Neurological Conditions And Neuroplasticity Flashcards
What is neuroplasticity?
Neuroplasticity describe the brain’s ability to change and adapt (re-wire) in response to the environment, sensory input, cognitive stimulation, and injury or illness experience(s).
Explain how age effects neuroplasticity.
A developing brain has more neuroplastic potential than an adult one.
List the 6 sensations (senses)
- Vision
- Hearing
- Taste
- Smell
- Touch
- Vestibular
Define presbyopia
Presbyopia = decreased near vision (usually a consequence of aging)
Describe the symptoms of Parkinson’s Disease (6).
- Rigidity
- Tremors / decreased coordination
- Dyskinesia (involuntary movement of the whole body)
- Shuffling / freezing gait (high is of falls)
- Flat affect (stiffness in facial muscles)
- Dysphagia
Define dyskinesia.
Involuntary and uncontrolled muscle movements ranging from shakes, tics, and tremors to full-body movements. Occurs mainly in face, arms, legs, and trunk.
Describe flat affect.
Feeling emotions but being unable to visually show these emotions. I.e. no facial expressions
Define dysphagia.
Swallow difficulties. High risk of choking when eating or drinking.
Does neurorehabilitation start with an adaptive approach or a remedial approach.
Remedial approach until baseline or plateau, then switch to adaptive approach.
List possible motor impairments post-CNS injury (8).
- Paresis/plagiarism of UE and LE
- Abnormal muscle tone
- Decreased trunk control
- Decreased balance
- Decreased motor control (dyspraxia)
- Decreased sensation
- Edema
- Fatigue or decreased endurance
Define dyspraxia.
Inability to plan movement.
List possible physical assessments that can be done with a neuro client to assess for ROM and muscle strength (3).
ROM = goniometry
Muscle strength = MMT, grip (dynamometer), lateral and traditional pinch
List 3 standardized assessments that can be used to evaluate neuromotor and neurosensory abilities.
- Nine-Hole Peg Test (NHPT)
- Box and Blocks
- Fugl-Meyer
Describe the purpose of the Nine-Hole Peg Test (NHPT).
Used to measure finger dexterity in patients with neurological diagnoses.
Using one hand, patient places / removes pegs in 3x3 grid containing holes as fast as possible.
Describe the purpose of the Box and Block standardized assessment.
Measures unilateral gross manual dexterity in client with neuromotor conditions.
Use one hand to move blocks (one at a time) from one side of a rectangular container to the opposite side of it (there is a divider in between).
Describe the purpose of the Fugl-Meyer Assessment (FMA).
A stroke-specific performance-based assessment used to evaluate motor, functioning, balance, sensation, and joint functioning in patients with post-stroke hemiplegia. Provides insight to disease severity and motor recovery.
List the 5 domains in the Fugl-Meyer Assessment (155 items total).
- Motor functioning (UE and LE —> score of 0 = hemiplegia)
- Sensory functioning (touch and position sense)
- Balance (seated and standing)
- Joint ROM
- Joint pain
Which joints are assessed in the Fugl-Meyer Assessment? (8)
- Shoulder
- Elbow
- Forearm
- Wrist
- Hand
- Hip
- Knee
- Ankle
List 3 functional assessment (ADLs and iADLs) that can be used with neuromotor patients.
- Chedoke Arm and Hand Activity Inventory (CAHAI)
- Barthel
- FIM
Describe the purpose of the CAHAI functional assessment.
Assess functional ability in the paretic arm and hand with the goal of promoting bilateral function.
Paretic = partial paralysis
List the 13 functional tasks in the CAHAI.
- Open a jar of coffee
- Call 911
- Draw a line with a ruler
- Put toothpaste on a toothbrush
- Cut medium consistency putty
- Pour a glass of water
- Wring out a washcloth
- Clean a pair of eyeglasses
- Zip up a zipper
- Bottom up 5 buttons
- Dry back with a towel
- Place a container on a table
- Carry a bag up the stairs
Describe the purpose of the Barthel Index for Activities of Daily Living functional assessment.
