Midterm Flashcards
1
Q
What is a nerve cell (neuron)?
A
- Basic part of our nervous system
- very specialized
- sends messages very rapidly
2
Q
Nerve cell parts
A
cell body
dendrites
axons
3
Q
How many neurons are the in the human brain?
A
86 billion neurons and 10000 as many connections
4
Q
Dendrites
A
thin structures that arise from the cell body
giving rise to a complex “dendritic tree
5
Q
Axon
A
A special cellular extension that arises from the cell body and travels for a distance as far as 1 meter in humans or even more in other species
6
Q
Cell body
A
a neuron might have multiple dendrites, but usually only one axon although the azon may branch hundred of times before terminate
7
Q
Direction of most neurons
A
one way
8
Q
Myelin
A
Electrically insulating material that forms a layer, the myelin sheath, usually around only the axon of a neuron. It is essential for the proper functioning of the nervous system.
myelin increase the electrical resistance across the cell membrane. Thus myelination helps prevent the electrical current from leaving the axon
Gap between myelin –> nodes of Ranvier
9
Q
Function of Myelin
A
increases the speed at which impulses propagate along the myelinated fiber
10
Q
Types of fibers based on coverage by myelin:
A
Unmyelinated fibers
Myelinated fibers
11
Q
Unmyelinated fibers
A
impulses move continuously as waves (Slow)
12
Q
Myelinated fibers
A
impulses hop (Fast)
13
Q
Origin of myelin
A
produced by oligodendrocytes in the CNS (not able to regenerate)
-Produced by Schwann cell in PNS (able to regenerate)
14
Q
Multiple Sclerosis (MS)
A
Abnormal immune reaction believed to attack myelin
-in MS, an abnormal immune system response produces inflammation in the central nervous system
15
Q
MS PROCESS
A
- damages/destroys myelin and oligodendrocytes
- produces damaged areas (lesions or scars) along the nerve, which can be detected on magnetic resonance imaging (MRI)
- slow or halts nerve conduction - producing the neurologic signs and symptoms of MS
- Causes damage to the underlying nerve fiber
16
Q
What symptoms would you expect when the myelin is damaged (MS)
A
weakness double vision fatigue slow vestibular reactions permanent damage to myelin may cause nerve death visual impairment paresis paralysis
17
Q
LABEL DIAGRAM
A
SLIDE 14 and SLIDE 15
18
Q
Types of nerve fibers based on their thickness Type A fibers
A
-Thickest and fastest conducting, myelinated, diameter of 1.5-20 micron
Speed of conduction is 4-120 m/sec
Examples: skelemotor fibers, fusimotor fibers and afferent fibres from skin.
19
Q
Types of nerve fibers based on their thickness Type B fibers
A
Medium in size, < Type A fibers; > type C fibers; myelinated, diameter of 1.5-3.5 micron; speed of conduction is 3-15 m/sec
Ex. Preganglionic autonomic efferent
20
Q
Types of nerve fibers based on their thickness Type C fibers
A
smallest and slowest; not myelinated; diameter of 0.1-2 microns; speed of conduction is 0.5-4 m/sec
Ex. Postganglionic autonomic efferent fibers to skin
21
Q
Synapse
A
A synapse is a structure that permits a neuron to pass an electrical or chemical signal to another cell. The plasma membrane of the signal-passing neuron ( the presynaptic neuron) comes into close apposition with the membrane of the target (postsynaptic) cell
22
Q
Types of Synapses
A
Electrical synapses
Chemical Synapses
23
Q
Electrical Synapse:
A
pre-synaptic and post-synaptic cell membranes are connected by special channels called gap junctions that are capable of passing electric current, causing voltage changes in the presynaptic cell to induce voltage changes in the postsynaptic cell. The main advantage of an electrical synapse is the rapid transfer of signals from one ell to the -transmission can be bidirectional
-transmission can be very fast
24
Q
Chemical Synapse
A
Electrical activity in the presynaptic neuron is converted into the release of a chemical called a neurotransmitter that binds to receptors located in the plasma membrane of the postsynaptic cell
25
Resting Potential
When at rest, neuron has negative charge (potential) on the inside of the cell, with respect to the outside. Resting potential is about -70mV. The resting potential is caused by an unequal concentration of chemical ions on the inside versus outside the cell
26
Action potential:
When a neuron is excited , there is a series of jumps in voltage across the cell membrane. These action potentials (nerve impulses) that take the voltage to about +30mV
27
Resting action potential threshold
about -55mV the action potential can cause excitation/inhibition in the next neuron by releasing neurotransmitters
28
Summation
-enough action potentials might build-up the depolarization to the threshold voltage for the action potential in the next neuron.
