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PHTH 528: Management of Neurological Conditions I > Exam 1 > Flashcards

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

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2
Q

What are four ways the brain can create neuroplasticity?

A

-Neurogenesis
-New synapses
-Strengthened synapses
-Weakened synapses (negative neuroplasticity)

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3
Q

What is neurogenesis?

A

The continuous generation of new neurons in certain brain regions

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4
Q

What creates new synapses?

A

New skills and experiences create new neural connections

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5
Q

How are synapses strengthened?

A

Repetition and practice strengthens neural connections

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6
Q

How are synapses weakened?

A

Connections in the brain that are not used become weak

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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

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8
Q

What does neuroplasticity based motor learning include?

A

-Repetition
-Neuroadaptive: task parameters continuously modified
-Attentionally engaging: task difficulty continuously adjusted
-Rewarding

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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

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10
Q

What are examples of task specific training?

A

-Sit to stand
-Opening a door
-Kicking a ball

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11
Q

What is motor control?

A

It is defined as the ability to regulate the mechanisms essential to movement

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12
Q

What is a motor skill?

A

Skills that require body, head, and limb movements to achieve a goal

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13
Q

What is performance?

A

Behavioral act of executing a skill at a specific time and in a specific situation

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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

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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

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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

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17
Q

What are the three stages of motor learning?

A

-Cognitive stage
-Associative stage
-Autonomous stage

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18
Q

What is the cognitive stage of motor learning?

A

-“What to do”
-Understanding the task and developing strategies
-large amount of attention

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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

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20
Q

What is the autonomous stage of motor learning?

A

-“How to succeed”
-Automaticity in the skill
-Low degree of attention required

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21
Q

What are the characteristics for promoting motor learning and transfer?

A

-Individual
-Task
-Environment

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22
Q

What are different aspects of task in motor learning and transfer?

A

-Elements
-Attributes
-Goals/nature
-Mobility
-Skill
-Stability

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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

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24
Q

What are different aspects of environment in motor learning and transfer?

A

-Physical features
-Regulatory
-Non-regulatory
-Social resources

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25
Q

What is the framework of current neurorehabilitation interventions?

A

-First level: restorative interventions
-Second level: functional training
-Final level: compensatory interventions

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26
Q

What are the key variables in motor learning?

A

-Practice and repetition
-Performance feedback
-Generalizability and variability
-Diverse activities in varied contexts

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27
Q

What are the different types of practice and practice parameters?

A

-Massed vs distributed practice
-Constant vs variable practice
-Blocked vs random
-Whole vs part
-Guidance vs discovery
-Transfer of learning
-Mental practice

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28
Q

What is blocked practice?

A

Practicing a skill repetitively during a session

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29
Q

What is random practice?

A

Practicing various skills rather than concentrating on the acquisition of a single skill during a practice session

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30
Q

What are the different types of performance feedback?

A

-Intrinsic/extrinsic
-Knowledge of results
-Knowledge of performance

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31
Q

What are types of external feedback?

A

-Demonstration
-Visual feedback
-Tactile feedback
-Verbal feedback
-Auditory feedback
-Biofeedback
-Neurofeedback

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32
Q

What is knowledge of results (KR)?

A

Information about the outcome of a movement

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33
Q

What is knowledge of performance (KP)?

A

Information about the characteristics of movement

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34
Q

What is involved in generalizability and variability?

A

-Different settings
-Different surfaces
-Different assist
-Different time of the day

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35
Q

What is involved in diverse activities in varied contexts?

A

-Blocked vs random practice
-Task changing weight, object, position, surface, location, etc.
-varied environments

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36
Q

What are evidence based interventions for motor learning?

A

-Magnetic stimulation
-Forced use
-Constraint induced therapy
-Virtual reality
-Body weight supported treadmill training
-Wearable robotics

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37
Q

What is transcranial magnetic stimulation (TMS)?

A

-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

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38
Q

What is postural control?

A

Controlling body position in space to maintain:
-Dynamic stability
-Orientation

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39
Q

What is balance?

A

Ability to maintain projected COM within the limits of BOS

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40
Q

What is involved in the postural control system?

A

-MSK system
-Neuromuscular synergies
-Sensory systems
-Sensory strategies
-Anticipatory mechanisms
-Adaptive mechanisms
-Eye-head coordination

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41
Q

What do we need for balance with the MSK system?

A

-ROM
-Tone/strength
-Postural tone
-Postural alignment

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42
Q

What do we need for balance with the neuromuscular synergies?

A

-Ankle strategy
-Hip strategy
-Stepping strategy
-Mediolateral control

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43
Q

What are adaptive mechanisms?

A

-Ankle strategy
-Hip strategy
-Stepping strategy

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44
Q

What are abnormal eye movements associated with balance?

A

-Nystagmus
-Abnormal saccade
-Diploplia

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45
Q

What sensory systems are involved in balance?

A

-Visual input
-Somatosensory input
-Vestibular input

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46
Q

What is anticipatory control?