An ordinal scale which measures a person’s ability to complete 10 common ADLs:
1. Feeding
2. Bathing
3. Grooming
4. Dressing
5. Bowel
6. Bladder
7. Toileting
8. Transfers (bed-to-chair and vice versa)
9. Mobility on level surfaces
10. Stairs
Items are scored from 0 - 2 and this scale describes different levels of independence:
0 = unable
1 = needs assistance
2 = independent
Sum of scores x 5 to get total score / 100. Higher scores = greater independence. Cut-off score for moderate dependency is 60-61/100.
Define muscle strength
The muscle’s ability to contract and create force in response to resistance.
Explain the difference between paresis and plegia.
Paresis = partial paralysis or weakness (loss of strength) of a body part
Plegia = complete paralysis of a body part
Define hemiparesis.
Partial paralysis or weakness occurring on half the body (depending on which side of the brain is affected). Weakness can be quantified as mild, moderate, or severe.
Define hemiplegia.
Complete paralysis occurring on half of the body (right or left, depending on which side of the brain was affected).
Why is it important to assess the scapular position and muscle tone post-stroke? (5)
- Functional implications related to weakness, spasticity, and/or paresis or paralysis
- Prevention of shoulder pain due to possible scapular dyskinesis (abnormal shoulder movement)
- Postural control / support of trunk alignment in order to promote use of proper body mechanics
- Presence of increased risk of shoulder subluxation post-stroke
- Prevent future shoulder complications (ex. Frozen shoulder)
What should an OT look for when assessing a client’s scapula post-stroke?
- Presence of shoulder subluxation by observing a space (palpable gap) between the acromion and humeral head. Looks like the humerus is hanging.
- Scapular positioning (winging in flex/ext?)
- ROM by observation not gonio
- Strength via MMT and dynamometer test
- Muscle tone
Why is there a higher risk for shoulder subluxation post-stroke? *pressence of hemiplegia
If hemiplegia is present, the muscles in the hemiplegia arm are flaccid/paralyzed therefore they are unable to provide support to the shoulder joint in the affected arm causing a subluxation.
List 2 ways to prevent shoulder subluxation in stroke patients. START IMMEDIATELY!
- Positioning with pillows, slings, and splints
- ROM exercises
Name the 10 principles of experience-dependent plasticity.
- Use it or lose it
- Use it and improve it
- Specificity
- Repetition matters
- Intensity (frequency) matters
- Time matters (acute vs chronic)
- Salience matters
- Age matters
- Transference
- Interference
Describe the “Use it of lose it” principle of experience-based neuroplasticity?
Neural connections that are frequently used become stronger and more efficient, while those that are rarely or never used may weaken and eventually be eliminated. This principle emphasizes the importance of ongoing stimulation and engagement to maintain cognitive functions.
Describe the “Use it and improve it” experience-based principle of neuroplasticity.
Engaging in specific activities can enhance corresponding neural circuits. For example, practicing a skill or learning new information can lead to structural and functional changes in the brain regions associated with that activity.
Expanding your reperatoire of an activity through real-life experience results in expanding your cognitive skills related to that activity and thus accomplish graded up tasks.
Describe the “specificity” experience-based principle of neuroplasticity.
Neuroplastic changes are often specific to the type of activity or experience. Different experiences lead to different neural adaptations. For instance, learning to play the piano will induce changes in brain regions related to motor control and auditory processing.
One activity can target multiple areas of the brain and pushing those areas to adapt to the needs of that activity.
Describe the “repetition matters” experience-based principlle of neuroplasticity.
practice makes perfect
Repeated engagement in an activity strengthens neural connections. Consistent practice and repetition help consolidate learning and promote lasting changes in the brain.
Describe the “intensity matters” experience-based principle of neuroplasticity.
intensity = frequency
The strength of neural connections can be influenced by the intensity of the experience. Intense, focused, and highly stimulating activities tend to have a more significant impact on neuroplasticity.
Describe the “time matters” experience-based principle of neuroplasticity.
The timing of experiences can influence the extent of neuroplastic changes. The brain is more adaptable during certain periods, known as critical periods, and some types of learning may be more effective during specific developmental stages.