29
Types of summation:
| Spatial summations
Action of multiple cells synapsing on the post synaptic neuron (multiple neurons affecting one neuron)
30
Types of summation: Temporal summations
synaptic potentials occur close together in time
31
Impact on the next neuron (action potential) (two functions on the postsynaptic terminal)
facilitation, inhibition
32
Neurotransmitters
chemicals that transmit signals across a synapse from one neuron to another "target" neuron
- Neurotransmitters are released from synaptic vesicles in synapses into the synaptic cleft, where they are received by receptors on other synapses.
1. be released from presynaptic terminals
2. Bind to receptors
33
What do medications/drugs do to your nervous system (4 points)
1. change speed/volume of production level of neurotransmitters
2. change speed/volume release of neurotransmitters
3. Act as a neurotransmitters
4. Block re-storage of neurotransmitters to the presynaptic cell
34
cocaine steps
dopamine: stimulates the reward pathways of the brain
cocaine: blocks the dopamine reuptake pumps
unable to be removed, there is overstimulation of deopamine
35
Addictive Process
CNS is flooded with with neurotransmitters dopamine--> decreased production of dopamine--> craving for the addictive substance
36
Synaptic Fatigue
occurs because of neurotransmitters deletion due to the repetitive stimulation of a pre-sympathetic neuron.
37
Functional Classifications of neurons Afferent Neurons (sensory Neurons)
Convey information from tissues and organs into the central nervous system
38
Functional Classifications of neurons Efferent neurons (motor neurons)
transmit signals from the central nervous system to the effector cells.
39
Functional Classifications of neurons Interneurons: connect
connect neurons within specific regions of the central nervous system
40
Structural Classification: Central Nervous System (CNS)
Brain
| Spinal Cord
41
Structural Classification: Peripheral nervous system (PNS)
Nerves that extend from the brain and spinal cord
| -spinal nerves and cranial nerves
42
Forebrain Parts:
Cerebral hemispheres:
- cerebral cortex
- subcortical white matter
- basal ganglia
- Thalamus
- Hypothalamus
43
Overview of the human CNS Components
Forebrain
Midbrain
Hindbrain
Spinal Cord
44
Neural Tube defects (two Examples)
1. Anencephaly
| 2. Spina bifida
45
Nervous System morphology:
Gray matter
| White matter
46
Grey matter
concentration of nerve cell bodies
47
Grey matter in CNS
Surface of hemispheres => Cerebral cortex
Middle of spinal cord--> grey matter of spinal cord
Deep within hemispheres and brainstem => Nuclei
(large cluster of cells in white matter including):
Thalamus
Cranial nerve nuclei
basal ganglia
48
Gray Matter in PNS
Clusters of cell bodies in the PNS => CLusters of cell bodies in the PNS => Ganglia
49
Greay and white matter
| in spinal cord:
- Dosal horn has sensory
| - ventral (anterior) horn has motor function
50
White matter
Myelinated axons in the CNS and PNS
| Afferent, Efferent, Interneurons
51
Spinal Cord
| segments
```
located in spinal column
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
Spinal cord ends at L1 or L2 (below this point the spinal canal includes cauda equina
-
```
52
Lumbar Puncture
Many conditions can be detected by the spinal Tap
infection of the membranes surrounding the brain and spinal cord (meningitis)
-bleeding (eg. subarachnoid hemorrhage, stroke)
-viral infection (encephalitis)
-Tumors (lymphoma, cancer)
-Autoimmune disorders like ms
53
Spinal Cord: spinal nerves arise from segments f spinal cord:
Each segment gives rise to both sensory and motor nerves
Dorsal nerve roots (sensory)
| Ventral Nerve roots (motor)
54
Spinal Cord Function: ( 3 points)
1. Carrying sensory and motor information to and from the brain
2. Some of the reflexes
include autonomic nervous system (ANS)
(control of respiration and coughing)
55
NAME THE PARTS OF THE SPINE WE HAVE TO REMEMBER
```
C5 and C6 helps you use of your thumb
T4 - Chest level
hold their head up
-most upper extremity works
-might have dexterity problems
-no lower limb function
no abdominal control
T10 (belly button level)
function upper limb well, control of head and some abdominal control, no lower limb function
```
56
A flexor reflex
| Flexor (withdrawal) reflex in upper limb
Pain Stimulus...... to dorsal root out ventral root
| -Flexor Stimulated, Extensors
57
Flexor Withdrawal Reflexes
| Flexor reflex in lower limb
Flexor(withdrawal) Reflex occurs during withdrawal of foot from pain
-polysynaptic reflex arc
-neural circuitry in spinal cord controls sequence and duration of muscle contractions
right leg Sensory Neuron --> motor neuron to right leg -extensors relax flexors contract
left leg -extensors contract and flexors relax
58
Pain is recieved on what side of the brain
opposite side of pain being felt
59
Autonomic Nervous System (ANS)
- is part of the peripheral nervous system
- functions unconsciously
- Controls visceral functions
60
Divisions of ANS
Sympathetic -flight or flight
| Parasympathetic -rest and digest
61
ANS is controlled by:
Limbic system
Hypothalamus
Afferent Information
62
Functions of Sympathetic
```
Heart
-increases heart rate
-increases force of contraction
Blood Vessels
-Constriction
Lungs
-Bronchodilation
GIT
-Decrease mobility
-Sphincter contraction
-Decreased Secretions
```
63
Function of parasympathetic
```
Heart
-decreases heart rate
-decreases force of contraction
Blood Vessels
-no effect
Lungs
-Bronchoconstriction
GIT
-increase mobility
-Sphincter relaxation
-increase Secretions
```
64
Cerebral Cortex
| Sulci (plural for sulcus)
Numerous infolding or crevices
| Fissure is a deep sulcus
65
Cerebral Cortex
| Gyri (plural for gyrus)
Bumps or ridges between sulci
66
longitudinal fissure
(or cerebral fissure, medial longitudinal fissure or interhemispheric fissure) is the deep grove that separates the two hemispheres of the brain
67
Sylvain Fissure (lateral sulcus)
The lateral sulcus divides both the frontal lobe and parietal lobe above from the temporal lobe below.
