Lecture 2 - Motor Pathologies

Question 1

What functions are involved in spinal cord lesions?

Answer 1

1. Stimulus generation

2. Stimulus propagation

Question 2

What main methods of rehabilitation could be used to treat spinal cord lesions?

Answer 2

1. Neuroprosthesis

2. Orthoses

Question 3

Which vertebrae can be injured to result in tetraplegia vs. paraplegia?

Answer 3

Tetraplegia: C1 - T1
Paraplegia: below T1

Question 4

What are possible causes for spinal cord pathologies?

Answer 4

1. Disease
2. Traffic & work accidents
3. Household accidents
4. Swimming and spots accidents
5. Other (attacks, suicide attempts, etc.)

Question 5

What function is affected in peripheral nervous system pathologies?

Answer 5

Stimulus propagation

Question 6

What main rehabilitation methods may be used to treat peripheral nervous system pathologies?

Answer 6

1. Spontaneous healing is possible
2. Surgical intervention
3. Orthosis

Question 7

What function is affected by muscular lesions?

Answer 7

Movement execution

Question 8

What main rehabilitation methods may be used to treat muscular pathologies?

Answer 8

1. Spontaneous healing is possible
2. Orthosis
3. Robotic support
4. Exoprosthesis

Question 9

What functions are affected by skeletal system lesions?

Answer 9

1. Movement execution

2. Body posture

Question 10

What main rehabilitation methods may be used to treat skeletal pathologies?

Answer 10

1. Spontaneous healing is possible
2. Orthosis
3. Robotic support
4. Exoprosthesis

Question 11

Describe the main causes and symptoms of muscular dystrophy.

Answer 11

• Genetic condition
• Patient is unable to create certain proteins needed for healthy muscles
• Increasing weakening and breakdown of skeletal muscles over time
• Many eventually lose ability to walk
• Duchene MD is most common
• No cure

Question 12

State possible reasons for amputation.

Answer 12

1. Traumatic (accidents)
2. Tumors (e.g. osteosarcoma)
3. Deformity (dysmelia)
4. Shortened upper limb (phocomelia)
5. Absence of upper limb (amelia)

Question 13

Describe the 3 recovery mechanisms of motor restoration of the CNS.

Answer 13

1. Adaptation & Compensation
   Learning of new movements (e.g. tricks with other muscles and limbs than before lesion)
2. Plasticity of the CNS
   New brain regions take over lost functions; generation of new synaptic connections (same muscles and limbs are active as before lesion)
3. Nerve Growth and Regeneration
   In the CNS only in the range of a mm; reversal of injury related factors (edema, diaschisis). Can be enhanced with special therapies (e.g. antibodies, stem cells, pharma)

Question 14

Give 2 definitions of neuroplasticity.

Answer 14

1. The ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganiing its structure, function or connections.
2. The modification of the nervous system on a cellular and behavioural level. It is triggered by injury or activity/training.

Question 15

Consider weak nerve lesions vs. full nerve rupture with intact myelin vs. full nerve rupture and how each would heal or be treated.

Answer 15

1. Weak nerve lesion - fast spontaneous regeneration
2. Full nerve rupture with intact myelin - slow spontaneous regeneration (several months)
3. Full rupture - surgical intervention (nerve grafts)

Question 16

Define neuroprosthesis.

Answer 16

Bracing of a limb by means of functional electrical stimulation and involves the application of FES (functional electrical stimulation) to motor nerves of muscles.

Question 17

Define motion therapy.

Answer 17

Manual or robotic movements of joints to improve ROM.

Question 18

State 4 approaches to assessing arm motor function, with examples for each.

Answer 18

1. Conventional Measurements
   - active ROM
   - passive ROM
2. Qualitative Clinical Scores
   - GRASSP (Graded Redefined Assessment of Strength, Sensibility and Prehension)
   - FMA-UE (Fugl-Meyer Assessment, Upper Extremity in stroke)
   - mAS (Modified Ashworth Score to scale spasticity)
   - MMT (Manual Muscle Test)
3. Machine Supported Measures
   - Movement smoothness (jerk)
   - Joint torques in different DOFs
   - End-effector forces, in Cartesian coordinates
   - Joint stiffness (change of torque vs. angle)
   - Muscle activity (EMG)
4. Tests
   - Wolf-Motor Function Test
   - Box and Block Test
   - 9-hole Peg Test

Question 19

State 3 approaches to assessing leg and gait function, with examples for each.

Answer 19

1. Conventional Measurements
   - aROM
   - pROM
2. Qualitative Clinical Scores
   - FMA-LE (Fugl-Meyer Assessment, Lower Extremity in stroke)
   - mAS (Modified Ashworth Score to scale spasticity)
   - TUG (Timed Up and Go = stand, walk 3m, walk back 3m, sit)
   - 6 min walk dist. or 10m walk time
   - Single Leg Balance Test
   - Self-selected Walking Speed, Fast Walking Speed
   - Skills scores (kind of gait assistance)
3. Machine Supported Measures
   - Movement smoothness (jerk)
   - Gait symmetry
   - Joint torques in different DOFs
   - GRFs (vertical and horizontal)
   - Joint stiffness
   - Muscle activity (EMG)

Question 20

State 2 approaches to assessing Activity and Participation, with examples for each.

Answer 20

1. Questionnaires
   - Motor Activity Log (MAL)
   - Barthel-Index
   - Stroke Impact Scale (SIS)
   - Short Form Health Survey (SF-36, SF-12)
   - Spinal Cord Independence Measure (SCIM)
2. Other
   - Goal Attainment Score (GAS)
   - different quality of life scores