Critical windows of time for interventions
Describe the “salience matters” experienced based principle of neuroplasticity.
The brain gives priority to experiences that are emotionally charged, novel, or particularly relevant. Such experiences are more likely to induce neuroplastic changes.
Special stuff takes up more brainspace
Describe the “age matters” experience-based principle of neuroplasticity.
The capacity for plasticity may vary with age. The brain is generally more adaptable in early life, but plasticity persists to some extent throughout adulthood.
Young = more plasticity
List components of a trunk control assessment (4).
- Trunk alignment
- Mobility / ROM
- Muscle tone
- Trunk stability
Is NDT a top-down or bottom-up remedial treatment approach?
Bottom-up.
It is considered to be a bottom-up treatment approach because it focuses on addressing impairments at the foundational level of motor control and movement patterns (muscle tone, joint ROM, postural alignment) . The intervention aims to establish a solid foundation for more advanced motor skills.
Ex.
* Hands-on facilitation techniques to guide and facilitate movement patterns. These techniques aim to influence muscle tone, coordination, and overall motor function from a bottom-up perspective.
* Sequential progression in intervention, starting with simpler movements and gradually advancing to more complex and functional tasks.
In a bottom-up approach, intervention starts by addressing basic components before progressing to more complex tasks.
b for basic
Provides sensory feedback to inhibit abnormal reactions and facilitate normal movement patterns & posture during functional tasks.
Stimulate the effective side, normalize movement patterns, and have them integrated into every day activities
Is sensory integration (SI) a top-down or bottom-up remedial approach? Why?
Bottom-up.
It is a bottom-up approach because it focuses on addressing sensory processing at the foundational level before targeting higher-level cognitive and motor functions.
Building a foundation:
It begins by addressing basic sensory functions such as touch, proprioception, vestibular input, and auditory and visual processing. The approach emphasizes the integration of various sensory inputs to create a more accurate and refined perception of the environment. This integration occurs at a neurobiological level, influencing the brain’s ability to organize and respond to sensory stimuli. This foundation supports more complex cognitive and motor behaviors. Activities are designed to gradually build on each other, starting with simpler sensory experiences and progressing to more complex and integrated tasks.
Describe an open-loop motor skills.
A skill that is performed in a variable or unpredictable environment which forces the individual to adapt on the spot more. This is an effective form of transfer learning.
Ex. driving
Describe a closed-loop motor skill.
A skill that is performed in a stable and familiar environment. As a result of its predictability, responses can be planned and are often self-paced and self-controlled.
Automatic feedback loop.
Ex. a gymnastics stunt
Describe the Constraint Induced Movement Therapy (CIMT) motor learning approach.
Top-down.
Therapist forces the client to use their affected side by limiting/restricting the movement/use of their non-affected/stronger limb (using a sling or splint).
Intense approach that requires high client motivation and concentration as therapy involves repetitive tasks using only the affected limb.
Describe Cognitive Orientation to Occupational Performance (CO-OP) motor learning approach.
Top-down.
Focus: Cognitive-based motor learning approach.
Goal: Enhance individual’s problem-solving abilities for daily meaningful activities.
Principles:
* Client-Centered: Client chooses their own goal based on their needs.
* Dynamic Performance Analysis: Client analyzes their activity performance in real-time.
* Strategy Use: Encourages self-discovery of effective cognitive strategies to improve motor performance.
* Guided Discovery: Facilitates problem-solving through guided questioning.
* Performance Feedback: Provides immediate, relevant feedback.
* Can use the COPM to evaluate self-reported ouutcomes
enable learning, generalization, and transfer
Describe the cognitive function: attention. List the 4 types.
- Sustained attention; writing a test
- Selective attention; listening to a conversation in a noisy restaurant
- Divided attention; driving (same time)
- Alternating attention; cooking a multistep/component meal (individually in sequence)
Which 2 cognitive functions does the Trail Making Test (A & B) evaluate?
Attention and executive functioning.
Which 2 tests can be used to screen/evaluate attention?
Bell’s Test and Apple’s Test.