68
Central Sulcus (also what are the names of of the gyrus before and after
is a fold in the cerebral cortex in the brains of
vertebrates between the parietal and frontal lobe
-precentral gryus
-post central gyrus
69
Lobes of the cerebral cortex
```
Frontal lobe
Parietal Lobe
Temporal Lobe
Occipital Lobe
+ Insula
```
70
insula
Deep to sylvain fissure - that is where we can see the insula
-more related to limbic system which is related to our emotions
71
Corpus Callosum
Connects the hemispheres
consists of white matter
the great mediator
72
Primary Sensory and motor areas of cortex (5)
1. Primary motor cortex
2. Primary somatosensory cortex
3. Primary auditory cortex
4. Primary Visual cortex
5. Prefrontal association area
73
Location/what does it do: Primary motor cortex
precentral gyrus (frontal lobe) when we want to move
in front is the motor association works when it is hard or when it is a new thing area (premotor cortex and supplementary motor cortex)
ex walking primary motor cortex
motor association when your learning to ride a bike until it becomes less complex
74
Location/what does it do: Primary somatosensory cortex
```
postcentral gyrus (parietal lobe)
Sensory information from skin, musculoskeletal system, viscera and taste buds
```
75
Location/what does it do: Primary auditory cortex
temporal lobe
| hearing
76
Location/What does it do: Primary Visual cortex
occipital lobe
| Vision
77
Location/what does it do: Prefrontal association area
frontal lobe
Coordinates information from other association areas, controls some behaviours
Reasoning skills
78
Blurred vision: damage to what lobe
occipital lobe
79
Problem in critical thinking: damage to what lobe
frontal lobe
80
Movement problems: damage to what part of the brain
frontal lobe and/or cerebellum
81
Sensation Problems: damage to what lobe
parietal lobe
82
Responsibilities of each brain hemisphere: Left
```
analysis
logic
lists
numbers
words
lines
```
83
Responsibilities of each brain hemisphere: Right
```
Colours
Daydreaming
3D
Rhythm
Imagination
Synthesis
```
84
Homunculus (little man)
is a representation of a small human being. It has historically referred to the creation of a miniature, fully formed human
sensory map of the human body
what part of our body is related to what part of cortex
85
Different parts of our body demonstrates different degrees of two-point discrimination why?
-the more we use it the bigger it is on the cortex
-tongue is big compared to toes
fingers are big as well as thumb
86
What if a person used legs more-does the homunculus change?
-if a person uses legs more the homunculus will change studies have shown this
87
Brain stem
posterior part of the brain, adjoining and structurally continuous with the spinal cord
Includes: midbrain
pons
meddulla obongata (connects the brain with spinal cord)
88
Midbrain
Vision, hearing, eye movement and body movement
89
Pons
Motor control and sensory analysis
90
Medulla
Maintaining vital functions such as breathing and heart rates
91
Whiplash injury can break what:
Odontiod process of xis. The fracture might damage the medulla and cause death
92
Menginges: layers
```
membranes that envelop the brain and spinal cord
Layers:
1. Pia mater
2. Arachnoid Mater
3. Dura Mater
```
93
Menginges Function:
