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OT 883 Cogneuro > Midterm > Flashcards

Midterm Flashcards

1
Q

What is a nerve cell (neuron)?

A
  • Basic part of our nervous system
  • very specialized
  • sends messages very rapidly
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2
Q

Nerve cell parts

A

cell body
dendrites
axons

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3
Q

How many neurons are the in the human brain?

A

86 billion neurons and 10000 as many connections

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4
Q

Dendrites

A

thin structures that arise from the cell body

giving rise to a complex “dendritic tree

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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

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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

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7
Q

Direction of most neurons

A

one way

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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

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9
Q

Function of Myelin

A

increases the speed at which impulses propagate along the myelinated fiber

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10
Q

Types of fibers based on coverage by myelin:

A

Unmyelinated fibers

Myelinated fibers

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11
Q

Unmyelinated fibers

A

impulses move continuously as waves (Slow)

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12
Q

Myelinated fibers

A

impulses hop (Fast)

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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)

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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

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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
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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
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17
Q

LABEL DIAGRAM

A

SLIDE 14 and SLIDE 15

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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.

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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

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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

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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

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22
Q

Types of Synapses

A

Electrical synapses

Chemical Synapses

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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

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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

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25
Q

Resting Potential

A

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

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26
Q

Action potential:

A

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

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27
Q

Resting action potential threshold

A

about -55mV the action potential can cause excitation/inhibition in the next neuron by releasing neurotransmitters

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28
Q

Summation

A

-enough action potentials might build-up the depolarization to the threshold voltage for the action potential in the next neuron.

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29
Q

Types of summation:

Spatial summations

A

Action of multiple cells synapsing on the post synaptic neuron (multiple neurons affecting one neuron)

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30
Q

Types of summation: Temporal summations

A

synaptic potentials occur close together in time

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31
Q

Impact on the next neuron (action potential) (two functions on the postsynaptic terminal)

A

facilitation, inhibition

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32
Q

Neurotransmitters

A

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
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33
Q

What do medications/drugs do to your nervous system (4 points)

A
  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
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34
Q

cocaine steps

A

dopamine: stimulates the reward pathways of the brain
cocaine: blocks the dopamine reuptake pumps
unable to be removed, there is overstimulation of deopamine

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35
Q

Addictive Process

A

CNS is flooded with with neurotransmitters dopamine–> decreased production of dopamine–> craving for the addictive substance

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36
Q

Synaptic Fatigue

A

occurs because of neurotransmitters deletion due to the repetitive stimulation of a pre-sympathetic neuron.

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37
Q

Functional Classifications of neurons Afferent Neurons (sensory Neurons)

A

Convey information from tissues and organs into the central nervous system

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38
Q

Functional Classifications of neurons Efferent neurons (motor neurons)

A

transmit signals from the central nervous system to the effector cells.

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39
Q

Functional Classifications of neurons Interneurons: connect

A

connect neurons within specific regions of the central nervous system

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40
Q

Structural Classification: Central Nervous System (CNS)

A

Brain

Spinal Cord

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41
Q

Structural Classification: Peripheral nervous system (PNS)

A

Nerves that extend from the brain and spinal cord

-spinal nerves and cranial nerves

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42
Q

Forebrain Parts:

A

Cerebral hemispheres:

  • cerebral cortex
  • subcortical white matter
  • basal ganglia
  • Thalamus
  • Hypothalamus
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43
Q

Overview of the human CNS Components

A

Forebrain
Midbrain
Hindbrain
Spinal Cord

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44
Q

Neural Tube defects (two Examples)

A
  1. Anencephaly

2. Spina bifida

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45
Q

Nervous System morphology:

A

Gray matter

White matter

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46
Q

Grey matter

A

concentration of nerve cell bodies

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47
Q

Grey matter in CNS

A

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

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48
Q

Gray Matter in PNS

A

Clusters of cell bodies in the PNS => CLusters of cell bodies in the PNS => Ganglia

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49
Q

Greay and white matter

in spinal cord:

A
  • Dosal horn has sensory

- ventral (anterior) horn has motor function

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50
Q

White matter

A

Myelinated axons in the CNS and PNS

Afferent, Efferent, Interneurons

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51
Q

Spinal Cord

segments

A 
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 
-
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52
Q

Lumbar Puncture

A

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

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53
Q

Spinal Cord: spinal nerves arise from segments f spinal cord:
Each segment gives rise to both sensory and motor nerves

A

Dorsal nerve roots (sensory)

Ventral Nerve roots (motor)

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54
Q

Spinal Cord Function: ( 3 points)

A
  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)
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55
Q

NAME THE PARTS OF THE SPINE WE HAVE TO REMEMBER

A 
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
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56
Q

A flexor reflex

Flexor (withdrawal) reflex in upper limb

A

Pain Stimulus…… to dorsal root out ventral root

-Flexor Stimulated, Extensors

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57
Q

Flexor Withdrawal Reflexes

Flexor reflex in lower limb

A

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

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58
Q

Pain is recieved on what side of the brain

A

opposite side of pain being felt

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59
Q

Autonomic Nervous System (ANS)

A
  • is part of the peripheral nervous system
  • functions unconsciously
  • Controls visceral functions
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60
Q

Divisions of ANS

A

Sympathetic -flight or flight

Parasympathetic -rest and digest

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61
Q

ANS is controlled by:

A

Limbic system
Hypothalamus
Afferent Information

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62
Q

Functions of Sympathetic

A 
Heart 
-increases heart rate 
-increases force of contraction 
Blood Vessels 
-Constriction 
Lungs
-Bronchodilation 
GIT 
-Decrease mobility 
-Sphincter contraction 
-Decreased Secretions
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63
Q

Function of parasympathetic

A 
Heart 
-decreases heart rate 
-decreases force of contraction 
Blood Vessels 
-no effect 
Lungs
-Bronchoconstriction 
GIT 
-increase mobility 
-Sphincter relaxation 
-increase Secretions
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64
Q

Cerebral Cortex

Sulci (plural for sulcus)

A

Numerous infolding or crevices

Fissure is a deep sulcus

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65
Q

Cerebral Cortex

Gyri (plural for gyrus)

A

Bumps or ridges between sulci

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66
Q

longitudinal fissure

A

(or cerebral fissure, medial longitudinal fissure or interhemispheric fissure) is the deep grove that separates the two hemispheres of the brain

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67
Q

Sylvain Fissure (lateral sulcus)

A

The lateral sulcus divides both the frontal lobe and parietal lobe above from the temporal lobe below.

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68
Q

Central Sulcus (also what are the names of of the gyrus before and after

A

is a fold in the cerebral cortex in the brains of
vertebrates between the parietal and frontal lobe
-precentral gryus
-post central gyrus

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69
Q

Lobes of the cerebral cortex

A 
Frontal lobe
Parietal Lobe 
Temporal Lobe 
Occipital Lobe 
\+ Insula
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70
Q

insula

A

Deep to sylvain fissure - that is where we can see the insula
-more related to limbic system which is related to our emotions

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71
Q

Corpus Callosum

A

Connects the hemispheres
consists of white matter
the great mediator

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72
Q

Primary Sensory and motor areas of cortex (5)

A
  1. Primary motor cortex
  2. Primary somatosensory cortex
  3. Primary auditory cortex
  4. Primary Visual cortex
  5. Prefrontal association area
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73
Q

Location/what does it do: Primary motor cortex

A

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

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74
Q

Location/what does it do: Primary somatosensory cortex

A 
postcentral gyrus (parietal lobe) 
Sensory information from skin, musculoskeletal system, viscera and taste buds
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75
Q

Location/what does it do: Primary auditory cortex

A

temporal lobe

hearing

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76
Q

Location/What does it do: Primary Visual cortex

A

occipital lobe

Vision

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77
Q

Location/what does it do: Prefrontal association area

A

frontal lobe
Coordinates information from other association areas, controls some behaviours
Reasoning skills

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78
Q

Blurred vision: damage to what lobe

A

occipital lobe

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79
Q

Problem in critical thinking: damage to what lobe

A

frontal lobe

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80
Q

Movement problems: damage to what part of the brain

A

frontal lobe and/or cerebellum

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81
Q

Sensation Problems: damage to what lobe

A

parietal lobe

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82
Q

Responsibilities of each brain hemisphere: Left

A 
analysis 
logic 
lists 
numbers 
words 
lines
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83
Q

Responsibilities of each brain hemisphere: Right

A 
Colours 
Daydreaming 
3D
Rhythm 
Imagination 
Synthesis
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84
Q

Homunculus (little man)

A

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

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85
Q

Different parts of our body demonstrates different degrees of two-point discrimination why?

