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
Describe the “transference” experience-based principle of neuroplasticity.
Neuroplastic changes resulting from one type of activity or experience may have positive effects on related activities. For example, improvements in attention and focus developed through mindfulness meditation might benefit other cognitive functions.
Describe the “interference” experience-based principle of neuroplasticity.
interference refers to the possibility that the plastic changes induced by one experience may interfere with the acquisition of another. This principle highlights the importance of designing learning experiences that complement rather than hinder each other.
Why should an OT encourage their client to use their impaired limb?
To avoid learned non-use.
List 3 examples of compensatory approaches for nonfunctional upper limb hemiplegia.
- Education in one-hand techniques
- Use of assistive devices
- Dominance retraining
Define muscle tone.
The amount of tension in a muscle at rest.
Define hypotonia.
Muscles that are slower to react to a stretch (therefore decreased muscle tone). Unable to sustain a prolonged muscle contraction.
Define hypertonic (spasticity).
Muscles are in an over-reactive state to stretch; in high tension and may maintain a prolonged contraction.
What is a risk of hypertonic muscles?
Risk for contractures
Define clonus.
Repetitive contractions in the antagonist muscles in response to rapid stretch. Therapist can feel the joint “vibrate” during manipulation due to the frequency of repetitive contractions.
List 3 assessments for spasticity (resistance to passive stretch).
- Ashworth Scale
- Tardieu Scale
- Composite Spasticity Index
List some treatment options for hypotonia.
- Positioning to facilitate function
- NDT weight bearing activities
- Pain management using hot/cold modalities and TENS
- Casts, splints, and PROM stretches to prevent contractures (avoid overstretch)
What is the purpose of neurodevelopmental treatment (NDT) approaches?
NDT = Bobath
A hands-on approach with functional goals and outcomes for clients with postural control difficulties due to injury of the CNS. The sessions involve using hands-on facilitation (use of sensory cues to improve motor performance), minimizing movement compensations, and providing the client with an overall management program for home practice. The goal is to organise the internal (proprioceptive) and external (exteroceptive) environment of the nervous system to promote functional participation in activities and typical movement patterns.
MORE DETAILS BELOW!
Uses normal postural reflex mechanisms to promote a motor skill’s performance. The normal postural reflex mechanisms consist of:
1. Righting and Equilibrium reactions.
2. Reciprocal innervation.
3. Coordination patterns.
It is aimed at preventing development of spasticity and improving residual function. Therapists work on tone to improve movement, not to normalise tone. Hypertonia can be reduced by:
1. Mobilisation of muscles and stiff joints.
2. Muscle stretch.
3. Practice of more normal movement patterns.
4. Through a more efficient, less effortful performance of functional tasks.
5. Weight-bearing during functional activities (ex. wiping down countertops with affected arm).
Integrating senses after hyposensitivity. Bobath therapists commonly shape movement with sensory inputs in the form of:
1. Tactile information from the hands / hand over hand approaches.
2. Removing manual guidance once patients are capable of self-generated movement.
https://www.physio-pedia.com/Bobath_Approach
What is dysmetria?
High five to the face every time.
The inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated movements.
Lack of coordination resulting from damage to the cerebellum.
What happens to muscle tissue length and joint mobilization decreases/spasticity increases?
Muscle tissue shortening (decreased length) and development of contractures (decreased ROM).
List a therapeutic goal for hypertonia.
- Decrease spasticity.
- Maintain ROM.
List interventions for hypertonia to prevent/decrease spasticity and contractures.
- Antispastic pattern positioning
- ROM exercises
- Stretching
- Splinting
- Botox
- Electrical stimulation (TENS) with botox to improve muscle tone
How does electrical stimulation with botox help treat spasticity and contractures?
Electrical stimulation, combined with Botox (botulinum toxin) treatment, helps manage spasticity and contractures by utilizing electrical impulses to stimulate targeted muscles, promoting circulation, reducing muscle stiffness, and enhancing the effectiveness of Botox in temporarily paralyzing overactive muscles, thus facilitating improved range of motion and functional outcomes.
List components of a trunk control assessment (4).
- Trunk alignment
- Mobility / ROM
- Muscle tone
- Trunk stability
Think walking
What is the purpose of the Trunk Control Test (TCT)?
Looks at balance and non-vestibular functional mobility of the trunk.
