-Attributes
-Goals/nature
-Mobility
-Skill
-Stability
23
Q
What are different aspects of individual in motor learning and transfer?
A
-Cognition
-Sensation/perception
-Motor function
-Impairments
-Comorbidities/complications
-Overall health status
24
Q
What are different aspects of environment in motor learning and transfer?
A
-Physical features
-Regulatory
-Non-regulatory
-Social resources
25
What is the framework of current neurorehabilitation interventions?
-First level: restorative interventions
-Second level: functional training
-Final level: compensatory interventions
26
What are the key variables in motor learning?
-Practice and repetition
-Performance feedback
-Generalizability and variability
-Diverse activities in varied contexts
27
What are the different types of practice and practice parameters?
-Massed vs distributed practice
-Constant vs variable practice
-Blocked vs random
-Whole vs part
-Guidance vs discovery
-Transfer of learning
-Mental practice
28
What is blocked practice?
Practicing a skill repetitively during a session
29
What is random practice?
Practicing various skills rather than concentrating on the acquisition of a single skill during a practice session
30
What are the different types of performance feedback?
-Intrinsic/extrinsic
-Knowledge of results
-Knowledge of performance
31
What are types of external feedback?
-Demonstration
-Visual feedback
-Tactile feedback
-Verbal feedback
-Auditory feedback
-Biofeedback
-Neurofeedback
32
What is knowledge of results (KR)?
Information about the outcome of a movement
33
What is knowledge of performance (KP)?
Information about the characteristics of movement
34
What is involved in generalizability and variability?
-Different settings
-Different surfaces
-Different assist
-Different time of the day
35
What is involved in diverse activities in varied contexts?
-Blocked vs random practice
-Task changing weight, object, position, surface, location, etc.
-varied environments
36
What are evidence based interventions for motor learning?
-Magnetic stimulation
-Forced use
-Constraint induced therapy
-Virtual reality
-Body weight supported treadmill training
-Wearable robotics
37
What is transcranial magnetic stimulation (TMS)?
-Electromagnetic coil is held against the head and short electromagnetic pulses which cause depolarization of the neurons in the brain are administered through the coil
-The magnetic pulse passes through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region
38
What is postural control?
Controlling body position in space to maintain:
-Dynamic stability
-Orientation
39
What is balance?
Ability to maintain projected COM within the limits of BOS
40
What is involved in the postural control system?
-MSK system
-Neuromuscular synergies
-Sensory systems
-Sensory strategies
-Anticipatory mechanisms
-Adaptive mechanisms
-Eye-head coordination
41
What do we need for balance with the MSK system?
-ROM
-Tone/strength
-Postural tone
-Postural alignment
42
What do we need for balance with the neuromuscular synergies?
-Ankle strategy
-Hip strategy
-Stepping strategy
-Mediolateral control
43
What are adaptive mechanisms?
-Ankle strategy
-Hip strategy
-Stepping strategy
44
What are abnormal eye movements associated with balance?
-Nystagmus
-Abnormal saccade
-Diploplia
45
What sensory systems are involved in balance?
-Visual input
-Somatosensory input
-Vestibular input
46
What is anticipatory control?
The patient's ability to prepare for anticipated displacements based on prior experience, anticipation, practice, and knowledge of physical constraints
47
What should be included in a balance assessment?
-A standardized functional measure of skills requiring postural control
-Assessment of sensory inputs
-Assessment of balance strategies
-Tests for underlying impairments of sensory, motor, and cognitive systems
48
What are some examples of balance assessments?
-Functional reach
-Tinetti
-POMA
-Berg balance scale
-TUG
-CTSIB
49
What are indications for balance training?
-Vestibular inner ear disorders
-Neurological problems
-Orthopedic injuries and procedures
-Decreased strength and flexibility
-Medications
-Self-confidence
50
What semicircular canals are there?
-Anterior
-Posterior
-Horizontal
51
What are the otolith organs?
-Saccule
-Utricle
52
What is benign paroxysmal positional nystagmus/vertigo (BPPN/V)?