1. protecting the brain and spinal cord from mechanical injury
2. Providing blood supply to the skull and to the hemispheres
3. Providing a space fro the flow of cerebrospinal fluid (CSF).
94
Cerebrospinal Fluid (CSF): where is it found and produced
- a clear colorless bodily fluid in the brain and spine
- occupies the subarachnoid space (the space between the arachnoid mater and the pita mater) and the ventricular system around and inside the brain and spinal cord
- Produced in the choroid plexus of the brain
95
CSF functions:
1. A cushion or buffer for the brain's cortex
2. A basic mechanical and immunological protection to the brain inside the skull
3. Clearing waste
96
Choroid Plexus location
In lateral ventricle, third ventricle and fourth ventricle
97
Upper motor Neuron (UMN) starts at
Motor region of the cerebral cortex; or in the brain stem ends where it connects with the LMN
and the spinal cord
98
Upper motor Neuron (UMN)
| Function
UMN controls LMN
1. Carry motor information down to the lower motor neurons
2. Send messages to start and stop muscle contraction
99
Lower motor Neuron (LMN) includes:
- the spinal cord motor neurons; and
| - cranial nerves with motor function in brain stem
100
Lower motor Neuron (LMN) function:
1. Innervate skeletal muscle fibers
2. Send messages to start muscle contractions
- -> for voluntary movement, both the UMN and LMN should be intact
101
Driver and car analogy
driver (UMN) -has control to start or stop the car
Engine (LMN) - can only cause movement
wheel - Muscle
as soon as the driver hits the gas -the wheels start rolling the muscle
-as soon as he hits the brake the car stops
-damage to LMN- wheel wont turn (flaccid / soft no tone hand will fall down)
-driver is unconscious ( no control) -car goes faster and faster - gas is always on (spacity) muscles are working without control
102
UMN Lesion (UMNL)
weakness and spasticity, hyperreflexia, disuse atrophy (stroke, cerebral palsy)
103
LMN lesion (lesion):
Weakness, hyporeflexia, wasting atrophy (eg facial palsy, disk herniation)
104
Hypotonicity
abnormal decrease in muscle tone
Cause:
LMN lesions:
-Damage to the motor neurons in the ventral horn
-damage to the spinal nerves in the periphery
Lesions to posterior cerebellar lobe (neocerebellar lobe) produce hypotonicity and hyporeflexia
105
hypertonicity
abnormal increase in muscle tone, accompanied by resistance to active and passive movement
Cause:
UMN damage
Lesions to the anterior cerebellar lobe (paleocerebellum lobe ) produce hypertonicity and hyperactive reflexes
106
Normal muscle tone:
The internal state of muscle-fiber tension within individual muscles and muscle groups
107
Damage to T10
Can cause damage to CNS and PNS
108
Damage to L5
causes damage to PNS but not CNS
109
Deep Tendon Reflexes (also called muscle stretch reflexes or myotonic reflex
muscle contraction when its tendon is percussed
- deep tendon reflex works on the principle of the spinal reflex arc.
- Common deep tendon reflexes: Biceps, brachioradialis, triceps, patella (knee), and achilles tendon (ankle)
110
UMNL (deep tendon reflexes)
deep tendon reflexes become hyper-reflexes
111
LMNL (deep tendon reflexes)
Deep tendon reflexes become hypo-reflexive
112
Receptor:
Muscle spindles (stretch receptors- sensitive to quick stretch)
113
Quick Stretch:
Muscle spindles stimulated -> increased muscle tone in the agonist (decreased tone in the antagonist)
114
Slow and Constant Stretch
Golgi tendon organs stimulated --> relax the muscle
115
Motor Pathways
| The most important motor pathways are
Pyramidal system :
1. Corticospinal Tract: connecting cortex and spinal cord
2: Corticobulbar tract: connecting cortex with medulla
Extrapyramidal system
116
Feedback Systems
the most important components are cerebellum and basal ganglia
117
Corticospinal Tract (Pyramidal tract)
- Connects cerebral cortex to the spinal cord with no synapses in the brain stem
- 85% of pyramidal tract fibers cross over at pyramidal decussation which is junction of medulla and spinal cord
Role: Fine movements associated with skills
118
Extrapyramidal tract
The extrapyramidal system represents part of the motor pathway system that has synapses within the brain stem
-Modulates anterior horn cells of the spinal cord and is involved in reflexes, locomotion, complex movements, and postural control
Role: Posture and gross motor activities
119
Cerbellum
- Plays an important role in coordination
- Does not initiate movement, but continues to coordination, precision, and accurate timing.
- Receives input sensory systems of the spinal cord and other parts of the brain, and integrates these inputs to fine-tune motor activity
120
Cerebellum Structure and Function:
Has two hemispheres and a vermis
-vermis is associated with bodily posture and locomotion
-Left hemisphere is responsible for left side of our body
Coordinates:
Fine movement
-Equilibrium
Posture
Motor Learning (visually triggered and guided movements)
-Modulates muscle tone
121
Malfunction of the cerbellum
```
Wide base gait
Dysmetria
Dysdiadochokinesia
Intention tremor
Macographia
```
122
Basal Ganglia location
```
Is situated at the base of the brain
Connects with:
-cerebral cortex
-Thalamus
-Brainstem
```
123
Basal ganglia Function
control of:
- voluntary motor movements particularly internally generated movements
- Procedural learning
- Routine behaviours or "habits"
- eye movements
- cognition and emotion
124
Basal ganglia includes
- Striatum (caudate nucleus and putamen)
- the globus pallidus
- the substania nigra: the source of the neurotransmitter dopamine, which plays an important role in basal ganglia function
- The subthalamic nucleus
125
Basal Ganglia Dysfunction:
1. Disorders of behvaiours control: eg obessive-compulsive disorder
2. Movement disorders:
- -> Parkison's disease involves degeneration of the dopamine-producing cells in the substania nigra
- Huntington's disease
126
Approaches to Motor Behaviour
| 1. Neurophysiological approach
A. Reflex model
B. Hierarchical model
C.Neuromaturation theory
127
Approaches to Motor Behaviour
| 2, System based task-related approaches
A. Systems model of motor control
| B. Ecological approach to perception and action
128
Reflex Theory
Reflex is an action that is performed as a response to a stimulus and without conscious thought.
