Neuro Rehabilitation

Question 1

the one factor that determines whether people will get a little better or a lot better is:

Answer 1

location

Question 2

location includes three segments:

Answer 2

brain (including brain stem), spinal cord (and medulla oblongata), peripheral nervous system

Question 3

_____ have a tremendous ability to heal bc:

Answer 3

peripheral nerves, they’re not made up of nerve cells, the axon itself is an extension of the cell rather than a cell itself

Question 4

what determines the degree to which a peripheral nerve will heal?

Answer 4

if the infrastructure is still inplace: you sit on the toilet too long: pinched off nerve, no damage; you damage a nerve but the infrastructure is still in tact? fully recover; you damage the myelin, etc no way to fully recover

Question 5

the key structualy element that determines regeneration?

Answer 5

schwann cells, must have nurriemma in tact (the thin sheath around a nerve axon- including myelin where this is present).

Question 6

scaffolding is:

Answer 6

non-axonal elements of the nerve

Question 7

_____ are the key element for rebuilding the scaffolding

Answer 7

schwan

Question 8

if severed, the ___ of the size of ____ determines the repair options and ______ repair is optimal.

Answer 8

the gap; end to end

Question 9

if less than 3 cm, _____ and _____ can be used. If greater than 3 cm then an ______ should be used, usually with the ______

Answer 9

allografts and synthetic grafts, autologous graft (usually the sural nerve)

Question 10

neurotmesis:

Answer 10

Neurotmesis (in Greek tmesis signifies “to cut”) is part of Seddon’s classification scheme used to classify nerve damage. It is the most serious nerve injury in the scheme. In this type of injury, both the nerve and the nerve sheath are disrupted.

Question 11

if less than 3 cm:

Answer 11

allograft: a tissue graft from a donor of the same species as the recipient but not genetically identical., synthetic

Question 12

if the size of the gap is greater than 3 cm, a ____ will be used:

Answer 12

Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person (auto- = “self-“). The autologous tissue (also called autogenous, autogeneic, or autogenic tissue) transplanted by such a procedure is called an autograft or autotransplant. sural nerve

Question 13

milieu

Answer 13

In order the brain functions proceed efficiently, neurons have to be kept in a proper and constant environment (=milieu). This environment provides the following:

protection from damage
insulation from unwanted electrical signals
guarantee of an appropriate ionic milieu
provision of energy and building substrates

Question 14

the repair of the milieu is _____ driven. They revert to a more primitive state and begin producig _____ and ______, thus creating an extracellular matrix for axonal growth

Answer 14

schwann cell. laminin collagen.

Question 15

the process of the schwann cells regrowing the milieu requires interleukin-1 and thus requires the ability to produce an _______

Answer 15

inflammatory response

Question 16

if loaded with anti-inflammatory drugs:

Answer 16

patients will be unable to regrow as much neural tissue

Question 17

60% of patients with carpel tunnel will improve with high dose:

Answer 17

vit B6

Question 18

How does time play into neuronal healing?

Answer 18

wallerian degeneration

Question 19

the first thing an axon does when it dies:

Answer 19

grows back to the nerve cell, then the schwann cells have to prolferate, then the axon begins to regrow and regrows 1-4 mm day

Question 20

regrowth of nerve cells is inhibited by tobacco because:

Answer 20

inhibits the nichotinic receptors and chemical reactions needed for regrowth (also alcohol, copper deficiency, too high or low sugar, drugs, vitamins can become neurotoxic, etc)

Question 21

TEST: Utilization of the end organ means:

Answer 21

use it or lose it: if you use the end organ of the blood vessel or nerve, there is a mechanism that helps it to regrow or stay healthy. Bapst or wobble board helps relearn proprioception, but also helps reorient the peripheral end organs

Question 22

spinal cord recovery is based on :

Answer 22

limiting secondary injury at the time of injury/sparing of the tracts at the time of injury (in the first 48 hours)

Question 23

the spinal cord has a mechanism in which a small injury will cause it to:

Answer 23

destroy itself via inflammatory response

Question 24

4 basic steps of cns trauma

Answer 24

1: prevent secondary injury to surviving neurons
2. replace damaged neurons
3. Stimulate and optimize axonal regrowth
4. Retrain neural to restore function

Question 25

steps in preventing secondary injury:

Answer 25

limit ischemia by correcting CBF

Question 26

how do you control CBF?