Predictor for walking ability post-stroke: At 18 weeks, scores of 50 or more were associated with recovery of walking
4 items:
1) Rolling to weak side
2) Rolling to strong side
3) Balance in sitting position
4) Sit up from lying down
Total score range: 0 (minimum) to 100 (maximum, indicating better performance).
Score of each item: (0, 12 or 25)
* 0 = unable to perform movement without assistance.
* 12 = able to perform movement, but in an abnormal style, for example, pulls on bed clothes, rope or monkey pole, or uses arms to steady self when sitting.
* 25 = able to complete movement normally.
https://www.physiotutors.com/wiki/trunk-control-test/
List factors that influence balance.
- Weight distrubution / weight bearing / base of support
- Lateral sway
- Alignment
- Postural Control / tolerance
- Symmetry
- Displacement / ability to reach outside base of support
- Protective reactions (safety against falls)
List 2 standardized evaluations for balance.
- BERG Balance Scale
- Mini-BEST test
https://www.physio-pedia.com/images/b/bd/Berg_balance_scale_with_instructions.pdf
https://www.sralab.org/sites/default/files/2017-06/MiniBEST_revised_final_3_8_13.pdf
What is the impact of balance on function?
ADLs, transfers, and mobility.
Define motor apraxia.
The loss of the cognitive/perceptual ability to execute or carry out skilled movement and gestures, despite having the physical ability and desire to perform them (NORMAL motor function).
Can involve limitations in:
* Formulation of the intention to move
* Planning the movement
* Sequence of actions or movements
* Command or by imitation
Define ideomotor apraxia.
Difficulty completing a movement from a verbal command or imitation.
Individuals with ideomotor apraxia may struggle with tasks that require motor planning and sequencing, making it challenging for them to mimic or imitate gestures, handle tools, or perform intentional movements in response to verbal commands. This condition is often associated with damage to the parietal lobe of the brain, particularly in the left hemisphere, and can result from various neurological conditions, such as stroke or traumatic brain injury.
Define ideational apraxia.
Inability to use real objects, inability to conceptualize a task and impaired ability to complete multistep actions. May complete
actions in incorrect orders.
List 2 standardized measures to assess for motor apraxia.
- Boston Praxis
- Test to measure Upper Limb Apraxia In Stroke (TULIAS)
List 2 screening measures for motor apraxia.
- Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)
- RPAB
https://www.sralab.org/sites/default/files/2017-07/apraxia_screen_of_tulia_ast.pdf
What is the purpose of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)?
$$$
Measure of basic cognitive skills and visual perception in older adults with neurological impairment.
Basic cognitive skills include: orientation, visual perceptual and psychomotor abilities, problem-solving skills and thinking operations
Consists of a total of 26 subtests within 6 areas:
1. Orientation (2 items)
2. Visual Perception (4 items)
3. Spatial Perception (3 items)
4. Motor Praxis (3 items)
5. Visuomotor Organization (7 items)
6. Thinking Operations (7 items)
https://strokengine.ca/en/assessments/loewenstein-occupational-therapy-cognitive-assessment-lotca/
List remedial treatment approaches for motor apraxia.
- hand over hand guidance
- frequent and consistent functional activity practice (transfers, ADLs, and iADLs)
- appealing to the senses as much as possible in interventions by using proprioceptive, tactile, and kinetic input
List compensatory treatment approaches for motor apraxia.
- environmental adaptation
- instructional adaptation = clear and concise verbal cues
- use familiar tasks and environments during OT sessions
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.
List 3 different types of motor learning remedial approaches.
- Task-oriented
- Cognitive Orientation to Occupational Performance (CO-OP)
- Constraint-Induced (CIMT)
Are motor learning remedial approaches top-down or bottom-up?
Top-down.
Define motor control.
The ability to regulate and direct the machanisms required for movement.
List motor control components. (6)
Motor planning and sequencing:
* Coordination
* Timing/ rate
* Motor memory
* Stabilizing/ fixing
* Muscle tone
* Strength/ Endurance
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
List 3 types of motor learning tasks.
- continuous
- discrete
- serial
What is the difference between a continuous and a serial motor learning task?
Define each and provide an example.
Continuous tasks do not have a clear starting point and end to the task. Example: walking.
Serial tasks are sequential in nature and consist of multiple discrete tasks in order. Example: getting dressed.
Define a discrete motor task and provide an example.
