L10 - Neurological rehab

Question 1

Experiences are needed to complete development of maps - which also involves…

Answer 1

changes in synaptic strength

Question 2

What are experience-expectant processes?

Answer 2

shape developing sensory and motor systems

musicians = hand

Question 3

What are experience-dependent processes?

Answer 3

experiences which differ in both timing and character and that are unique to the individual

Question 4

true or false

movements, not muscles, are represented in the brain

Answer 4

true

Question 5

What have reorganisation follow brain lesion studies in monkeys shown us?

Answer 5

map of brain done with microstimulation

Injuries that caused a paralysed hand, if they were exposed to training involving shaping behavioural experiences with moments, had more plasticity

Question 6

true or false

The residual corticospinal projects after spinal hemisection (cut) contribute after the recovery?

Answer 6

true

recovered upper limb function but couldn’t move dextrously

Question 7

Give a description of motor control of the hand, from the brain

Answer 7

corticospinal tract

• the only direct link between the brain and the spinal cord
• provides direct connections with motorneurons
• critical for skilled voluntary movement, esp of hand

Question 8

true or false

alll neurons in the corticospinal tract terminate on motor neurons

Answer 8

false

not all will but some do

Question 9

How is upper limb function affected after stroke?

Answer 9

30-60% of stroke survivors fail to regain functional use of their arm and hand

reduced upper limb function after stroke is associated with poor QOL and carer burden

dissatisfaction with inadequate training possibilities after discharge from hospital

Question 10

what are the issues with upper limb rehabilitation?

Answer 10

low expectations, lower priority given

insufficient time spent on upper limb activities during rehab

current dose of interventions inadequate to drive neural reorganisation

Question 11

what is the evidence-practice gap?

Answer 11

clinical guidelines for rehabilitation after stroke recommend early, intenstive, repetitive, task oriented activity

current dose of interventions inadequate to drive neural reorganisation

Question 12

What are the technological devices used in upper limb rehab?

Answer 12

robotic devices, have algorithms to assist - very expensive

coaching devices - don’t assist movement but track progress (computer games). An example is Hand Hub

Question 13

What have been the key outcomes of technological devices used in upper limb rehab?

Answer 13

Increased opportunities for upper limb rehab

significant improvements in arm function and QOL

games are cognitively engaging - improvements in attention, memory and visual perception

Question 14

Spinal cord injury is an extreme example of forced inacitivty

How is the patient effected?

Answer 14

immediate and severe loss of sensory and motor function leads to ‘‘metabolic chaos’’

Disruption of Ca and Phosphate metabolism: loss of bone

Immunosuppression: vulnerability to infections

muscle atrophy - causes falls and breaks

poor circulation

exacerbation of neuro dysfunction due to inactivity - retraining effects initiated later are limited

secondary complications: pressure ulcers and fractures

Question 15

Without descending input what happens to the distal neurons?

Answer 15

they shrink and die - major problem

they need to be maintained for any hope of return of function if the SC is repaired

Question 16

SCIPA Switch-on?

Answer 16

Early exercise to prevent musculoskeletal atrophy

Question 17

50% of people living with Sc injury engaged in leisure time physical activity for an average of only ___ min per day

Answer 17

27min

Question 18

What are the barriers to physical activity after SC injury?

Answer 18

Physical health

Psychological factors - depression

Accessiblity - equipment/facilities

Financial cost

Lack of knowledge and awareness about availability and appropriate exercises

Experts not discussing its importance enough

Question 19

What are the facilitators to physical activity after SC injury?

Answer 19

Action planning, goal setting

support from advocacy organisation

counselling services

building codes - accessibility

awareness of local resources: gyms

Question 20

What are the physical activity guidelines after SC injury?

Answer 20

Aerobic - twice weekly, moderate to vigorous, 20min duration

Strength - 3 set of 8-12 reps, two times a week

Question 21

programs exist to help Sc injury patients with phtysical exercise - what are they and do they work?

Answer 21

customised/evidence based guidelines

8-12 weeks, 2-3 times a week

exercise levels remained above baseline after the program was initiated

Question 22

What are the downsides of the rehab environment?

Answer 22

very hospital-like

cognitive deterioration while in hospital makes active capacity to cope and improve more difficult

Question 23

Animal studies: what are the effects of environmental enrichment on the brain?

Answer 23

changes in neurochemistry and physiology

enhancement of synaptogenesis

increase in cortical thickness

strengthens plasticity and survival of neural networks

Question 24

Human studies:what are the effects of environmental enrichment on the brain?

Answer 24

promotes improved forelimb motor function after brain injury

cognitive or social activity enhances cognitive recovery

Question 25

true or false

survivors of stroke and TBI may be vulnerable to reversal of gains when transitioning from rehab to home

Answer 25

true

Question 26

Rehab is often a isolated experience, how can environmental enrichment in the rehab setting help?

Answer 26

significant improvements at discharge in depression, anxiety, cognitive function compared to routine ward activity

Question 27

What is the basic principle underlying neurological rehab?

Answer 27

to harness neural plasticity

'’use it or lose it!’’

Question 28

True or false

exercise helps to maintain the NS

Answer 28

true