A

The patient’s ability to prepare for anticipated displacements based on prior experience, anticipation, practice, and knowledge of physical constraints

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47
Q

What should be included in a balance assessment?

A

-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

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48
Q

What are some examples of balance assessments?

A

-Functional reach
-Tinetti
-POMA
-Berg balance scale
-TUG
-CTSIB

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49
Q

What are indications for balance training?

A

-Vestibular inner ear disorders
-Neurological problems
-Orthopedic injuries and procedures
-Decreased strength and flexibility
-Medications
-Self-confidence

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50
Q

What semicircular canals are there?

A

-Anterior
-Posterior
-Horizontal

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51
Q

What are the otolith organs?

A

-Saccule
-Utricle

52
Q

What is benign paroxysmal positional nystagmus/vertigo (BPPN/V)?

A

-Most common disorder resulting in dizziness in older population
-Mechanical disorder caused by otoconia displaced from the macula of the utricle

53
Q

What are the symptoms of BPPV?

A

-Vertigo
-Nausea
-Nystagmus

54
Q

What are the types of BPPV?

A

-Cupulolithiasis
-Canalithiasis

55
Q

How are the vertical canals assessed for BPPV?

A

Loaded Dix Hallpike

56
Q

What is the most common treatment for vertical canal BPPV?

A

Epley maneuver

57
Q

What is the most common test for horizontal canal BPPV?

A

Supine roll test

58
Q

What is the most common treatment for horizontal canal BPPV?

A

Barbecue roll

59
Q

What is the most common treatment for cupulolithiasis?

A

Semont maneuver

60
Q

What maneuver can be added to the HEP for someone with posterior canal BPPV?

A

Brandt-Daroff exercise

61
Q

What are signs and symptoms of central vestibular disorder?

A

-Ataxia
-Abnormal smooth pursuit
-Usually no hearing loss
-Diploplia
-Altered consciousness
-Lateropulsion
-Nystagmus: pure vertical

62
Q

What are signs and symptoms of peripheral vestibular disorder?

A

-Mild ataxia
-Normal smooth pursuit
-Hearing loss
-Fullness in ears
-Tinnitus
-Signs of acute vertigo
-Nystagmus: up or down beating and torsional

63
Q

What is included in the oculomotor exam?

A

-Smooth pursuit
-Saccade
-Observe nystagmus
-VOR

64
Q

What does an impaired VOR look like?

A

-Head movement/velocity and eye movement does not match
-Retinal slip: pt’s complain of decreased visual acuity and blurry vision

65
Q

What is a retinal slip?

A

The eyes lag behind causing blurry vision with head or eye movement

66
Q

What is included in the vestibular exam?

A

-History: signs and symptoms
-Oculomotor exam
-VOR
-CTSIB or mCTSIB

67
Q

What are the signs and symptoms of unilateral vestibular hypofunction?

A

-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
Q

What are signs and symptoms of bilateral vestibular hypofunction?

A

-Ototoxicity
-Oscillopsia: visual blurring with head movements
-Disequilibrium
-No nausea
-Gait ataxia

69
Q

What is otitis media?

A

Infection of the middle ear causing fever and ear pain

70
Q

What is ototoxicity?

A

Ear poisoning caused by drugs

71
Q

What are general principles for vestibular rehabilitation?

A

-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
Q

What are interventions for UVH?

A

-Gaze stabilization exercises
-VOR x 1
-VOR x 2
-Whole body with head movements

73
Q

What are interventions for BVH?

A

-Gaze stabilization

74
Q

What is Meniere’s Disease? What are signs and symptoms?

A

-Recurrent and usually progressive vestibular disease
-Tinnitus
-Deafness
-Sensation of fullness in the ear
-Vertigo

75
Q

What is an acoustic neuroma? What are signs and symptoms?

A

-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
Q

What is the function of the basal ganglia?

A

-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
Q

What occurs with a defective basal ganglia?

A

-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
Q

What are the cardinal signs of Parkinson’s Disease?

A

TRAP
-Tremors
-Rigidity
-Akinesia, bradykinesia
-Postural instability

79
Q

What is the presentation of akinesia or bradykinesia in PD?

A

-Hesitation
-Slow movement
-Impaired repetitive movement
-Freezing
-Diminished arm swing
-Facial masking

80
Q

What are signs and symptoms of PD?

A

-Akinesia
-Bradykinesia
-Rigidity
-Tremor
-Slow, shuffling, and festinating gait
-Monotone speech and decreased volume

81
Q

What is gait festination?

A

Involuntary shortening of steps and hastening of cadence part way through a task

82
Q

What are non-motor symptoms of PD?

A

-Orthostatic hypotension
-Autonomic dysfunction
-Sensory symptoms
-Seborrhea, edema, fatigue
-Behavioral abnormalities: depression, personality changes, sleep disturbance, etc.

83
Q

What should be included in a PD eval?

A

-Functional status
-H & Y scale
-Standardized tests/outcome measures
-Pain
-Mobility
-Gait
-Postural assessment
-RAM
-Cognitive status

84
Q

What are the Hoehn and Yahr Stages of PD?