129
Hierarchical Theory
- System has several level of control
| - Each level subordinates to the one above it
130
Neurophysiological approaches
| Models of motor control
1. Reflex model
2. Hierarchical model
combine to make Reflex-Hierarchical model
131
Reflex-Hierarchical Model
| movements and needs
Movements:
Elicited by sensory input, or controlled by central program
Needs:
Open-loop system: system uses pre-programed instructions, do not use feedback
Closed loop system: system that feedback to correct movements and achieve planned movement
132
Reflex-Hierarchical Model of Motor Control cycle
1. Motivation to move is generated
2. Long-term memory is searched
3. Program is developed and adapted
4. Program is executed
5. Feedback from sensory information (feedback to step 2)
6. Program is stored in memory for future use
133
C. Neuromaturation theory of motor development
1. CNS maturation
2. Predictable sequence
3. Damage causes regression
4. Environment has limited role in CNS outputs
134
```
CNC lesions (from neurophysiological approach)
Recovery:
```
motor dysfunction following CNS is related to the site and extent of the lesion
Recovery:
-is due to change in the CNS
-Follows a sequence
-Can stop at any level along the continuum
-The speed of early recovery gives clue about the ultimate level of recovery
135
```
CNC lesions (from neurophysiological approach)
Assessment (focused on the abilities and capacities impaired by CNS damage)
```
-Bottom-up evaluation framework
-Focused on impairments due to the CNS lesion
Include: muscle tone, abnormal reflexes, movement patterns, postural control, sensation, cognition and perception
136
Ecological Approach
| Emphasis on:
Emphasis on: interaction between the person and the environment during every function task
- close linkage between perception and action
- Goal directed and object presented activities result in more efficient movement patterns
- When learning a new activity coordinative structures (ie. muscles that work together for a certain task) work together.
137
Systems model of motor control:
Empaisis on:
- ->Interaction between the person and environment/task
- ->Motor behaviour emerges from multiple system interacting with unique task and environmental contexts
- Nervous system is one of the systems involved in motor behaviour
- Nervous system works heterarchically so higher centers interact with lower systems but do not control them
138
Systems model of motor behavior
Role Performance (Social participation)
Occupation performance tasks (Performance in Areas of Occupation)
Cognitive- connected with -psychosocial and sensorimotor
Physical - Connected with- Socioeconomic and Cultural
139
Chart:
| Models of motor control:
Neurophysiological approaches:
Reflex-Hierarchical
OT task oriented approach:
Systems
140
Chart:
| Theory of motor Development
Neurophysiological approaches:
Neuromaturational
OT task oriented approach:
Systems
141
Chart:
| Assumptions therapeutic approaches
Neurophysiological approaches:
- CNS is hierarchically organized
- Sensory input inhibits and facilitates movement
- Repetition
- CNS recovery has predictable sequence
- Behavioural changes due to changes in neurophysiology
OT task oriented approach:
- P, E and CNS are hierarchically organized
- Functional tasks organize behaviour
- Various ways of doing task
- Recovery is based on environment
- Behavioural changes due to compensation to complete a task
142
Chart: Evaluation
Neurophysiological approaches:
Performance components: muscle tone, Reflexes, stereotypical patterns, Postural control, sensation and perception, memory and judgement, stage of recovery
OT task oriented approach:
Performance components with client-centred approach and Task analysis
143
CNS Lesions (from OT task oriented approach)
- Following CNS damage, the person compensates for the lesion to achieve functional goals.
- Recovery is a process of discovering what abilities and capabilities remains to enable activity performance
- Therapist must consider all systems to be able to explain the behaviour for each specific task.