-Most common disorder resulting in dizziness in older population
-Mechanical disorder caused by otoconia displaced from the macula of the utricle
53
What are the symptoms of BPPV?
-Vertigo
-Nausea
-Nystagmus
54
What are the types of BPPV?
-Cupulolithiasis
-Canalithiasis
55
How are the vertical canals assessed for BPPV?
Loaded Dix Hallpike
56
What is the most common treatment for vertical canal BPPV?
Epley maneuver
57
What is the most common test for horizontal canal BPPV?
Supine roll test
58
What is the most common treatment for horizontal canal BPPV?
Barbecue roll
59
What is the most common treatment for cupulolithiasis?
Semont maneuver
60
What maneuver can be added to the HEP for someone with posterior canal BPPV?
Brandt-Daroff exercise
61
What are signs and symptoms of central vestibular disorder?
-Ataxia
-Abnormal smooth pursuit
-Usually no hearing loss
-Diploplia
-Altered consciousness
-Lateropulsion
-Nystagmus: pure vertical
62
What are signs and symptoms of peripheral vestibular disorder?
-Mild ataxia
-Normal smooth pursuit
-Hearing loss
-Fullness in ears
-Tinnitus
-Signs of acute vertigo
-Nystagmus: up or down beating and torsional
63
What is included in the oculomotor exam?
-Smooth pursuit
-Saccade
-Observe nystagmus
-VOR
64
What does an impaired VOR look like?
-Head movement/velocity and eye movement does not match
-Retinal slip: pt's complain of decreased visual acuity and blurry vision
65
What is a retinal slip?
The eyes lag behind causing blurry vision with head or eye movement
66
What is included in the vestibular exam?
-History: signs and symptoms
-Oculomotor exam
-VOR
-CTSIB or mCTSIB
67
What are the signs and symptoms of unilateral vestibular hypofunction?
-Impairment of balance system in inner ear
-Peripheral vestibular system not working in one ear
-Dizziness or vertigo
-Poor balance, especially with head turns
-Blurred vision, especially when turning head quickly
-Nausea
-Trouble walking, especially outdoors
68
What are signs and symptoms of bilateral vestibular hypofunction?
-Ototoxicity
-Oscillopsia: visual blurring with head movements
-Disequilibrium
-No nausea
-Gait ataxia
69
What is otitis media?
Infection of the middle ear causing fever and ear pain
70
What is ototoxicity?
Ear poisoning caused by drugs
71
What are general principles for vestibular rehabilitation?
-Intervention should begin ASAP
-Adaptation enhanced when exercise is specific to individual
-Exercises should be brief but repeated throughout the day
-Exercises may increase symptoms
-Typically 6 weeks of rehab
-Patient education
72
What are interventions for UVH?
-Gaze stabilization exercises
-VOR x 1
-VOR x 2
-Whole body with head movements
73
What are interventions for BVH?
-Gaze stabilization
74
What is Meniere's Disease? What are signs and symptoms?
-Recurrent and usually progressive vestibular disease
-Tinnitus
-Deafness
-Sensation of fullness in the ear
-Vertigo
75
What is an acoustic neuroma? What are signs and symptoms?
-Tumor on vestibular nerve leading from inner ear to brain
-Hearing loss on one side
-Tinnitus in affected ear
-Unsteadiness
-Loss of balance
-Dizziness
-Facial numbness
76
What is the function of the basal ganglia?
-Assists motor cortex in running well learned motor skills via output to the supplemental motor cortex and premotor cortex
-Allows skilled movements to run with minimal attentional requirements
77
What occurs with a defective basal ganglia?
-Degrades the programmed control of movement
-Creates difficulty with well learned complex tasks
-Slows adapting response in changing environment
-Decreased amplitude of movement
-Difficulty switching from one task to another
-Imprecise release of sub-movements
-Inaccurate terminations
78
What are the cardinal signs of Parkinson's Disease?
