Lecture 2 - Theoretical Frameworks

Question 1

Motor Control

Answer 1

Ability to regulate/direct mechanisms that are essential for movement

Question 2

What are the 3 theories of motor control

Answer 2

1) Reflex Theory: Reflex chaining as a basis for action. A stimulus leads to a response which becomes the stimulus for the next response, which becomes the stimulus for the next response
2) Hierarchical Theory: The CNS is organized in a top down structure in which higher centers control the lower centers (prefrontal cortex -> motor cortex -> prefrontal cortex)
3) Distributed Control/Systems Theory: Need to understand characteristics of the system you are moving, the external and internal forces acting on the body, need to consider mass, gravity, inertial forces, muscles, skeletal systems, and many systems work together to achieve movement

Question 3

What are some limitations to the reflex theory

Answer 3

Question 4

What is a limitation to the hierarchical theory

Answer 4

Doesnt explain dominance of reflex behavior in certain situations in normal adults

Question 5

What are some limitations to the distributed Control/Systems Theory

Answer 5

Question 6

Explain movement in terms of the task, individual and environment

Answer 6

Question 7

How do the motor control models play into the neurological rehabilitation models

Answer 7

Question 8

What are the 3 neurological rehabilitation models

Answer 8

1. Muscle re-education Approach: Based on polio where virus attacks CNS and loses innervation to peripheries. To compensate for loss, surviving motor neurons sprouted new nerve terminals to develop new large motor units and some recovery of movement
2. Neurophysiological Approach: Bobath discovered through treating children with cerebral palsy that primitive reflexes must be inhibited and tone/sensation normalized to promote normal movement patterns. Bruunstrom discovered through stroke that a person’s ability to control movement depends on spasticity (need to decrease to promote movement). Rood unveiled that their is homeostasis/balance between systems (eg. sympathetic vs parasympathetic). Kabat used proprioceptive neuromuscular facilitation (PNF) to re-educate movement patterns. Temple Fay focused on teaching normal movement patterns to children by emphasizing practice and repetition.
3. Motor Learning/Task oriented Approach

Question 9

What is Brunnstrom’s 7 stages of recovery

Answer 9

Question 10

What are 5 assumptions of the neurophysiological approach

Answer 10

Question 11

What are 3 clinical implications of the neurophysiological approach

Answer 11

Question 12

Combining the neurophysiological approach to the motor learning approach, what is our new focus with rehab of disorders

Answer 12

To strengthen the affected side as before we were only strengthening the unaffected side. So we need to focus on motor learning and task-oriented training of the affected side.

Question 13

What are 4 assumptions of the motor learning/task-oriented approach

Answer 13

Question 14

What are the clinical implications of the motor learning/task-oriented approach

Answer 14

Question 15

Neuroplasticity

Answer 15

Practice dependent to cause persistent long-lasting changes by reorganizing the brain to accommodate new data

Question 16

What happens to neuroplasticity after a stroke with no rehab

Answer 16

Nudo used monkeys to study this by giving them strokes

Question 17

What happens to neuroplasticity after a stroke with rehab

Answer 17

Nudo with monkeys again

Question 18

Does neuroplasticity increase or decrease from rehab following a stroke

Answer 18

Increases

Question 19

Can circuitry after a stroke be spared?

Answer 19

YEs although some structural and functional changes may happen to the circuitry

Question 20

What are the 6 steps of the model for development of learned non-use

Answer 20

Learned non-use is why the first 3 months of rehab post-stroke is crucial

Question 21

Explain the 5 steps of the constraint induced movement therapy (CIMT)

Answer 21

Question 22

What do you do in CIMT

Answer 22

Question 23

What are the 10 principles off Experience Dependent Plasticity

Answer 23

Question 24

Difference between learning vs performance in terms of neuroplasticity

Answer 24

Changes within a session do not reflect learning but rather to demonstrate new abilities it must be demonstrated over time
**Do many repetitive movements for neuroplasticity training following a stroke (see image)

Question 25

T or F: you should always match exercises to what the patient can do to prevent them from feeling defeated and wanting to give up

Answer 25

T

Question 26

What are 3 variations of practice that could impact motor learning

Answer 26

Question 27

Blocked vs random organization of practice and when you should use them

Answer 27

Question 28

Is true learning, retention, and resistance to decay better with blocked or random learning

Answer 28

Random is better for retention, true learning, and shows very little decay. Stage 2 and 3 (Fitt and Posner Theory) is best for random learning. In stage 1 you should use blocked practice to be able to learn the task and all its components

Question 29

Compare the feed back methods of knowledge of results vs knowledge of performance

Answer 29

Question 30

What are 3 types of feedback

Answer 30

Question 31

Whole vs part-task training

Answer 31

Question 32

How should the acute phase of rehab look post-stroke

Answer 32

-Early mobilization prevents or minimizes harmful effects of bedrest and deconditioning (minimized learned nonuse of hemiparetic extremities)
-Educate family and caregivers (about condition, risk factors, and recovery process)
-Control environment to enhance patient attention (be aware of visual field deficits and perceptual changes of the patient)
-Spend approx 5 days in acute care hospital , but too early of discharge can lead to complications/setbacks in the rehab setting

Interventions include:
1) Functional Mobility Training (bed mobility, sitting, transfers, locomotion)
2) ADL training
3) ROM
4) Splinting
5) Positioning

Question 33

How should a therapist talk to a stroke patient

Answer 33

1) Talk slowly
2) Normal tone and volume
3) Giving adequate time to respond
4) Using simple yes/no questions
Gestures and tactile cues

Question 34

How should the sub-acute phase of rehab look post-stroke

Answer 34

-Referred to inpatient rehab if can handle intensive therapy of 6 days per week for a minimum of 3 hours each day
-Referred to transitional care unit if they require less intensive therapy that are 5 days per week for 60-90 mins
-Shorter onset to admission to one of these units (within 20 days) is correlated to a greater prognosis of recovery
-Other factors that influence timing of rehab are: medical stability, severity of cognitive-perceptual deficits, motivation, patient endurance, and recovery

Question 35

How should the chronic phase of rehab look post-stroke

Answer 35

-More than 6 months post-stroke in outpatient rehab setting, community, or at home
-use other interventions like constraint-induced movement therapy, bilateral training, VR training, and electromechanical assisted walking
-Interventions take place 2-3 times per week for 60-90 mins
-Interventions target to improve flexibility, strength, balance, locomotion, endurance, and UE function
-Need to examine and modify environment for return to home
-Patient should be assisted in resuming participation in community and recreational activities (eg. Monitoring endurance and using energy conservation techniques)
-Water based programs and community fitness programs shown to improve function post-stroke
-Services should be gradually phased out but follow-up visits should occur periodically for long-term maintenance of function