144
Assessments - OT task oriented approach (CNS lesions)
-Top-down approach
Include: Task analysis to determine the performance components and context that limit function
-Identify preferred movement patterns
-Transition to new patterns
145
Pt Procedure based on system based-task-oriented approach
Referral -->
Role checklist-->
Interest checklist -->
COPM -->
Task analysis (task factors, Person factors evaluation, Environment factors evaluation) -->
Identify the control parameters -->
Evaluate the stability of the motor behaviour-->
Generate individualized treatment goals "just right challenge"
146
Motor characteristics of CNS dysfunctions
1. Primary motor impairment
- Positive: spacity, hyperreflexia
- Negative: weakness, fatigue, slowness, lack of coordination, balance problems
2. Secondary impairments
3. Adaptive features or synergies or maladaptive strategies
147
Brunnstrom Movement Therapy Approach
| Assumptions:
- Spinal and brainstem reflexes (modified) --> Purposeful movements
- Stroke causes "development in reverse"
- Use proprioceptive and exteroceptive stimuli
- Progress happens in sequence
- Practice newly learned patterns of movement
- Practice with ADL
148
Brunnstrom Movement Therapy Approach
| General treatment sequence:
1. Uses reflexes eg. associated reaction
2. Isometric contraction
3. Eccentric contraction (most effective)
4. Concentric Contraction
5. Repetition
6. Function
149
Brunnstrom stages of recovery for upper limb
Stage 1; Flaccid paralysis
Stage 2: Development of minimal movement in synergies
Stage 3: Voluntary movement synergy dependent
Stage 4: Some movements out of synergy
Stage 5: Movements almost independent of synergy
Stage 6: Isolated motor control ; Minimal spasticity
Stage 7: Normal speed/coordination of motor function
150
Stage 4
- Hand behind back
- Arm to forward horizontal position
- Pronation supination + elbow ext
151
Stage 5:
- Arm forward and overhead
- Arm to side horizontal position
- Pronation supination + elbow flex
152
Brunstorm (1951)
- Reflexes and associated reaction
- Flexor and extensor synergies
- Stages of recovery (specially arm)
- Use reflexes and hypertonicity for getting movements
153
Bobath/Neurodevelopmental (NDT) approach
| Hemiplegia is associated with:
-Loss of normal movements
-Development of abnormal movements
combined (cause of abnormal patterns)
154
Bobath/Neurodevelopmental (NDT) approach:
| hemiplegia cause:
- Loss of postural control
- Loss of selective movement control
- Abnormal tone
- Associated reaction
--> Problem in weight shifting
--> problem in functional performance
155
NDT treatment
```
Goal:
-Normalizing tone
-Improving coordination
-Retraining movement responses
By Handling:
-Positioning
-Controlling abnormal reflexes
-Activate normal responses
Combined: reeducate normal movements
```
156
Bobath Neurodevelopmental Therapy (1970)
- Spasticity is the obstacle to move
- Once the person is used to using a synergy, it is hard to get back t normal patterns
- Abnormal patterns are secondary to maladaptive synergies
157
Rood Approach
Involves superficial sensory stimulation and feedback to the affected extremity by means of:
Brushing
-Light touch (stroking)
-Tapping
-Icing
-Vibration
Sudden or gentle stretching of the muscle
158
Proprioceptive Neuromuscular Facilitation (PNF)
| Based on the principles of normal human development:
- Mass movements precede individual movements (not always)
- Reflexive movements precede volitional movements (not always)
- Most developments occur cephalically to causdally (not always)
- Control is gained proximally prior to distally (not always)
159
Proprioceptive Neuromuscular Facilitation (PNF)
Involves repeated muscle activation of the limbs
Uses different techniques such as
Quick stretching
traction
approximation
maximal manual resistance in functional directions
Use of a diagonal patterns to assist with motor relearning and increasing sensory input
160
Rood and PNF (mid-20h century)
Developmental model like an infant
- Proximal - distal approach to treatment
- Using sensory stimuli
161
What is the difference between learning and training
Goal of training: to memorize a prescribed solution to selected task challenge
Goal for learning: to develop own solution which can be applied to many situations
Difference in setting
-Repetition
-Type of task
-When we get to our goal: Persistence over time (applied in different situations)
Problem solving
Active engagement
Prepare for underlying motor, cognitive and social determinants of occupation
162
Task-oriented treatment Principles #1
Client centred
| -Client centered and active participation of the person
163
Task-oriented treatment Principles #2
Occupation Based
- Use functional tasks rather than practicing specific movements
- Use meaningful tasks
- Task analysis
164
Task-oriented treatment Principles #3
Therapist as a coach
- Encourage performance
- Discourage adaptation that limit effectiveness
- Help patient know the goal
- Not too much focus on the task movements rather attention to the task completion
- Practice in real environment
- Relearn effective strategies
- Practice in a variety of tasks rather than repeating the same task
- Provide: written directions, photographs, drawings
- Group program
165
Task-oriented treatment Principles #4
```
Person and Environment
Identify factors that:
-Influence occupational performance
-can change outcome
might change
Adapt the environment
Use natural objects and environment
```
166
Somatosensory System
| Main parts
1. receptors
2. Somatosensory pathways
3. Thalmus
4. Somatosensory cortex
167
Types of Sensory Receptors
| Exteroceptors
- Receptor for the reception of stimuli from the external world (outside of the body)
- ex visual, aditory, tactile, olfactory, and gustatory receptors
168
Types of Sensory Receptors
| Interoceptors
Receive sensory information from inside the body - eg. from viscera (hollow organs and glands)
Detect internal bodily sensations: stomach pain and pinched spinal nerves
169
Types of Sensory Receptors
| Proprioceptors
Located in the muscles, tendons and joints of the body, and in the utricles, saccules and semicircular canals of the inner ear
-Detect body position and movement
170
Peripheral Receptors
a. Muscle spindles (active in stretch reflex loop)
b. Golgi Tendon Receptors
c. Joint Receptors
d. Cutaneous Receptors
171
Muscle Spindles Location
Proprioceptors located within the belly of the muscle
172
Muscle Spindles function
Detect changes in the length of the muscle and send length information to the CNS via sensory neurons.