TRAP
-Tremors
-Rigidity
-Akinesia, bradykinesia
-Postural instability
79
What is the presentation of akinesia or bradykinesia in PD?
-Hesitation
-Slow movement
-Impaired repetitive movement
-Freezing
-Diminished arm swing
-Facial masking
80
What are signs and symptoms of PD?
-Akinesia
-Bradykinesia
-Rigidity
-Tremor
-Slow, shuffling, and festinating gait
-Monotone speech and decreased volume
81
What is gait festination?
Involuntary shortening of steps and hastening of cadence part way through a task
82
What are non-motor symptoms of PD?
-Orthostatic hypotension
-Autonomic dysfunction
-Sensory symptoms
-Seborrhea, edema, fatigue
-Behavioral abnormalities: depression, personality changes, sleep disturbance, etc.
83
What should be included in a PD eval?
-Functional status
-H & Y scale
-Standardized tests/outcome measures
-Pain
-Mobility
-Gait
-Postural assessment
-RAM
-Cognitive status
84
What are the Hoehn and Yahr Stages of PD?
Stages 0-5
85
What is Stage 1 on the H & Y scale?
Symptoms on only one side of the body
86
What is Stage 2 on the H & Y scale?
Symptoms on both sides of the body and no difficulty walking
87
What is Stage 3 on the H & Y scale?
Symptoms on both side of the body and minimal difficulty walking
88
What is Stage 4 on the H & Y scale?
Symptoms on both sides of the body and moderate difficulty walking
89
What is Stage 5 on the H & Y scale?
Symptoms on both side of the body and unable to walk (wheelchair dependent)
90
What are the 3 key elements of PT treatment of PD?
-Teach ability to move with ease and postural stability strategies
-Management of secondary problems
-Promote physical activities and fall prevention
91
What does strategy training-compensation involve?
-Breaking down long or complex sequences into component parts
-Focused attention
-Performing each task separately
-Performing one task at a time
-Mental rehearsal & visualization
92
What are external cues that can be used with PD?
-Visual
-Auditory
93
What are some examples of visual cues for PD?
-Mirror
-Lines on floor
94
What are some examples of auditory cues for PD?
-Metronome
-Steady beat music
95
What are some strategies to avoid freezing?
-Rhythmical sensory cueing
-Relaxation
-Stop, pause, restart task
-Avoid complex, long sequenced movement
-Cognitive compensation
-Stairs
96
When should LSVT-BIG be used with PD?
Only when it is applicable to the client
97
Who founded Constraint Induced Movement Therapy (CIMT)?
-Edward Taub
-Steven Wolf
98
What is the theory of learned non-use?
-Early after CVA the pt attempts to use the paretic limb and fails and there is subsequent selective reinforcement of the use of the other limb
-Persists into chronic stage despite spontaneous recovery potential to use the limb
99
What are the two proposed mechanisms of action of CIMT?
-Eliminating learned non-use
-Use-dependent cortical reorganization
100
How does increased motivation affect functioning of the paretic UE or LE?
Increased motivation can increase spontaneous hand use and improved functional ability
101
How does task practice affect functioning of the paretic UE or LE?
-Altered cortical limb representation due to increased use
-This leads to increased spontaneous hand use and improved functional ability
102
What is the traditional CIMT program?
-Pt participates in CIMT 4-6 hours, 5 days/week for 2-3 consecutive weeks
-For UE programs, pt's wear a mitt on their uninvolved UE for 90% of their waking hours during those 2-3 weeks
-For LE programs, the uninvolved LE is not constrained, but activities are focused on increased reliance on the involved LE
103
What is the modified CIMT (mCIMT) program?
-Pt participates in 1-2 hours of PT or OT for 3-5 days/week for 3-4 weeks
-Therapy focuses on CIMT activities
-Pt wears mitt for 5-6 hours during their waking hours
104
What are elements of CIMT?
-Intensive task-oriented training
-Behavioral strategies
-Restriction of the uninvolved extremity
105
What are different types of intensive task-oriented training?
-Task practice
-Shaping
106
What are different behavioral strategies involved in CIMT?
