L8 Neuroplasticity Flashcards
compensation in neuro rehab
optimize new skills with new methods of performing tasks to minimize loss of motor function; for neurodegenerative conditions
ex:
AFO for foot drop
adapting enviroment
adaptive equipment
recovery and restoration in neuro rehab
restoring loss of motor skill/function
ex:
guillain barre
return gait speed to norms
neuroplasticity
neuro rehab principles
specificity
repetition
intensity
time
salience
experience expectant
neuroplasticity dependent on genetics and the developmental process
ex: vision, child needs to be exposed to stimulus for it to develop
experience induced plasticity
occurs after neuro injury and induced by experiences such as:
motor learning
skilled motor activity
skill adaptation
as well as: diet, exercise type, enviro, stress, natural aging, neurotrophic factors, brain reserve
why do we do early rehab in acute neuro events like stroke?
sensorimotor cortex recovery is associated with motor activity patterns normalizing
if pt is medically stable they should be mobilized after 24 hours in CVA
long term potentiation
neuroplasticity at the cellular level
permanent change by persistent strengthening of synaptic connections from high frequency activity
what cellular level changes occur in LTP?
presynaptic NTs: more NTs released
# of receptors postsynaptic: more receptors to receive NT signalling
what types of exercise induce neurogenesis?
aerobic and resistive
enhance LTP by increasing O2 and GLC to brain, improve brain’s ability to adapt
neuroplastic mechanisms that contribute to neural remodeling
modified gene expression
increased circulating neurotrophins: proteins that help w development, maintenance, and function of the NS
synaptic strengthening
cytogeensis
myelin plasticity
dendritic remodeling
how does motor learning affect cellular neuroplasticity?
learning new skills increases dendritic spine density, survival of new spines in motor cortex, and connections to striatum/BG for selection of motor programs
neurons surviving better because they are being used
what type of skill promotes neurogenesis in brain injury pts?
anticipatory postural control w activities like:
- ping pong
- ball rolling
- sticks
learning new skills: CVA pts
need to relearn how to activities like transfers w hemiplegia
learning a previously known skill with now motor/sensory deficits is like learning a new skill
task based activities
STS w body mechanics, GRF, speed is all motor learning
dosing neuroplasticity activities for CVA
wait 24 hours after or until medically stable
start w small doses frequently throughout the day
exercise larger amounts 2-3 months after
3+ hours of rehab has better outcomes
what types of training target which part of the motor pathway?
strength, co contraction, and motor training
strength: spinal motor neuron and AHC excitability
co contraction: reduce muscle spindle transmission
motor training: brain plasticity
why should we train multimodal exercise?
exercise including multiple sensory or motor activities in one
pts need working memory and attention to be successful at mulitsensory processing, cognitive abilities are dependent on ability to process multiple sensory inputs at once
effects of training multisensory integration
enhanced speed, detection, localization, reaction in superior colliculus which integrates visual, auditory, somatosensory signals to enhance vigor of pt response
aspects of multisensory training to incorporate
vision: salience increases motivation/attention
motivation: BG
attention: frontal lobe
auditory
somatosensory
postural control
varying speed, difficulty, cognitive load
effect of multimodal stimulation in PD pts
reduces festination and improves turning by reducing steps taken
gait training intensity in CVA
strong evidence for high intensity
70-85% HRmax
results of high intensity gait training: variable vs forward
forward and variable showed much higher gains in step length and balance confidence than low intensity, forward may be superior to variable in these measures but variable showed more well rounded improvements and daily stepping for community ambulation
benefits of variable activity and neuroplasticity for CVA pts
increase strength of paretic leg: stairs, leg weights
increase balance: perturbations while walking
walk multiple directions
avoid/over obstacles
TENS as spasticity management in stroke
NMES, FES, or TENS for focal spasticity
temporarily reduces spasticity
could reduce permanently over time with repeated treatments or being combined with activity
resets muscle spindle
dosing TENS for spasticity management in stroke
30 min better than 60, both effective
used at sensory level
how is TENS used in SCI?
assist in voluntary oscillation of limbs
allows greater amplitude even after stimulation is removed in short term
creates constant muscle stimulation
TENS and neuropathic pain
stimulates at the source of the pain
can weaken pain synapses and strengthen sensory ones if performed consistently over time
treat pt even if not curing source
modulates pain at the dorsal horn
negative neuroplasticity in neuropathic pain
pain synapses are being stimulated frequently increasing:
spine density, mature spines, redistribution of spines close to cell body, receptor clustering/activation, hyperexcitability
all results in better pain transmission
PD and neuroplasticity: which types of training show best improvements
goal based and aerobic activity imprive cognitive and automatic motor control with experience dependent neuroplasticity
TASK BASED
MS and neuroplasticity
TASK BASED increases white and gray matter from neuroplasticity over 2 months
training types include: exercise w visual feedback, resistive, balance, running
MS resistive training improves what?
corticospinal connectivity, synapses, AHC activation, reduces tau protein
motor priming
prepares NS for performing a task
ex) CV task primes neural circuits with plasticity to work on another task like step length
happens bc aerobic activity produces lactate and BDNF altering cortical excitabiltiy and reducing GABA inhibition
when does motor learning occur across one/multiple sessions?
can increase rapidly in one session, then start higher at next session
will eventually plateau
dosage for neuro rehab
high dose rehan with extended training hours induce strutural, neuroplastic changes and reorganize neural networks to improve motor function
neuro rehab principles modofy what parts of the brain?
some modify specific brain areas like motor areas of cortex
- mass practice, task based, multisensory
some modifiy brain networks
- goal oriented, diffiulty, observation, motor imagery, mirror, rhythmic cuing
both should be incorporated
how to set up a program: dosage
training more than 5 hours a week can speed functional recovery
how to set up a program: structured practice
frequent training with longer breaks leads to better retention than massed practice
how to set up a program: task specific practice
movements that are relevant to ADLs and goal oriented results in maximal learning
how to set up a program: variable practice
incorporate several tasks requiring different movements for better retention and generalized rehab
how to set up a program: multisensory stim
provide feedback through mutliple senses to restore sensorimotor contingencies
how to set up a program: increasing difficulty
progressively increase task difficulty to augment use of impaired limb
how to set up a program: explicit feedback
knowledge of results (success/failure/outcome) leads to retention of adapted movement
how to set up a program: implicit feedback
knowledge of performance obtained from tracking, analyzing, visualizing kinematic movement data
reduces sensorimotor prediction error and promotes learning
how can VR help with walking?
coupling VR and walking allows carryover of locomotor tasks to many contexts otherwise not available in clinic or hospital (task based)
generalizes task
which interventions are not very effective for improving locomotor function?
static/dynamic balance, BW supported treadmill training, robotic training, strength training, cycling