This information is then processed by the CNS to determine the position of body parts.
2. detect static length of whole muscle
3. Active in stretch relax loop
Stretch in muscle spindles results in contraction of the muscle and inhibition of the antagonists
173
Highest muscle spindle density is found in
Extraocular muscles (eyes)
hand muscles -dexterity
neck muscles -very sensitive (brain needs to know how head is located)
174
Golgi Tendon Organs (GTO) Location:
At the muscle-tendon junction
| -Afferent information from the GTO is carried to the nervous system
175
Golgi Tendon Organs (GTO) Function:
Sensitive to tension changes that result from either stretch or contraction of the muscle
-inhibits its own muscle and excites its antagonist
176
Joint receptors location
Joints
Afferent information rom joint receptors ascends to the cerebral cortex and contributes to perception of our position in space (proprioception)
177
Joint receptors function:
Provide a danger signal about extreme joint motions
| -CNS determines joint position by monitoring which receptors are activated.
178
Cutaneous Receptors
```
Location: skin
Function: sense of:
-touch
-Pressure
-Vibration
-Temperature
-Pain
```
179
Somatosensory pathways to spinal cord -what are the two pathways
Anterolateral pathway
(cross over in the spinal cord)
--> pain, temp and touch
Posterior Column Pathway
(cross over at the medulla)
-->proprioception, vibration, fine, and discrimination touch
180
Thalamus
All sensory information (except olfactory) is first organized through the thalamus before it travels to the cortex for interpretation
- The thalamus is the gateway to the cortex
- The thalamus also receives motor information from the cerebral hemispheres and relays it to the motor receptors
- The thalamus has a role in sleep-wake cycles and consciousness
181
Hypothalamus
Most important Function: links the nervous system to the endocrine system
-Controls body temp, hunger, sex behaviour, thirst, fatigue, sleep and circadian rhythms
182
Somatosensory Cortex
Lies in the Postcentral gyrus
| -Involves sensation of opposite side of the body
183
Overview Cycle (somatosensory)
```
Receptor
Somatosensory pathways
Thalamus
Somatosensory Cortex
Motor Cortex
Corticospinal tract
Spinal Cord
Muscle
```
184
Association Cortex Location
the cerebral cortex outside the primary areas
185
Association Cortex Function
Essential for mental functions that are more complex than detecting basic dimensions of sensory stimulation
- Association areas take up an increasingly larger percentage of the cerebral cortex as brain size increase among different species
- the increasing size of association cortex correlated with the complexity of behaviour and inferred mental functions that different species show
186
Primary Auditory Cortex Function and location
Function: Understanding language when listening
Location: Superior temporal Lobe (wernicke's area dominant hemisphere (left side) )
187
Primary Visual Cortex Function and location
Function: Understanding language when reading
Location: Occipital lobe (wernicke's area dominant hemisphere (left side))
188
Primary Auditory and Primary Visual Cortex Syndrome
Receptive (sensory or Wernicke's) aphasia
189
Broca's Area function, location and syndrome
Function: Movement in lips, tongue, face and larynx
Location: adjacent to motor cortex in frontal lobe (left side)
Syndrome: Expressive (motor or Broca's) aphasia
190
Visual Association Cortex function, location, and syndrome
Function: Complex processing of visual information
Location: Parieto-occipital and inferior temporal lobes
Syndrome: Prosopagnosia (inability to recognize faces) Achromatopsia (inability to recognize colours)
Visual Hallucinations
191
Apraxia: damage to
Frontal or left parietal lobe
192
Hemineglect, Anosognosia (unaware of deficit): damage to
Parietal lobe (R)
193
Cerebral Circulation
Brain derives its arterial supply from the carotid and vertebral arteries
- Internal carotid arteries and branches supply anterior anterior 2/3 of cerebral hemispheres
- Vertebral and basilar arteries supply posterior and medial regions of hemispheres, brainstems, cerebellum and cervical spinal cord
194
Circle of Willis
```
(anterior Cerebral Artery
Internal Carotid artery
Posterior Communicating artery
Posterior Cerebral Artery
Anterior Communicating artery)
Circle of willis
Middle cerebral artery
Basilar Artery
Vertebral Artery and posterior Inferior Cerebellar Artery
```
195
Chronic Condition
any condition that present itself for longer than six months, involves slow changes and may be controlled but is often not curable
196
Chronic Conditions can be various health related states such as:
```
syndromes, physical impairments, disabilities, as well as diseases:
-infectious diseases
-Non-infectious diseases (non-communicable)
-Hormonal disorders
-Addictions
-Autoimmune diseases
-Pain Syndromes
Psychiatric Conditions
```
197
Chronic Conditions in Canada
