Factors Influencing Recovery Flashcards
What are some common misconceptions about brain dysfunction?
- Recovery depends on the person’s efforts
- That someone with brain dysfunction will recovery completely (tissue will not regrow!!)
- People missattribute behavior (fatigue, aggression) that is a result of the dysfunction to their personality or phase of their life.
- People are more forgiving of behaviors for those with a bandage on their head than if not.
- People believe emotional problems are not related to brain dysfunction.
- People believe that second brain injuries can restore lose memories
- People believe that amnesic patients are totally fine in every other respect
- People believe those with amnesia have no trouble learning NEW memories (but anterograde amnesia exists too!)
What is a critical predictor of recovery?
What are some studies that show this?
KNOWING you have a problem.
Patients with agnosognosia don’t know they have an issue.
Problem: finding ppl in denial vs. people with agnosignosia
Prigatano and Wong predicted that those with realistic goals (aka those without agnosignoia) had better recovery outcomes.
Jehkonen said that those with anosognsia had poorer functional outcomes than those who didn’t have it in pt.s with right hemisphere strokes
Gialanella said rehab progress isn’t as strong when anosognosia is present, when pts had neglect vs. no neglect. HOWEVER
Gheng and Man started an awareness program (AIP) what showed self awareness was NOT associated with improved functional outcomes. - changing their awareness with therapy didn’t make them recover faster.
Good INDICATOR, but changing it doesn’t lead to a better outcome
What are the effects of Anosognosia?
Common in stroke patients and those with paralysis, or contralateral neglect
- Overlaps with movement, memory disorders, neglect, disexecutive syndrome (frontal lobe syndrome: disinhibition, aggression, impulsiveness, disruptinos in planning and working memory)
always goes away (takes sometimes 6 months)
What is the effect of age on dysfunction?
CHildrens brains are incredibly elastic. A young girl had half her brain taken out and she was totally fine! Brain can deal with insults very well at this young age.
Studies in monkeys have shown that removing inhants primary motor cortex is less dramatic impairment than an adults.
Aphasic brain injury BEFORE 1 year old is associated with best recovery. BUT not in the prefrontal cortex, before 16 months, this may impair social/moral learning later, changes who we are fundamentally (sociopathy) Reverse in adults.
Children bang their heads into things all the time and are fine.
What is the effect of lesion size and location?
larger lesions, more functional impairments.
BILATERAL lesions show less recovery than unilateral lesions.
Neighbouring regions do take over, but bilateral damage is super duper sever.
If you damage left pareital you don’t see lots of impairments, or one side of the hippocampus. but if you damage right pariental or bilateral hipocampus you see great impairment
What is the effect of speed of onset?
Massive tumors that take a long time to grow often cause little impairment, slow growths often aren’t symptomatic.
vs. sudden stroke with same size of damage is DEVASTATING.
What is an Edema? What are it’s effects?
Swelling> after stroke it may mask/distort function in intact regions of the brain. when swelling goes down, you can show recovery.
What is Diaschisis?
functional impairment. metabolic depression in cerebral areas REMOTE to the lesion.
Lesion can cause dysfunction in an area that isn’t where the damage IS because of strong connections to that area.
i.e. when motor cortex is damaged, it doesn’t give inputs to cerebellum so it is less active there!!
Eventually brain reweights synapses after a connection is lost and see a restoration of some function.
- this happens with removal of edema or loss of diaschisis
How do environmental factors influence recovery?
BEST PREDICTOR of recovery is MOST TRAUMATIC ENVIRONMENT.
i.e. enriched environments (in rats, this means good playpens with other rats), constraint induced movement therapy (force someone to use bad part of their body) , organisms recover better if theyre in good social conditions.
USE IT OR LOSE IT
How does the brain compensate during recovery?
there is no restitution, but there will be SUBSTITUTION.
- a patient learns new strategies to adapt.
in rats, lesioned motor cortexes, they learn to walk again quickly on beams but if you look closely their gaits are really weird.
New tissues handle the new functions (new = preexisting)
Adult brains are less flexible
Why is it positive to have a less flexible brain?
To keep being the person you are and to retain long term memories (wisdom)
How does cortical representation change with neuroplasticity?
Functional areas are flexible, representation is based on USE.
i.e. If you lose a finger, the cortex responsible for that finger will now take over functions of adjacent fingers and you might even get enhanced sensitivity.
Opposite if you use that finger a lot,
in violin players, their fretting fingers have more cortical representation for those fingers in their brains.
USE IT. OR LOSE. IT.
What is phantom limb?
Large scale plasticity. Person who loses an arm will maintain sensation for that arm even if it doesn’t exist. Patients will report ‘clenching their fist’ that is no longer a part of them.
Cortical representation will ‘spread out’ and is now responsible for face and hand sensation - if you touch someone’s face, it feels like you’re touching their nonexistant arm.
- not the same as phantom pain (which is in dorsal root ganglion)
What is the publication bias method for meta analysis?
You have a triangle shaped graph, look for publication bias (ppl not publishing bad results) with this funnel plot. Triangle that should get skinnier towardst the top. Less statistical error with more participants. If there is publication bias there will be no data on the left side of the funnel.
LOHSE META ANALYSIS
