Neurological Rehabilitation Flashcards
Neurological rehabilitation
Self-management
Patient centred care
Teamwork
ICF
Functional movement re-eduction
Neural plasticity
Skill acquisition
Systems of model of sensory motor control
Sensory motor control
Control of movement by the CNS and MSK system as well as the physical and social aspects of the environment
Requires intact - musculoskeletal system, sensory-motor control system, cognitive processes
Skill acquisition
Motor skill learning
1. Early cognitive phase
2. Intermediate associative phase
3. Late autonomous phase
Skill acquisition: 1. Early cognitive phase
Declarative phase
E.g. attempting to understand basic phase and moments of juggling
Skill acquisition: 2. Intermediate associative phase
Implicit and explicit learning
E.g. often dropping balls but able to identify and correct the problem through trial and error by practicing
Skill acquisition: 3. Late autonomous phase
Procedural learning
E.g. able to juggle automatically with few errors and able to focus on uni-cycling at the same time
Motor learning
Learning new skills
Motor re-learning
Improvements seen after stroke or damage
E.g. improvements in function
Neural plasticity
Neuro - nerve cells
Plasticity - changeable
Any enduring changes in neurone structure or function, and occurs in everyone
Can be changes in the anatomy (structure) of the brain or changes in the physiology (function) of area of the brain
Types of plasticity
Developmental plasticity
Functional plasticity
Adaptive plasticity
In neurological injury often combination of both functional and adaptive
Not always a positive thing
Types of plasticity: developmental plasticity
Modification in structure and function of the CNS during embryonic growth and development
Types of plasticity: functional plasticity
Changes in the adult CNS induced by the environment
Learning
E.g. professional violinists found to have greater cortical representation of left hand
Types of plasticity: adaptive plasticity
Changes induced by injury or lesion to specific components of the CNS
Damage induced changes to the CNS: stroke
Damage to nervous tissue at the site of the primary injury
Necrosis - core ischaemia, minutes
Penumbra - delayed cell death, hours to days
Diaschisis - remote secondary damage and dysfunction distal to the site of injury
Recovery after stroke
Restoration
Reorganisation
Recruitment
Recovery after stroke: restoration
Function within damaged area of the motor cortex restored with rehabilitation
Recovery after stroke: reorganisation
Rehabilitation can drive residual neural tissue to reorganise to compensate for lost function
Recovery after stroke: recruitment
When insufficient resources are found within the damage area, other areas mat take over or the contralateral motor cortex may be recruited
Mechanisms of neural plasticity following motor training: long-term potentiation/ synaptic plasticity
Persistent strengthening of synapses based on recent patterns of activity
Produce a long-lasting increase in signal transmission between two neurones
More receptors on the postsynaptic neurone
Mechanisms of neural plasticity following motor training: cortical reorganisation
Preserved brain tissue taking on a new functional role
Adapts and takes on the function that was lost due to the damage
Changes in cortical maps and functional organisation of brain regions
Mechanisms of neural plasticity following motor training: neurogenesis
Individual neurones
Dendrite remodelling and atonal sprouting
Generation of new neurones in specific brain areas
Mechanisms of neural plasticity following motor training: axonal sprouting
Formation of new connections or sprouting of existing axons
Corticospinal tract and other neural pathways involved
Mechanisms of neural plasticity following motor training: dendritic remodelling
Structural changes in dendrites, including sprouting and arborisation
Affected and unaffected brain regions are involved
Task specific functional practice
Best way to relearn a task is to practice the task
Involves repetitive practice of meaningful, real-life tasks with the intention of acquiring a skill
Challenging, progressively adapted, practiced within different contexts and environments
Aims towards reconstruction and mastery of the whole task
Intensity/ time
Intensity - number of repetitions performed within treatment session and physiological effort exerted
Should do lots of repetitions
Types of practice
Direct supervision
Semi-supervised practice
Independent/ unsupervised practice
Types of practice: direct supervision
One to one practice with a therapist
Types of practice: semi-supervised practice
Takes place in the therapy area but not under the direct supervision of a therapist
Types of practice: independent/ unsupervised practice
Takes place outside the of the therapy area, i.e. on the hospital ward or at home, and is not supervised by a therapist
Late rehabilitation
Change faster early after injury/ disease
Functional changes has been evident even when the rehab programme was initiated 20 years after the lesion
Therefore, no absolute end to potential
Key aims of Neuro physiotherapy
RAMP
Restore
Adapt
Maintain
Prevent
Restore
Restore functional activities and increase participation as identified by patient led goals
Aim your treatments at an activity level where possible
The practice of motor skills needs to be both task and context specific
Adapt
Viewed both negatively and positively
Promote compensatory strategies that are necessary for function and discourage those that may be detrimental
Maintain
Maintenance of function
In progressive conditions such as MS physiotherapist can help maintain functional ability despite deteriorating impairments
Prevent
Increased risk of developing secondary complications e.g. contracture, pressure area and reduced skin integrity, respiratory or urinary infections
Need to work with the MDT to identify those most at risk and prevent the development of secondary complication