- 33%of Canadians live with one or more chronic condition
| - On average every Canadian older than 65 has 2 or more chronic conditions
198
Chronic Conditions in Canada: Health care utilizations:
51% of family physician/general practitioner consultations
- 55% of specialist consultations
- 66% of nursing consultations
- 72% of night spent in hospital
199
Chronic Disease in Ontario
- most frequent among older Ontarians
- 80% of those over the age of 45 are living with a chronic condition
- 70% of chronically ill Ontarians over the age of 45 have multiple conditions
- -In ontario, chronic diseases account for 55% of direct and indirect health costs
200
People with Neurological conditions in Canada
- use more universally insured health services than average Canadian with chronic health condition
- Are heavy users of health care services not included in universally insure services
- Make extensive use of formal and informal caregiving
- Have out-of-pocket expenses even if they have medical insurance
201
People with Neurological conditions in Canada
| Use more:
physiotherapy,
social work,
occupational therapy, audiology, and speech therapy than other Canadians, even those with two or more non-neurological chronic conditions
202
Comorbidities with MS
```
Depression
anxiety
Hypertension
Hyperlipidemia
Chronic lung disease
-common even at diagnosis
-19% of individuals have sought care for depression by the time
-11.1% have sought care for anxiety
```
203
Comorbidities in Spinal cord injury
```
arthritis (40%)
hypertension (39%)
Hyperlipidemia (29%)
overweight (27%)
depression 24%
diabetes (15%)
```
204
Older adults with SCI compared to those without SCI
```
Hypertension (63 to 61)
Atrial Fibrillation (26 to 9)
Arthritis (53 5o 31)
Osteoporosis (16 vs 8)
Depression (21 vs 12)
Diabetes (32 vs 28)
```
205
Short-term and long-term consequences of living with chronic condition: eg. Stroke
Symptoms: motor problems, balance problems, visual problems, cognitive problems,......
- Participation
- Roles changes
- social life changes
206
Burden of chronic condition on the society
```
Direct costs (medication, hospital)
-Indirect Costs (unemployment)
```
207
In a study on 948 Canadians with neurological conditions
| only 40% of working aged adults were employed resulting in
Low family income
-Less access to insurance, healthcare resources
-Less access to intangible benefits of work (social, personal, mental), health/mental health, engagement
(more pressure on the family and cost for the community)
208
Conventional primary care
| is designed to handle acute conditions, emphasize is on:
- Brief clinical encounters to diagnose signs and symptoms
- Arrange for triage
- Ensuring patient flow
- Offering only brief patent education followed by patient-initiated follow-up care
209
Chronic Care model
```
At the top: community and inside community Health system: below community we have services: patient centred timely efficient, evidence based and safe, coordinated
below services
Productive interactions :
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
--> improved outcomes
```
210
In order to be able to serve a person with a chronic condition, we need to deal with:
```
Symptoms,
Disability
Emotional aspect
Complex treatment options
Lifestyle changes
Helping the person access to services
```
211
Self-Management Definition:
The individual's ability to manage
- ->symptoms
- ->treatment
- ->physical
- ->psychological consequences
- ->lifestyle changes inherent in living with a chronic condition
212
Emotional cycle of chronic condition
```
Diagnosis
Denial
Anger
Bargaining
Depression
Acceptance
at any step can fall backwards to any of these steps
```
213
Self-Efficacy
How confident they are able to complete the task.
Ex in a scale of 1 to 10, how confident are you that you can ride a monobike
-work in groups
214
Core Self-Management tasks
| Medical or behavioural management
such as taking medication, adhering to special diet, or doing exercise
215
Core Self-Management tasks
| Role management
Involves maintaining, changing, and creating new meaningful behaviours or life roles. For example, people with MS may need to work part time.
216
Core Self-Management tasks
| Emotional Management
Requires one to deal with the emotional sequel of having a chronic condition, which alters, one's view of the future.
217
Core Self-management Skills
```
Problem solving
Decision making
Resource utilization
Health partnerships
Taking action
```
218
Chronic Disease Self-management program (CDSMP)
```
group education programs
6 * 2.5 hour weekly interactive sessions
-action plans, group discussions
Covering how to:
-manage symptoms
-communicate with your doctor more effectively
-lessen frustration
-make daily tasks easier
-fight fatigue
-get more out of life
```
219
Efficacy of self-management programs
| 80 systematic reviews on efficacy of self-management programs
```
Quality of life
self-efficacy
depression
symptom
Participation
```
