lecture 4: experience based neuroplasticity & motor learning Flashcards
how does sleep influence neuroplasticity
facilitates storage and consolidation of earlier days learning
plasticity continues during sleep
what is reduced in major depression and can influence neuroplasticity
reduced hippocampus
mild stress during neuroplasticity will do waht
enhance learning/memmory
Chronic/ high stress during neuroplasticity can cause what
neuronal loss, especially in hippocampus
t/f : regular ex in mid to late life decreased risk of dementia
true
what are 5 things that aerobic improves/enhances
• Improves cognition
• Enhances neurogenesis
• Increases dendritic spine density
• Enhances angiogenesis
• Enhances long term potentiation
___ % walk post stroke
80
98% independently walked at 6 months IF what 2 things happened
independent sitting balance in 1st 3 days
and
LE strength of at a lease 1/5 HF, knee extensors and ankle DFs in first 3 days
upon admission to in patient rehab , if a pateint has a berg balance scale of < ___ and a FIM- L at a __ or ___ then they are 20x more likely to achieve house hold ambulation by DC
20
1 oe 2
AROM of ___ and ___ _ predicted 71% variance in UE function at 3 months
shoulder and middle finger
what is the gate speed needed to do these things
- unlimited house hold ambulation
-limited community ambulation
-unlimited community ambulation
- to cross a commercial stress
- community ambulation for adults without stroke:
Unlimited household ambulation: 0.27 m/sec
Limited community ambulation: 0.58 m/sec
Unlimited community ambulation: 0.80 m/sec
• To cross a commercial street: 2 m/sec
• Community ambulation for adults without stroke: at least 1.2 m/sec
Von Schroeder et al. reported that normal** 64 y/o** were able to ambulate with a speed of ___
m/sec while chronic stroke survivors of similar
age walked at ___ m/sec
1.07
0.8
what is considered the 6th vital sign
gait speed
a supported treadmill ambulation enchanes the normal reciprocating pattern of limb
movement during walking by decreasing challenges
faced by weakened muscles due to what 3 things
Gravity
Postural instability
Inadequate balance reactions
supported treatmdiull ambulation also enhances ___ ___ by providing repetitition of lumbar movements versus the typical asymmetric hemiparesis gait
motor learning
what are teh 3 neurology of walking
essential neuro anatomy
important neuro anatomy
accessory regions
muscle and peripheral nerves are part of what neurology of walking
essential neuroantatomy
what spinal cord pathways are apart of the essential nerupanatomy of walking
ventralateral and ventromedial
what 2 llocomotor regions are apart of the essential neuro anatomy of walking
mesencephalic and subthalamic locomotor region
what are the spinal cord CPG for essential neuroanatomy for walking
intrinsic circuits located in the ventral and intermediate gray matter that produces and repeats a functional behavior
for walking what does the spinal cord CPG (for essential neuroanatomy for locomotor contril) switch betweeen
flexors and extensors
\what are the 4 central properties of CPGs fir essential neuroanatomy
- invovled in intra- and inter- limb coordination
- react appropriately to sensory inputs
- they can recover
- they can learn
where is teh decision to walk made for the essential neuroanatomy
medial medullary reticular formation
what is the final integrate center for locomotion before the spinal cord
medial medullary reticular formation
what is consider the “Driving” center for locomotion in all animals
medial medullary reticular formation
what is the source of pathway that descends in ventrolateral cord to provide the tonic drive toCPG in the spinal cord
medial medullary reticular formation
the Medial Medullary Reticular Formation is Involved in inter-limb coordination via ___ loops that detect symmetry or asymmetry of limb
movement
feedback
why can PT’s influence gait at the level of the Medial medullary RF
even tho atypical gait is usually asymmetric , slow and attention dependent … in a support treadmill training , limbs can be moved at the same time so that feedback goes into the reticular system and then medial medullary RF can begin to develop a better “driver” for the CPG’s
Gait speed is important, since it will control level
of feedback provided to ___ via stretch-
sensitive muscle receptors.
cerebellum
When this region of midbrain is stimulated with E-
stim (in cats) locomotion is initiated with the
speed of movement consistent with the intensity
of the E-stim… what region is this talking about anf what would this maybe help modulate
Mesencephalic Locomotor Region and may help modulate speed of walking
what is the subthalamic locomotor region responsible for in essential neuroanatomy of walking
spontaneous goal directed locomotion
*The _____ is the top of the hierarchy, where you can identify the motivation to walk. Also explains why “fear” shuts down the system.
hippocampus
what are the 2 accessory regions for walking
-motor cerebral cortex
-pyramidal tract
what might the cerebral cortex participate in for walking ? but also the cortex would interfer with walking if what
may influence initiation, timing, the transition
from stance to swing, and the precise positioning
of the foot
may interfere with walking if attention is required for a task also
what are the 3 key sensory inputs operate the CPG
- stertch the hip flexor - resets the CPG
- unweighting of triceps surae (group of calfs) - gives legs permission to take step
- weight bearing to facilitate extensor tone in stance limb
what is the key phase of gait
hip extension during mid stance to heel off
why does stretching of the hip flexors help with walking CPG
bc hip extension during mid stance to heel off triggers swing of the limb via activation of the velocity and amplitude but if the hip is kept from extending (bc of tight HF) then walking stops soooo PT shoudl stertch the iliopsoas during key phase of gait and let the leg swing through
If walking is the goal for the patient what should u avoid walking on
static position control
the lokomat can progress a patient by what 4 things
increasing speed
increasing time
decreasing BWS
decreasing guidance forces
what can LEARNED NON USE occur with and what may it start with
can occur w overuse of other UE and compsnesatoin
may start w decreased sensation and/or motor abilities initially post stroke
one of the primary rationale of constraint induced movement therapy is the use - dependent or treatment induced ___ reorganization can which can occur with apportpraite and agressive treatment
cortical
another primary rationale of contraint induced movemtn therapy is that cortical mapping done by transcranial magnetic stimulation (TMS) or fMRI has
shown ___ in the muscle output area
size in the affected hemisphere.
increases
according to the cortical reorganization principles .. increased arm use occurs from what 2 things
Overcoming learned non-use
Use-dependent cortical reorganization
what are the 3 cortical reorganization principles
increased arm use
requires massed practice
requires high motivational drive and concentration
what is the constraint induced movement therapy flow
patient is learned non use, masked recovery of limb use > increased motivation > affected UE use > positive reinforcement > further practice & reinforcement > use dependent cortical reorganization > learned non use reversed , UE used in life situation
who are candidates for CIMT ( constraint induced movement therapy)
patients with CVA or TBI who meet the following criteria
- raise arm to 45°
- extend elbow at least 20°when shoulder is flexed to 90°
- extend wrist to 10-20° , slightly extend at least 2 fingers & extend/adb thumb at least 10°
- stand 2 min
*bowel and bladder continence - can understand adn follow directions
- medically stable and motivated
what are the 3 components of CIMT protocol
- Repetitive, task-oriented training
- Adherence-enhancing behavioral strategies
- Constraining use of less-affected UE
what does the wolf motor function test assess
times motor task and strength of the arm
what does the motor activity log assess
- amount of use
- how well arm is used
-participant interview
what does the stroke impact scale assess
- Strength
- ADL/IADL
- Social participation
- Physical domain