Answer 26

drive CO2 down, mannitol, steroids to control edema (survival rate drops, although in spinal cord injuries it doesn’t change)

Question 27

second step in prevention of secondary injury:

Answer 27

limit excitotoxicity cascade (inflammation response)

Question 28

the excitotoxicity response is ___ driven, and leads to ______ and _____, causes ______

Answer 28

glutamate, edema and Ca2+ influx, dna damage which leads to repair thus driving up cellular metabolic demands, which leads to cell ATP starvation and death because the nerves will only use glucose and there is already a limited amount

Question 29

in addition to the glutamate driven processes,there is a _____ driven process that involves______; if it is controlled too much or too little it leads to cell death

Answer 29

cytokine, interleukin-1-beta,

Question 30

glial scars present:

Answer 30

axonal targeting

Question 31

cns plasticity:

Answer 31

changes in brain organization and functin that can be mediated by structural alterationas in brain maps and morphological and biochemical changes that can be sustained over time

Question 32

some of the point regarding plasticity:

Answer 32

may be beneficial or not (maladaptation)

Question 33

if plasticity is not hepful it is deemed

Answer 33

maladaptation

Question 34

some higher level skills may be more limited because of “cortical crowding”

Answer 34

a form of agnosia (no longer precieve two seperate things as separate, i.e. visual spatial skills

Question 35

MAG measures the phenomenon in which:

Answer 35

someone percieves pain because the sensory nerves for one region is crowded and eventually any stimulus in that area causes a sensation (when someone feels pain in their amputated foot)

Question 36

One reason that plasticity is possible in the cns is due to :

Answer 36

parallel circuit phenomenon

Question 37

the parallel circuit phenomenon refers to:

Answer 37

redundancy in pathways that assume a greater role after injury (i.e. VLF and VC of the spinal cord)

Question 38

there is _____ of the hemispheres particularly found in the fetus and children _____

Answer 38

equipotentiality; 2 to 5

Question 39

subtitution and functino refers to __

Answer 39

non-injured brain taking over function of the injured brain

Question 40

___ input directly enhances rapid reorganizatino of cortex maps

Answer 40

sensory input

Question 41

intensive training stiumulates expansion of ____

Answer 41

cortical maps (olympic athletes cortical map gets bigger and bigger the more they train)

Question 42

if you use mirror therapy to move the good toe.leg, etc, and you stiumulate the bad side at theh same time, the brain SEES the movement of the limb and it instantly gets better due to :

Answer 42

cortical mapping, reorganization or localized function can be altered by affecting the opposite hemisphere and reorganization has been documented for up to 2 years after TBI

Question 43

optimizing plasticity includes:

Answer 43

use of catecholamine neurotransmitters (amantadine)

Question 44

TBI may include ____ which inhibits regrowth and regeneration

Answer 44

glial scarring

Question 45

_________ is the degeneration of the axon and myelin sheath distal to the injury site caused by the lack of nutrients.

Answer 45

wallerian degeneration

Question 46

10 yr old severed his radial nerve. Which cell plays a role in regrowth?

Answer 46

schwann

Question 47

wallerian degeneration involves:

Answer 47

successive fragmentation of the axon

Question 48

_______ results in breakdown of myelin and occurs as a result of nerve injury

Answer 48

wallerian degeneration

Question 49

___________is a complete division of a nerve fiber.

Answer 49

neurotmesis

Question 50

degeneration of the axon and myelin sheath distal to the injury site caused by the lack of nutrients

Answer 50

wallerian degeneration