A

-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

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86
Q

What if a person used legs more-does the homunculus change?

A

-if a person uses legs more the homunculus will change studies have shown this

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87
Q

Brain stem

A

posterior part of the brain, adjoining and structurally continuous with the spinal cord
Includes: midbrain
pons
meddulla obongata (connects the brain with spinal cord)

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88
Q

Midbrain

A

Vision, hearing, eye movement and body movement

89
Q

Pons

A

Motor control and sensory analysis

90
Q

Medulla

A

Maintaining vital functions such as breathing and heart rates

91
Q

Whiplash injury can break what:

A

Odontiod process of xis. The fracture might damage the medulla and cause death

92
Q

Menginges: layers

A 
membranes that envelop the brain and spinal cord 
Layers: 
1. Pia mater 
2. Arachnoid Mater 
3. Dura Mater
93
Q

Menginges Function:

A
  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
Q

Cerebrospinal Fluid (CSF): where is it found and produced

A
  • 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
Q

CSF functions:

A
  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
Q

Choroid Plexus location

A

In lateral ventricle, third ventricle and fourth ventricle

97
Q

Upper motor Neuron (UMN) starts at

A

Motor region of the cerebral cortex; or in the brain stem ends where it connects with the LMN
and the spinal cord

98
Q

Upper motor Neuron (UMN)

Function

A

UMN controls LMN

  1. Carry motor information down to the lower motor neurons
  2. Send messages to start and stop muscle contraction
99
Q

Lower motor Neuron (LMN) includes:

A
  • the spinal cord motor neurons; and

- cranial nerves with motor function in brain stem

100
Q

Lower motor Neuron (LMN) function:

A
  1. Innervate skeletal muscle fibers
  2. Send messages to start muscle contractions
    - -> for voluntary movement, both the UMN and LMN should be intact
101
Q

Driver and car analogy

A

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
Q

UMN Lesion (UMNL)

A

weakness and spasticity, hyperreflexia, disuse atrophy (stroke, cerebral palsy)

103
Q

LMN lesion (lesion):

A

Weakness, hyporeflexia, wasting atrophy (eg facial palsy, disk herniation)

104
Q

Hypotonicity

A

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
Q

hypertonicity

A

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
Q

Normal muscle tone:

A

The internal state of muscle-fiber tension within individual muscles and muscle groups

107
Q

Damage to T10

A

Can cause damage to CNS and PNS

108
Q

Damage to L5

A

causes damage to PNS but not CNS

109
Q

Deep Tendon Reflexes (also called muscle stretch reflexes or myotonic reflex

A

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
Q

UMNL (deep tendon reflexes)

A

deep tendon reflexes become hyper-reflexes

111
Q

LMNL (deep tendon reflexes)

A

Deep tendon reflexes become hypo-reflexive

112
Q

Receptor:

A

Muscle spindles (stretch receptors- sensitive to quick stretch)

113
Q

Quick Stretch:

A

Muscle spindles stimulated -> increased muscle tone in the agonist (decreased tone in the antagonist)

114
Q

Slow and Constant Stretch

A

Golgi tendon organs stimulated –> relax the muscle

115
Q

Motor Pathways

The most important motor pathways are

A

Pyramidal system :
1. Corticospinal Tract: connecting cortex and spinal cord
2: Corticobulbar tract: connecting cortex with medulla
Extrapyramidal system

116
Q

Feedback Systems

A

the most important components are cerebellum and basal ganglia

117
Q

Corticospinal Tract (Pyramidal tract)

