L8: Neuro Rehabilitation Flashcards
what are the main principles of neurological rehabilitation?
- Reduce disability/maximise independence
- Acquire new skills and strategies, which will maximise activity
- Promote neuroplasticity and recovery
- Ensure safety
- Improvement in efficiency of movement/minimise compensations
- Improvement in quality of life
How does neurological recovery occur?
- The ability of the brain and nervous system to change structurally and functionally as a result of input from the environment.
- Cellular changes, cortical remapping
- Neuroplasticity occurs when neurons in the brain sprout and form synapses. As the brain processes sensory information, frequently used synapses are strengthened while unused synapses weaken
Where are motor programs developed in the brain?
In the cortex of the brain.
What is the role of motor programs in movement?
Motor programs are learned and refined through repetitive use, guiding movements.
How is ongoing movement detected in the body?
By proprioceptors in the muscles and joints.
What allows for movement corrections when the outcome doesn’t match the goal?
Feedback control, based on sensory input from proprioceptors.
How does feedback influence future movement?
Over time, feedback influences feedforward signals created by the cortex, improving movement accuracy.
What is the term for the process when feedback influences future feedforward signals in the brain?
Motor learning.
What happens to motor programs with repetitive use?
They are refined and become more accurate and efficient over time.
How does the cortex adjust its motor signals over time?
Through feedback from proprioceptors, which helps refine future motor commands (feedforward signals).
What is the role of proprioceptors in motor learning?
Proprioceptors detect ongoing movement and provide feedback for corrections to the motor programs.
What occurs when the motor outcomes align more closely with the movement goals over time?
Motor learning has successfully taken place.
What are two major approaches to influencing motor learning and neuroplasticity?
Motor relearning (Carr and Shepherd) and the Bobath approach.
What is the Motor Relearning approach (Carr and Shepherd)?
A method focused on helping patients regain motor control through practice and task-specific training.
What is the Bobath approach in motor learning?
A therapeutic approach that emphasizes normalizing movement patterns through facilitation and inhibition techniques.
How does feedback influence motor learning?
Increasing feedback helps correct and refine movements by providing real-time information on performance.
What role does proprioceptive input play in motor learning?
It helps the body sense movement and position, which is crucial for refining motor control and adjustments.
What does facilitation refer to in motor learning?
The process of guiding or assisting movements to encourage proper motor patterns.
Why is promoting normal movement important in neurological rehabilitation?
It encourages the development of efficient and functional motor patterns.
Why is repetition and practice crucial in motor learning?
Repetition helps reinforce motor programs, leading to better skill acquisition and retention.
What is the benefit of using both whole and part task practice?
Practicing whole tasks develops overall coordination, while part task practice refines specific components of a movement.
Why is it important to consider the individual, task, and environment in motor learning?
Tailoring rehabilitation to these factors ensures that training is relevant and functional for the patient’s daily life.
What does it mean to keep it functional in motor learning?
The activities and tasks should closely mimic real-world movements that are meaningful to the patient’s daily activities.
what are the 10 principles of neuroplasticity?
- use it or lose it
- use it an improve it
- specificity
- salience matters
- transference
- interference
- time matters
- age matters
- repetition matters
- intensity matters
describe ‘use it or lose it’ principle of neuroplasticity
Neural connections lose strength when they are not being used
describe ‘use it and improve it’ principle of neuroplasticity
Neural pathways grow stronger the more they are used
describe the ‘specificity’ principle of neuroplasticity
Your brain forms a specific circuitry in response to specific activities
describe the ‘salience matters’ principle of neuroplasticity
Brain exercises must be meaningful to you in order to yield lasting change
describe the ‘transference’ principle of neuroplasticity
Working to improve one skill may transfer its benefits to enhancing others
describe the ‘interference’ principle of neuroplasticity
Neuroplastic changes that result from maintaining a bad habit can interfere with learning and adopting a new good habit
describe the ‘time matters’ principle of neuroplasticity
It takes varying amounts of time for the brain to change depending on how complex or foreign the new behavior or skill is to you
describe the ‘age matters’ principle of neuroplasticity
Younger brains are more plastic but neurogenesis and plasticity continue at any age and phase of life.
describe the ‘repetition matters’ principle of neuroplasticity
Consistency is the key to building new synapses and solidifying new skills
describe the ‘intensity matters’ principle of neuroplasticity
Neuroplastic changes result from incremental progressive challenges to elicit a positive growth response
What kind of service is provided for acute stroke care and some stroke rehabilitation?