-Bahvioral contract
-Home skill assessment
-Home diary
-Motor activity log (MAL)
107
What are the guidelines for task practice?
-Functionally relevant tasks performed continuously for 15-30 minutes
-Global feedback is provided by the therapist about overall performance
-Challenging task
-Contextually appropriate tasks
108
What are examples of UE task practice activities?
-Grooming
-Brushing teeth
-Folding clothes
-Ironing
-Hammering nails
-Sanding
-Painting
-Vacuuming
-Cutting food
-Eating
109
What are the guidelines for shaping activities?
-Characterized by repetitions of a defined movement in a series of trials
-Functional activities are practiced for a set of 10 timed trials w/ feedback from therapist
-Patients are challenged to increase the # of successful reps or reduce the time it takes to complete the same amount of reps
-Tasks are chosen based on movement goals
-Also called "Adapted Task Practice"
110
What are some examples of UE shaping activities?
-Stack blocks
-Deal playing cards
-Write
-Type
-Tie shoes
-Open door
-Remove jar lids
111
What is massed practice?
-Characterized by practicing a motor skill with relatively little or no rest between repeat performances of the skill
-Amount of practice time is greater than the amount of rest time
112
What are some CIMT LE acticities?
-Cycling
-Aquatics
-Sit to stand
-Stairs
-Walking on uneven surfaces
-Treadmill training
113
What is a behavioral contract for CIMT?
-Signed contract between pt, caregiver, and PT
Pt agrees to:
-Wear mitt 90% of waking hours
-Use involved UE/LE as much as possible
-Perform HEP
-Not wear mitt for safety concerns
Caregiver agrees to:
-Assist with follow through of HEP
-Supervise daily activities when mitt is on
-Remove mitt when patient will be unsupervised
114
What is home skill assignment and practice?
Functional tasks assigned nightly to perform:
-With mitt
-Without mitt
-Only w/ supervision
-With bilateral UE/LE
115
What does a home diary consist of for CIMT?
Pt is asked to write in a diary daily the following:
-List of activities done with involved extremity
-Time of day
-# of trials performed
-How successful the activity was
-Compliance with mitt
-Any other comments
116
What is a motor activity log (MAL) for CIMT?
-Subjective self-report of the amount and quality of use of the involved UE for 30 specified tasks
-Example: open a drawer
117
What should be considered when the non-dominant UE is involved?
-Fine motor activities
-Functional activities not expected of non-dominant UE should be used sparingly
-Using non-dominant UE for stabilizing food when cutting, etc.
118
What is UE movement criteria for CIMT?
Traditional:
-20 degrees wrist extension
-10 degrees IP/MCP extension of each finger
Modified:
-10 degrees wrist extension
-10 degrees thumb abduction
-10 degrees IP/MCP extension of 2 fingers
119
What are outcome measures that are used to determine if CIMT is right for a patient?
-Motor activity log (MAL)
-Actual Amount of Use Test (AAUT)
-Wolf Motor Function Test (WMFT)
120
What is an example of a question that would be on the MAL? How would it be graded?
-"In the last week, how often did you use your weaker arm to turn on a light with a light switch?"
-Graded 0-5, 0 being they did not use it at all and 5 being they used it as much as they did pre-stroke
121
What is the actual amount of use test (AAUT)?
-Video of a set of task scenarios with patient unaware they are being recorded
-Movement assessed by therapist for use of involved limb and quality of movement
122
What are some examples of tasks on the AAUT?
-Open file foler
-Put paper in pocket or purse
-Turn pages of photo album
123
How are the tasks graded while performing the AAUT and WFMT?
Functional ability scale
124
What are some considerations when determining if someone can participate in CIMT?
-Balance
-Cognitive status
-Pain
-Contractures
-Sensation
-Hearing
-Sit and stand independently
-Pt is medically stable
125
What conditions other than stroke can you use CIMT with?
-LE surgery
-TBI
-Spinal cord injury
-Pediatrics
-Aphasia
-MS
-PD
