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FALL2 NEURO > experience dependent neuroplasticity > Flashcards

experience dependent neuroplasticity Flashcards

1
Q

What are principles of neuroplasticity?

A
  1. use it or lose it
  2. use it and improve it
  3. specificity
  4. repetition
  5. intensity
  6. salience/meaningfulness
  7. time since onset: 1st year after TBI/3mo-1yr post stroke
  8. age: younger=more
  9. transference
  10. interference
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2
Q

Ways to grade functional tasks for LE (gait)

A
  1. speed
  2. load
  3. assistance
  4. intensity
  5. error
  6. UE support/assistive devices
  7. cardiovasc. factors
  8. accuracy
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3
Q

ways to grade functional tasks for UE

A
  1. position of patient
  2. objects (position/weight/size)
  3. adaptive devices
  4. time constraints
  5. unilateral vs bilateral
  6. accuracy
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4
Q

studies with _____ during locomotor training facilitated walking ability

A

enhanced errors
ex. split belt treadmill (running belts at diff speeds, forwards/backwards)

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5
Q

variability is ____ for learning

A

good! more like real life

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6
Q

when is there too much variability in practice? When our patient exhibits signs of…

A

learned helplessness
demoralization
decreased motivation to not fail

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7
Q

what happens when we sleep?

A

plasticity
(downsizing of dendrites/spines of unnecessary inputs)
-facilitates storage, consolidation of earlier day’s learning

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8
Q

depression results in

A

smaller hippocampus
neuronal loss
decreased neurogenesis
deficits in concentration/memory

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9
Q

what happens during increased stress

A

mild stress enhances learning/memory but chronic stress causes NEURONAL LOSS IN HIPPOCAMPUS
-deficits in concentration/memory

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10
Q

regular exercise in mid/late life decreases risk of

A

dementia!
CARDIORESPIRATORY/AEROBIC EXERCISE

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11
Q

aerobic exercise causes

A
  1. better cognition
  2. better neurogenesis
  3. more dendritic spine density
  4. more angiogenesis
  5. more long term potentiation
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12
Q

_% of people are able to walk post stroke

A

80% (doesn’t include quality of walking)

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13
Q

_% independently walked at 6 months IF
1.
2.

A

98% independ. walk at 6 months IF
1. indep sitting balance in first 3 days
AND
2. LE strength of at least 1/5 hip flexors, knee extensors, ankle DFs in first 3 days

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14
Q

27% walked if criteria unmet at ___ days post stroke

A

27% walked if criteria unmet in 3 days

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15
Q

___% walked if criteria unmet at 9 days post stroke

A

10% walked if criteria unmet at 9 days

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16
Q

what 2 measures accurately predicted who will be homebound 92% of the time?

A
  1. BERG BALANCE SCALE
  2. FIM-LOCOMOTOR
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17
Q

upon admission to inpatient rehab facility, if BBS was less than ___ and FIM-L ____, then
20x more likely to achieve household ambulation by dc.

A

BBS below 20
FIM-L 1-2

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18
Q

what is a predictor of UE functional recovery post stroke?

A

AROM of shoulder and mid finger predicted 71% of variance in UE function at 3 months

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19
Q

What were the results of AVERT study?

A

no significant diff in deaths, falls, adverse events BUT
better with time in PT, time to first mobilization,
*DECREASED COST OF CARE AT 3 MONTHS
*BETTER MODIFIED RANKIN SCALE AT 3, 12 MONTHS
*ABILITY TO WALK UNASSISTED AT 3, 6 MONTHS

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20
Q

gait speed for unlimited household ambulation

A

0.27 m/sec

21
Q

gait speed for limited community ambulation

A

0.58 m/sec

22
Q

unlimited community ambulation gait speed

A

0.8 m/sec

23
Q

gait speed needed to cross commercial street

A

2 m/sec

24
Q

community ambulation for adults without stroke

A

1.2 m/sec

25
Q

Von Schroeder et al. reported that normal 64 y/o were able to ambulate with a speed of _____ while chronic stroke survivors of similar age walked at ____

A

normal: 1.07 m/sec
chronic stroke survivors of similar age walked at 0.8 m/sec

26
Q

what is the 6th vital sign?

A

gait speed
0.8 m/sec

27
Q

What are essential neuroanatomy for walking?

A

SPGs (spinal cord pattern generators)
mm and peripheral nerves
3. ventrolateral and ventromedial spinal cord pathways
4. medullary reticular formation
5. mesencephalic locomotor region
6. subthalamic locomotor region

28
Q

what are spinal cord CPGs?