A seven-day service.
When should a stroke patient be assessed after admission?
Within 24 hours.
Why is goal setting important in acute stroke management?
It helps create a focused, personalized rehabilitation plan.
Which team plays a crucial role in the acute management of stroke patients?
The Multidisciplinary Team (MDT).
What is an early priority regarding mobility in acute stroke care?
Transferring the patient out of bed as soon as appropriate.
Why is updating transfer and mobility status important for nursing staff?
To ensure safe and appropriate handling of the patient during transfers.
What regular check is necessary to monitor stroke patients’ respiratory status?
A respiratory check and interventions as required.
Why is proper positioning important in acute stroke management?
To prevent complications such as pressure sores and to promote optimal recovery.
What kind of exercises should patients be encouraged to do if able?
Self-directed bed or chair exercises.
When should upper limb rehabilitation be provided to a stroke patient?
As indicated based on the patient’s condition and needs.
Why is early discharge planning critical in acute stroke management?
To ensure a smooth transition to appropriate care settings and continued rehabilitation.
According to the AVERT trial, when should patients with difficulty moving after a stroke be assessed by a healthcare professional?
As soon as possible within the first 24 hours of stroke onset.
What is the purpose of early assessment in stroke patients according to the AVERT trial?
To determine the most appropriate and safe methods of transfer and mobilisation.
When should medically stable stroke patients with mobility difficulties be offered mobilisation?
Between 24 and 48 hours after stroke onset, with frequent, short, daily mobilisations.
What types of mobilisations are recommended for medically stable stroke patients early after stroke?
Sitting out of bed, standing up, and walking with assistance from appropriately trained staff.
According to the AVERT trial, when is mobilisation within 24 hours of stroke onset appropriate?
Only for patients who require little or no assistance to mobilise.
What do the NICE guidelines suggest about high-intensity mobilisation within the first 24 hours after a stroke?
There is evidence of clinical harm associated with high-intensity mobilisation within the first 24 hours.
According to the NICE guidelines, which group of stroke patients is most at risk of harm from early high-intensity mobilisation?
Those who need help to sit out of bed, stand, or walk.
Why does the NICE recommendation limit early mobilisation to patients needing assistance?
To prevent harm but not to restrict appropriate early mobilisation for patients who are independently mobile.
What is the main focus of early intervention in stroke rehabilitation according to the AVERT trial?
Safe, appropriate mobilisation by trained staff using the right equipment, typically within 24-48 hours of onset.
Why is early mobilisation important in stroke rehabilitation?
It helps improve recovery outcomes, but it must be done safely to avoid harm, especially in patients requiring assistance.
What is the role of specialist seating in stroke rehabilitation?
To provide postural support, improve comfort, and prevent complications like pressure sores.
How are orthotics/splinting used in physiotherapy management?
To support joint alignment, prevent contractures, and improve functional movement in affected limbs.
Why are onward referrals important in stroke rehabilitation?
They ensure the patient receives additional specialized care, such as referrals to other healthcare professionals or services.
What is the recommended intensity of treatment in stroke rehabilitation?
Three hours of therapy per day for at least five days a week, including physiotherapy, occupational therapy, and speech and language therapy.
Which therapies are included in the three-hour daily treatment plan?
Physiotherapy, occupational therapy, and speech and language therapy.
How does intensive therapy benefit stroke patients?
It enhances recovery by providing consistent, focused rehabilitation, improving physical and cognitive functions.
In long-term stroke management, what is often a primary focus?
More focus on upper limb function and activities of daily living (ADLs).
Why is quality of life a key consideration in long-term management?
Because ongoing rehabilitation aims to improve overall well-being and functionality in daily activities.
What is the goal of maintenance therapy in long-term stroke management?
To sustain improvements and prevent deterioration in physical and functional abilities.
How does promoting social participation benefit stroke patients in long-term care?
It enhances emotional well-being and integration into community life, supporting mental health.
What is tonal management in long-term stroke rehabilitation?
