Factors of Recovery

Question 1

Anosognosia

Answer 1

patient unaware of dysfunction
- most often seen in stroke in right hemisphere, paralysis on left side of body

linked to:
movement disorders
contralateral neglect
memory disorders
dysexecutive syndrome (frontal lobe syndrome)

Question 2

Anosognosia and recovery

Interventions?

Answer 2

• predictor of recovery
• as it goes away, rehab gets better and better
• study that had people set goals. patients with anosognosia set unrealistic goals. but people who set realistic goals showed better recovery
• ppl with anosognosia show poorer functional outcomes (even if it was gone by three months)

Possible intervention: Awareness Intervention Program: showed improved self-awareness but not associated with better functional outcomes

Question 3

rasmussen’s encephalitis

Answer 3

chronic inflammation of one half of brain

• doctors can remove half the brain (if young) and person can function
• highlights AGE effect of disorder
• brain able to reorganize at young age

Question 4

effect of age in recovery

Answer 4

• removal of infant motor cortex results in less dramatic impairment than adult
• brain injury resulting in aphasia before age 1 is associated with best recovery

BUT…

• insults to PFC can fundamentally change who we end up being “acquired sociopathy”, problems with social norms

Question 5

effect of lesion size and location

Answer 5

• direct relationship between size of brain lesion and extent of recovery
• larger = more impairments
• patients with bilateral lesions show less recovery than unilateral

Question 6

Chronic vs acute dysfunction

Answer 6

slow growth don’t always manifest as symptomatic problem

• brain slowly compensates with slow growth
• if you lose area all at once, major impairments
• onset of damage is

Question 7

Secondary effects of dysfunction

Answer 7

edema= swelling
- after stroke may mask or distort functions in intact areas of brain

Diaschisis
= brain lesion can cause dysfunction in an area remote to it because of connections to that area
- recovery can occur because eventually brain cells reweight synapses and diaschisis goes away

Question 8

most critical predictor of recovery in humans

Answer 8

ENVIRONMENT!

- in animal models, enriched environments = better recovery

Question 9

constraint induced therapy

Answer 9

• take away functional body part (i.e. hand) force person to use hand affected by damage
• shows better recovery

Question 10

benefit of lack of plasticity in adulthood

Answer 10

• ability to be the same person
• remember things from long ago
• stable behaviours

Question 11

cortical representations

Answer 11

• cortex develops in person based on experiences, change through adulthood
• if you lose a digit, neurons sitting around that part of cortex grow bigger, divide responsibilty

Question 12

phantom limbs

Answer 12

• Common that person who loses arm maintains sensation for it even though it doesn’t exist
• Feel like they are clenching hand, yet they can feel like they are clenching hand
• Whole area devoted to hand suddenly has no inputs
○ Nearby is face and arm cortical representations
○ Area that used to be responsible for hand is now responsible for arm and face
○ You could touch their face, or part of arm, and they would feel it in the hand

Question 13

relationship between therapy time and recovery

complications?

Answer 13

more therapy = greater recovery after controlling for time after stroke

complications: if started too early, intensive therapy may hinder rate of recovery or have no benefit over less intensive. too many hours of therapy could lead to drop out

Question 14

what can a meta-analysis reveal

Answer 14

• publication bias!!

use a funnel plot. with no bias, should get a triangle. if there were bias, would see no negative values (not a triangle)