A

Stages 0-5

85
Q

What is Stage 1 on the H & Y scale?

A

Symptoms on only one side of the body

86
Q

What is Stage 2 on the H & Y scale?

A

Symptoms on both sides of the body and no difficulty walking

87
Q

What is Stage 3 on the H & Y scale?

A

Symptoms on both side of the body and minimal difficulty walking

88
Q

What is Stage 4 on the H & Y scale?

A

Symptoms on both sides of the body and moderate difficulty walking

89
Q

What is Stage 5 on the H & Y scale?

A

Symptoms on both side of the body and unable to walk (wheelchair dependent)

90
Q

What are the 3 key elements of PT treatment of PD?

A

-Teach ability to move with ease and postural stability strategies
-Management of secondary problems
-Promote physical activities and fall prevention

91
Q

What does strategy training-compensation involve?

A

-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
Q

What are external cues that can be used with PD?

A

-Visual
-Auditory

93
Q

What are some examples of visual cues for PD?

A

-Mirror
-Lines on floor

94
Q

What are some examples of auditory cues for PD?

A

-Metronome
-Steady beat music

95
Q

What are some strategies to avoid freezing?

A

-Rhythmical sensory cueing
-Relaxation
-Stop, pause, restart task
-Avoid complex, long sequenced movement
-Cognitive compensation
-Stairs

96
Q

When should LSVT-BIG be used with PD?

A

Only when it is applicable to the client

97
Q

Who founded Constraint Induced Movement Therapy (CIMT)?

A

-Edward Taub
-Steven Wolf

98
Q

What is the theory of learned non-use?

A

-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
Q

What are the two proposed mechanisms of action of CIMT?

A

-Eliminating learned non-use
-Use-dependent cortical reorganization

100
Q

How does increased motivation affect functioning of the paretic UE or LE?

A

Increased motivation can increase spontaneous hand use and improved functional ability

101
Q

How does task practice affect functioning of the paretic UE or LE?

A

-Altered cortical limb representation due to increased use
-This leads to increased spontaneous hand use and improved functional ability

102
Q

What is the traditional CIMT program?

A

-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
Q

What is the modified CIMT (mCIMT) program?

A

-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
Q

What are elements of CIMT?

A

-Intensive task-oriented training
-Behavioral strategies
-Restriction of the uninvolved extremity

105
Q

What are different types of intensive task-oriented training?

A

-Task practice
-Shaping

106
Q

What are different behavioral strategies involved in CIMT?

A

-Bahvioral contract
-Home skill assessment
-Home diary
-Motor activity log (MAL)

107
Q

What are the guidelines for task practice?

A

-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
Q

What are examples of UE task practice activities?

A

-Grooming
-Brushing teeth
-Folding clothes
-Ironing
-Hammering nails
-Sanding
-Painting
-Vacuuming
-Cutting food
-Eating

109
Q

What are the guidelines for shaping activities?

A

-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
Q

What are some examples of UE shaping activities?

A

-Stack blocks
-Deal playing cards
-Write
-Type
-Tie shoes
-Open door
-Remove jar lids

111
Q

What is massed practice?

A

-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
Q

What are some CIMT LE acticities?

A

-Cycling
-Aquatics
-Sit to stand
-Stairs
-Walking on uneven surfaces
-Treadmill training

113
Q

What is a behavioral contract for CIMT?

A

-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
Q

What is home skill assignment and practice?

A

Functional tasks assigned nightly to perform:
-With mitt
-Without mitt
-Only w/ supervision
-With bilateral UE/LE

115
Q

What does a home diary consist of for CIMT?

A

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
Q

What is a motor activity log (MAL) for CIMT?

A

-Subjective self-report of the amount and quality of use of the involved UE for 30 specified tasks
-Example: open a drawer

117
Q

What should be considered when the non-dominant UE is involved?

A

-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
Q

What is UE movement criteria for CIMT?

A

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
Q

What are outcome measures that are used to determine if CIMT is right for a patient?

A

-Motor activity log (MAL)
-Actual Amount of Use Test (AAUT)
-Wolf Motor Function Test (WMFT)

120
Q

What is an example of a question that would be on the MAL? How would it be graded?

A

-“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
Q

What is the actual amount of use test (AAUT)?

A

-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
Q

What are some examples of tasks on the AAUT?

A

-Open file foler
-Put paper in pocket or purse
-Turn pages of photo album

123
Q

How are the tasks graded while performing the AAUT and WFMT?

A

Functional ability scale

124
Q

What are some considerations when determining if someone can participate in CIMT?

A

-Balance
-Cognitive status
-Pain
-Contractures
-Sensation
-Hearing
-Sit and stand independently
-Pt is medically stable

125
Q

What conditions other than stroke can you use CIMT with?

A

-LE surgery
-TBI
-Spinal cord injury
-Pediatrics
-Aphasia
-MS
-PD

PHTH 528: Management of Neurological Conditions I (1 decks)

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