A
  • 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
Q

Extrapyramidal tract

A

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
Q

Cerbellum

A
  • 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
Q

Cerebellum Structure and Function:

A

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
Q

Malfunction of the cerbellum

A 
Wide base gait 
Dysmetria 
Dysdiadochokinesia
Intention tremor 
Macographia
122
Q

Basal Ganglia location

A 
Is situated at the base of the brain
Connects with: 
-cerebral cortex 
-Thalamus 
-Brainstem
123
Q

Basal ganglia Function

A

control of:

  • voluntary motor movements particularly internally generated movements
  • Procedural learning
  • Routine behaviours or “habits”
  • eye movements
  • cognition and emotion
124
Q

Basal ganglia includes

A
  • 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
Q

Basal Ganglia Dysfunction:

A
  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
Q

Approaches to Motor Behaviour

1. Neurophysiological approach

A

A. Reflex model
B. Hierarchical model
C.Neuromaturation theory

127
Q

Approaches to Motor Behaviour

2, System based task-related approaches

A

A. Systems model of motor control

B. Ecological approach to perception and action

128
Q

Reflex Theory

A

Reflex is an action that is performed as a response to a stimulus and without conscious thought.

129
Q

Hierarchical Theory

A
  • System has several level of control

- Each level subordinates to the one above it

130
Q

Neurophysiological approaches

Models of motor control

A
  1. Reflex model
  2. Hierarchical model
    combine to make Reflex-Hierarchical model
131
Q

Reflex-Hierarchical Model

movements and needs

A

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
Q

Reflex-Hierarchical Model of Motor Control cycle

A
  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
Q

C. Neuromaturation theory of motor development

A
  1. CNS maturation
  2. Predictable sequence
  3. Damage causes regression
  4. Environment has limited role in CNS outputs
134
Q 
CNC lesions (from neurophysiological approach) 
Recovery:
A

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
Q 
CNC lesions (from neurophysiological approach) 
Assessment (focused on the abilities and capacities impaired by CNS damage)
A

-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
Q

Ecological Approach

Emphasis on:

A

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
Q

Systems model of motor control:

A

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
Q

Systems model of motor behavior

A

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
Q

Chart:

Models of motor control:

A

Neurophysiological approaches:
Reflex-Hierarchical

OT task oriented approach:
Systems

140
Q

Chart:

Theory of motor Development

A

Neurophysiological approaches:
Neuromaturational

OT task oriented approach:
Systems

141
Q

Chart:

Assumptions therapeutic approaches

A

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
Q

Chart: Evaluation

A

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
Q

CNS Lesions (from OT task oriented approach)

A
  • 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
Q

Assessments - OT task oriented approach (CNS lesions)

A

-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
Q

Pt Procedure based on system based-task-oriented approach

A

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
Q

Motor characteristics of CNS dysfunctions

A
  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
Q

Brunnstrom Movement Therapy Approach

Assumptions:

A
  • 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
Q

Brunnstrom Movement Therapy Approach

General treatment sequence:

A
  1. Uses reflexes eg. associated reaction
  2. Isometric contraction
  3. Eccentric contraction (most effective)
  4. Concentric Contraction
  5. Repetition
  6. Function
149
Q

Brunnstrom stages of recovery for upper limb

A

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
Q

Stage 4

A
  • Hand behind back
  • Arm to forward horizontal position
  • Pronation supination + elbow ext
151
Q

Stage 5:

A
  • Arm forward and overhead
  • Arm to side horizontal position
  • Pronation supination + elbow flex
152
Q

Brunstorm (1951)

A
  • Reflexes and associated reaction
  • Flexor and extensor synergies
  • Stages of recovery (specially arm)
  • Use reflexes and hypertonicity for getting movements
153
Q

Bobath/Neurodevelopmental (NDT) approach

Hemiplegia is associated with:

A

-Loss of normal movements
-Development of abnormal movements
combined (cause of abnormal patterns)

154
Q

Bobath/Neurodevelopmental (NDT) approach:

hemiplegia cause:

A
  • Loss of postural control
  • Loss of selective movement control
  • Abnormal tone
  • Associated reaction