Strategies to manage muscle tone abnormalities such as spasticity or rigidity to improve function.
Why is pain management important in long-term stroke care?
Chronic pain can hinder rehabilitation progress and reduce quality of life.
What role does fatigue management play in long-term stroke rehabilitation?
It helps patients cope with physical and mental exhaustion, improving their ability to participate in daily activities.
What is the importance of 24-hour positioning in long-term management?
To prevent pressure sores, manage muscle tone, and promote comfort during sleep and rest.
Why might a patient need long-term respiratory management after a stroke?
To address breathing difficulties and reduce the risk of respiratory complications.
Can patients with a chronic neurological condition still make improvements?
Yes, responsiveness to treatment is present even at later stages post-stroke, though it gradually declines with chronicity.
What aspect of therapy is considered important for improving outcomes in chronic stroke patients?
A higher intensity of practice has proven to be crucial for effective physical therapy.
What do recent findings suggest about stroke rehabilitation guidelines?
They should be revised to incorporate high-intensity rehabilitation protocols throughout all stages of chronicity.
What is another name for the Bobath approach?
The Neurodevelopmental approach.
What key concept is the Bobath approach based on regarding brain function?
Neuroplasticity—the brain’s natural ability to recover, develop, and adapt to changes in movement and posture.
How does the Bobath approach view the body in treatment?
It uses a holistic treatment approach, addressing the entire body.
What is the main focus of Bobath physiotherapy?
The restoration of normal movement patterns and improving the quality of movement.
How does the Bobath approach aim to normalize muscle tone?
By helping patients regain motor control and making movements easier to achieve.
What does the Bobath approach strive to minimize during rehabilitation?
Compensations, so that the patient uses proper movement strategies
What role does sensory input play in the Bobath approach?
It is used for the activation and inhibition of movement, often through facilitation techniques.
What is an essential component of motor learning in rehabilitation?
The provision of an expert coach (therapist) and the opportunity for intensive practice and exercise.
What is facilitation in the Bobath approach?
A method of providing sensory input to guide and support normal movement patterns.
Why is it important to ensure adequate soft tissue, flexibility, and muscle strength in motor learning?
It enables effective skill acquisition and improves movement performance.
How does practicing one action in motor learning affect other actions?
Practice of one action can generalize into better performance of another.
What is the main goal of motor learning in rehabilitation?
To improve functional ability by making treatment task-specific.
What kind of approach is emphasized in motor learning?
A task-oriented approach, focusing on actions like standing, stepping, and activities of daily living (ADLs).
How does motor learning encourage patient involvement?
By promoting active involvement throughout the rehabilitation process.
How does motor learning differ from approaches like Bobath in terms of movement focus?
it places less focus on normal movement patterns and compensations, emphasizing functional outcomes instead.
what are the advantages of the Bobath approach
- improved efficiency and quality of movement
- decreased impact of tonal changes
- therapist led
what are the disadvantages of the Bobath approach
- less task orientated and engaging for patients
- not always practical with time/ staff/ bed pressure constraints
- relies on therapist handling, so sometimes ‘restrictive’ of progress
what are the advantages of the Carr and Shepherd method
- Task oriented and engaging for patients
- More pragmatic approach
- Strength focused and encourages independence
what are the disadvantages of the Carr and Shepherd approach
- Allowing compensatory movement may hinder recovery of weaker muscles
- Can result in less efficient movement, increased fatigue
- May not address tonal changes
What is compensation in the context of rehabilitation?
Compensation involves accomplishing a task in a different way than before injury, often by overusing one set of muscles to compensate for weaker or non-functional muscles.
How does compensation affect muscle use?
It may involve fast-twitch muscles working harder in place of slow-twitch, postural muscles.
Are compensatory strategies always negative?
No, compensatory strategies are sometimes helpful and necessary to achieve movement and function.
When can compensatory strategies be beneficial in rehabilitation?
When they help achieve functional movement that is needed for daily activities, based on clinical reasoning.
How should compensatory strategies be managed to avoid negative consequences?
We should constantly change compensatory strategies to avoid reinforcing abnormal movement through neuroplasticity.
What is the role of clinical reasoning in using compensatory strategies?
Clinicians should use their reasoning skills to determine when compensatory strategies are appropriate and when to adjust them.