A

Intrinsic circuits located in the ventral and intermediate gray matter that produces and repeats a functional behavior
For walking, it switches between flexors and extensors
(extensors more peripheral)

29
Q

properties of CPGs

A
  1. They are involved in intra- and inter- limb coordination (involving many joints).
  2. They can react appropriately to sensory inputs.
  3. They can recover.
  4. They can learn.
30
Q

medial medullary reticular formation

A

Final integrative center for locomotion before the cord
“Driving” center for locomotion in all animals
Decision to walk is made here.
Source of pathway that descends in V-L cord to provide the tonic drive to CPG in spinal cord
Involved in inter-limb coordination via feedback loops that detect symmetry or asymmetry of limb movement

31
Q

Why PT’s can influence gait at the level of the Medial Medullary Reticular Formation:

A

However, in supported treadmill training, limbs can be moved symmetrically, so that feedback goes into the reticular system and the medial medullary RF can begin to develop a better “driver” for the CPG’s.
Gait speed is important, since it will control level of feedback provided to cerebellum via stretch-sensitive muscle receptors.

32
Q

mesencephalic locomotor region

A

When this region of midbrain is stimulated with E-stim (in cats) locomotion is initiated with the speed of movement consistent with the intensity of the E-stim.
Thus, this area may help modulate speed of walking.
May be involved in exploratory locomotion

33
Q

Responsible for spontaneous goal-directed locomotion

A

subthalamic locomotor region

34
Q

important but not essential neuroanatomy

A

Sensation
Dorsolateral spinal cord pathways
Pontomedullary locomotor strip
Cerebellum (vermal)
Red nucleus
Lateral vestibular nuclei
Substantia nigra
Globus pallidus, internal segment
Nucleus accumbens
Limbic cortex

35
Q

where can you identify motivation to walk?

A

hippocampus! fear can shut down system

36
Q

important neuroanatomy interact with essential regions to control locomotion indirectly by:

A

Timing of swing versus stance phases of gait
Detection of sensory gains during walking (especially if sensations are atypical)
Coordination of walking
Motivation to walk*

37
Q

accessory regions involved in walking

A
  1. motor cerebral cortex
  2. pyramidal tracts
38
Q

what is the cerebral cortex involved in?

A

May influence initiation, timing, the transition from stance to swing, and the precise positioning of the foot
However, cortex may interfere with walking if attention is required for a task

39
Q

what are 3 key sensory inputs for CPG

A
  1. Stretch of hip flexors* – resets the CPG
  2. Unweighting of triceps surae – gives leg “permission” to take a step
  3. Weight bearing to facilitate extensor tone in stance limb (muscle receptors in triceps surae, pressure receptors in foot, and joint receptors)
40
Q

Hip extension during ______(Key phase of gait) triggers swing of the limb via activation of the velocity and amplitude dependent muscle spindles.

A

Mid-stance to Heel off

41
Q

key spinal cord segments involved in “stretch of hip flexors”

A

L2, 3, 4
*if hip is kept from extending, then walking STOPS

42
Q

For therapeutic benefit, therefore, PT should stretch the_____during key phase of gait and let the leg swing through.

A

iliopsoas during midstance to heel off

43
Q

Avoid working on ______, if walking is the goal

A

static position control
(COM is outside the base of support 80% of the time when walking normally)

44
Q

learned non-use…

A

Can occur with overuse of other UE and compensations
May start with decreased sensation and/or motor abilities initially post-stroke

45
Q

forced use: constraint induced movement therapy

A
  1. ability to extend wrist 10-20 degrees (from any position) and slightly extend 2 fingers AT LEAST
  2. ability to understand and follow directions!

*other criteria (raise arm 45 deg, extend elbow 20 deg with shoulder flexed to 90, stand 2 min, B&B, extend/abduct thumb 10 degrees, medically stable, highly motivated)

46
Q

CIMT: Adherence-Enhancing Behavioral Strategies (Transfer Package)

A

Behavioral contract
Home diary
Home skill assignment
Daily administration of Motor Activity Log
Home practice

47
Q

EXCITE trial results

A

CIMT stroke survivors!
wolf motor function test, motor activity log, SIS (all improved!
*improvements kept up at 12 and 24 months
*total of 70 participants

48
Q
A

FALL2 NEURO (8 decks)

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