–> Problem in weight shifting

–> problem in functional performance

155
Q

NDT treatment

A 
Goal: 
-Normalizing tone 
-Improving coordination 
-Retraining movement responses 
By Handling: 
-Positioning 
-Controlling abnormal reflexes 
-Activate normal responses 
 Combined: reeducate normal movements
156
Q

Bobath Neurodevelopmental Therapy (1970)

A
  • 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
Q

Rood Approach

A

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
Q

Proprioceptive Neuromuscular Facilitation (PNF)

Based on the principles of normal human development:

A
  • 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
Q

Proprioceptive Neuromuscular Facilitation (PNF)
Involves repeated muscle activation of the limbs
Uses different techniques such as

A

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
Q

Rood and PNF (mid-20h century)

A

Developmental model like an infant

  • Proximal - distal approach to treatment
  • Using sensory stimuli
161
Q

What is the difference between learning and training

A

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
Q

Task-oriented treatment Principles #1

A

Client centred

-Client centered and active participation of the person

163
Q

Task-oriented treatment Principles #2

A

Occupation Based

  • Use functional tasks rather than practicing specific movements
  • Use meaningful tasks
  • Task analysis
164
Q

Task-oriented treatment Principles #3

A

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
Q

Task-oriented treatment Principles #4

A 
Person and Environment 
Identify factors that: 
-Influence occupational performance 
-can change outcome 
might change 
Adapt the environment 
Use natural objects and environment
166
Q

Somatosensory System

Main parts

A
  1. receptors
  2. Somatosensory pathways
  3. Thalmus
  4. Somatosensory cortex
167
Q

Types of Sensory Receptors

Exteroceptors

A
  • Receptor for the reception of stimuli from the external world (outside of the body)
  • ex visual, aditory, tactile, olfactory, and gustatory receptors
168
Q

Types of Sensory Receptors

Interoceptors

A

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
Q

Types of Sensory Receptors

Proprioceptors

A

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
Q

Peripheral Receptors

A

a. Muscle spindles (active in stretch reflex loop)
b. Golgi Tendon Receptors
c. Joint Receptors
d. Cutaneous Receptors

171
Q

Muscle Spindles Location

A

Proprioceptors located within the belly of the muscle

172
Q

Muscle Spindles function

A

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
Q

Highest muscle spindle density is found in

A

Extraocular muscles (eyes)
hand muscles -dexterity
neck muscles -very sensitive (brain needs to know how head is located)

174
Q

Golgi Tendon Organs (GTO) Location:

A

At the muscle-tendon junction

-Afferent information from the GTO is carried to the nervous system

175
Q

Golgi Tendon Organs (GTO) Function:

A

Sensitive to tension changes that result from either stretch or contraction of the muscle
-inhibits its own muscle and excites its antagonist

176
Q

Joint receptors location

A

Joints
Afferent information rom joint receptors ascends to the cerebral cortex and contributes to perception of our position in space (proprioception)

177
Q

Joint receptors function:

A

Provide a danger signal about extreme joint motions

-CNS determines joint position by monitoring which receptors are activated.

178
Q

Cutaneous Receptors

A 
Location: skin 
Function: sense of:
 -touch
-Pressure 
-Vibration 
-Temperature 
-Pain
179
Q

Somatosensory pathways to spinal cord -what are the two pathways

A

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
Q

Thalamus

A

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
Q

Hypothalamus

A

Most important Function: links the nervous system to the endocrine system
-Controls body temp, hunger, sex behaviour, thirst, fatigue, sleep and circadian rhythms

182
Q

Somatosensory Cortex

A

Lies in the Postcentral gyrus

-Involves sensation of opposite side of the body

183
Q

Overview Cycle (somatosensory)

A 
Receptor 
Somatosensory pathways 
Thalamus
Somatosensory Cortex 
Motor Cortex 
Corticospinal tract 
Spinal Cord 
Muscle
184
Q

Association Cortex Location

A

the cerebral cortex outside the primary areas

185
Q

Association Cortex Function

A

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
Q

Primary Auditory Cortex Function and location

A

Function: Understanding language when listening
Location: Superior temporal Lobe (wernicke’s area dominant hemisphere (left side) )