Discrete motor tasks have a clear starting point and end to the action. Example: throwing a ball.
Explain the difference between instrinsic and extrinsic feedback.
Intrinsic and extrinsic feedback are 2 different types of information sources in motor learning.
Intrinsic Feedback, also known as inherent or internal feedback, comes from the sensory system as a result of performing a motor skill. It arises from the inherent sensory information generated by the movement itself.
* Example: proprioception
* Timing: It is immediate and continuous.
Extrinsic Feedback, also called augmented feedback, comes from external sources other than the individual’s sensory system. It is information provided by an external entity, such as another person, video analysis, or biofeedback device.
* Example: A coach providing verbal cues, visual feedback from watching a video of the performance, or the sound of a metronome guiding the timing of movements.
* Timing: Extrinsic feedback can be provided during or after the performance of the motor skill. It can be immediate or delayed.
Describe a task-oriented motor-learning approach. Is it top-down or bottom-up?
Top-down since it starts with carrying-out functional tasks.
Motor-learning and improving on motor skills via actual performance of functional tasks in real life. This approach emphasizes the integration of skills into meaningful activities in “natural”/familiar that individuals may encounter in their daily lives.
Ex. practice slapshot on the ice using a hockey stick w/ goalie in net
List different ways that an OTcan provide feedback to a client on their ability to perform a task-oriented activity. Ensure that the feedback provided encourages congnitive reflection on activity performance and enables problem-solving behaviours.
- Verbal encouragement
- Physical cues
- Visual prompts
- Quantitative data recorded over time to show the client their progress over time
- Ask the client for grading/adaptation ideas
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 the protocol for CIMT.
Frequency and duration
Use only affected side for 90% of waking hours (+6h/day) for 2 weeks.
Inclusion criteria:
The minimum motor criterion for inclusion into therapy is:
10°wrist extension
10°thumb abduction
10°finger extension
effective for post-stroke clts w/out cognitive difficulties
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
Which client population is NDT used in?
Hemiplegia and children with CP
List benefits of weight-bearing and weight-shifting activities.
- Postural alignment
- Maintains muscle strength
- Postural symmetry
- Improves co-contraction
- Proximal stability
List 5 cognitive functions.
- Alertness and Orientation
- Attention
- Memory
- Executive Functioning
- Language
Describe the cognitive function: alertness and orientation.
Alertness is defined as ones ability to become aroused and respond to stimuli.
Orientation is awareness of time, person, and place.
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)
Describe the cognitive function: memory. List the 3 types.
Memory in the context of cognitive functioning refers to the mental processes involved in encoding, storing, and retrieving information, allowing individuals to retain and recall past experiences, knowledge, and skills.
- Short-term memory
- Working memory
- Long-term memory
Describe the cognitive function: executive functioning.
Executive functioning refers to a set of cognitive processes responsible for planning, organizing, initiating, sustaining, and adapting behavior to achieve goals, encompassing skills such as working memory, cognitive flexibility, and inhibitory control.
Involved in the execution of complex goals/tasks
Define dysarthria.
A condition where a person has difficulty speaking clearly because the muscles involved in speech, such as those in the lips, tongue, and throat, are weakened or have trouble coordinating. This can make their speech sound slurred, slow, or difficult to understand.
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.
List 2 assessments that can be used to evaluate executive functions.
- Trail A & B
- MoCA (subtest)
List and describe 8 neurobehavioural impairments.
- Wandering: Aimless or repetitive movement, often without a clear purpose or destination.
- Disinhibition: Lack of restraint or inhibition, leading to behaviors that are socially inappropriate.
- Impulsivity: Tendency to act on urges or impulses without considering potential consequences. SAFETY RISK!
- Flat affect: Lack of emotional expression or a restricted range of emotions, often presenting as a neutral or monotone facial expression.
- Emotional lability: Rapid and unpredictable shifts in emotions, with intense or exaggerated responses to stimuli. INTENSE MOOD SWINGS!
- Agitation/Aggressivity: Restlessness, heightened arousal, or aggressive behavior often resulting from emotional distress or discomfort.
- Preseveration: Persistent repetition of thoughts, words, or actions, often beyond the point of relevance. Ongoing motor-loop with no end/ broken-record
- Changes in mental health: General term indicating alterations in emotional, cognitive, or behavioral well-being, often observed in conditions like anxiety, depression, or cognitive disorders.