187
Q

Primary Visual Cortex Function and location

A

Function: Understanding language when reading
Location: Occipital lobe (wernicke’s area dominant hemisphere (left side))

188
Q

Primary Auditory and Primary Visual Cortex Syndrome

A

Receptive (sensory or Wernicke’s) aphasia

189
Q

Broca’s Area function, location and syndrome

A

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
Q

Visual Association Cortex function, location, and syndrome

A

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
Q

Apraxia: damage to

A

Frontal or left parietal lobe

192
Q

Hemineglect, Anosognosia (unaware of deficit): damage to

A

Parietal lobe (R)

193
Q

Cerebral Circulation

A

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
Q

Circle of Willis

A 
(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
Q

Chronic Condition

A

any condition that present itself for longer than six months, involves slow changes and may be controlled but is often not curable

196
Q

Chronic Conditions can be various health related states such as:

A 
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
Q

Chronic Conditions in Canada

A
  • 33%of Canadians live with one or more chronic condition

- On average every Canadian older than 65 has 2 or more chronic conditions

198
Q

Chronic Conditions in Canada: Health care utilizations:

A

51% of family physician/general practitioner consultations

  • 55% of specialist consultations
  • 66% of nursing consultations
  • 72% of night spent in hospital
199
Q

Chronic Disease in Ontario

A
  • 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
Q

People with Neurological conditions in Canada

A
  • 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
Q

People with Neurological conditions in Canada

Use more:

A

physiotherapy,
social work,
occupational therapy, audiology, and speech therapy than other Canadians, even those with two or more non-neurological chronic conditions

202
Q

Comorbidities with MS

A 
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
Q

Comorbidities in Spinal cord injury

A 
arthritis (40%) 
hypertension (39%) 
Hyperlipidemia (29%)
overweight (27%)
depression 24% 
diabetes (15%)
204
Q

Older adults with SCI compared to those without SCI

A 
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
Q

Short-term and long-term consequences of living with chronic condition: eg. Stroke

A

Symptoms: motor problems, balance problems, visual problems, cognitive problems,……

  • Participation
  • Roles changes
  • social life changes
206
Q

Burden of chronic condition on the society

A 
Direct costs (medication, hospital) 
-Indirect Costs (unemployment)
207
Q

In a study on 948 Canadians with neurological conditions

only 40% of working aged adults were employed resulting in

A

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
Q

Conventional primary care

is designed to handle acute conditions, emphasize is on:

A
  • 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
Q

Chronic Care model

A 
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
Q

In order to be able to serve a person with a chronic condition, we need to deal with:

A 
Symptoms, 
Disability 
Emotional aspect 
Complex treatment options 
Lifestyle changes
Helping the person access to services
211
Q

Self-Management Definition:

A

The individual’s ability to manage

  • ->symptoms
  • ->treatment
  • ->physical
  • ->psychological consequences
  • ->lifestyle changes inherent in living with a chronic condition
212
Q

Emotional cycle of chronic condition

A 
Diagnosis  
Denial 
Anger 
Bargaining 
Depression 
Acceptance 
at any step can fall backwards to any of these steps
213
Q

Self-Efficacy

A

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
Q

Core Self-Management tasks

Medical or behavioural management

A

such as taking medication, adhering to special diet, or doing exercise

215
Q

Core Self-Management tasks

Role management

A

Involves maintaining, changing, and creating new meaningful behaviours or life roles. For example, people with MS may need to work part time.

216
Q

Core Self-Management tasks

Emotional Management

A

Requires one to deal with the emotional sequel of having a chronic condition, which alters, one’s view of the future.

217
Q

Core Self-management Skills

A 
Problem solving 
Decision making 
Resource utilization 
Health partnerships 
Taking action
218
Q

Chronic Disease Self-management program (CDSMP)

A 
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
Q

Efficacy of self-management programs

80 systematic reviews on efficacy of self-management programs

A 
Quality of life 
self-efficacy 
depression 
symptom 
Participation

OT 883 Cogneuro (2 decks)

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