neurophysio Flashcards
systems approach to motor control
movement is organised around abehavioural goal/function & results from an interation between
- enviroment (moving obstacles, different light levels)
- task (turning, dual task, picking up objects)
- individual
and sends info to the
- musculoskeletal system
- sensory-motor control system
- cognitive processes
neuro rehab guiding principles
self management
patient centered care
team work
.
ICF
.
Skill acquisition
functional movement re-education
systems model of sensory motor control
neural plasticity
neural plasticity definition breakdown of words
neuro- nerve cells
plasticity - changeable
neuroplasticity
2
any enduring changes in neurone structure or function and occurs in everyone (kleim 2009)
can be changes in the anatomy structure of the brain or changes in the physiology function of areas of the brain
developmental plasticity
modification in structure (anatomy) and function (physiology) of the CNS during embryonic growth and development
functional plasticity
changes in the adult CNS induced by the enviroment = learning e.g professional violinists found to have greater cortical representation of left hand
definition & 2 points
adaptive plasticity
changes induced by injury or lesions to specific components of the CNS
- in neurological injury often combination of both functional and adaptive plasticity
- not always a positive thing use it or lose it
damage induced changes to cns - stroke
damage to nerve tissue at the site of the primary injury
- core ischemia (necrosis) (minutes)
- delayed cell death (penumbra) (hours-days)
damage induced changes to cns - stroke
remote secondary damage and dysfunction distal to site of injury
- due to **diaschisis **
- diaschisis with a heamorrhige is bigger due to the increased pressure in the brain (is reversible if the heamorrhig reduces naturally or surgically reduces pressure)
spontaneous natural recovery after stroke
through reduction in inflammation surrounding a lesion (penumbra) reversal/ resolution of diachisis
motor training after stroke can induce recovery by what mechanisms?
- resoration
- reorganisation
- recruitment
restoration
function within damaged area of the motor cortex restored with rehabilitation
- making pathways easier/ faster/ more efficient (physiological)
reorganisation
- rehab can drive residual neural tissue to reorganise in order to compensate for lost function
- finding new routes (physiological)
recruitment
- when insufficient resources are found within the damage area, others may take over or the contralateral motor cortex may be recruited
- making new pathways (anatomical)
making pathways easier (physiological)
- more neurotransmitters
- stronger link between neurones
10 principles that drive neuroplasticity
- use it or lose it - neural circuits not actively engaged will start to atrophy or degrade
- use it and improve it
- specifcity - plasticity is experience specific to the individual
- repetition matters - have to practise a lot of times to see neural changes
- intensity matters- need the right amount of physical activity to cause brain changes
- time matters - waiting to late to start the activity means a decreased capability to change
- salience matters - has to be motivating & important to that person
- age matters- younger patients brains adapt and change more easily
- transference - if you practice something in a nearby area of the brain it will transfer to other areas of the brain
- interference - sometimes neural plasticity can be delayed
10 principles that drive neuroplasticity
use it or lose it
neural circuits not actively engaged will start to atrophy or degrade
10 principles that drive neuroplasticity
specifcity
plasticity is experience specific to the individual
10 principles that drive neuroplasticity
repetition matters -
have to practise a lot of times to see neural changes
10 principles that drive neuroplasticity
intensity matters-
need the right amount of physical activity to cause brain changes
10 principles that drive neuroplasticity
time matters -
waiting to late to start the activity means a decreased capability to change
10 principles that drive neuroplasticity
salience matters -
has to be motivating & important to that person
10 principles that drive neuroplasticity
age matters-
younger patients brains adapt and change more easily
10 principles that drive neuroplasticity
transference
- if you practice something in a nearby area of the brain it will transfer to other areas of the brain
10 principles that drive neuroplasticity
interference
- sometimes neural plasticity can be delayed
skill aquisition
- early learning phase (declarative phase) - attempting to understand basic phases and movements of functioning
- intermediate associative phase (implicit and explicit learning - eg. often dropping bslls but able to identify and correct the problem through trial and error by practising
- autonomous phase (procedural learning) - able to juggle automatically with few errors and able to focus on uni-cycling at the same time
6
how to use it in practice
- repetition
- fascilitates normal movement
- provide sensory and proprioceptive feedback
- functional tasks
- minimise abnormal recovery of movement and spasticity
- think about stages of learning
late rehab
change fastest early after injury/disease (kwakkel et al 2004)
- functional change has been evident even when the rehab programme was inititated 20 hears after the lesion (ward et al 2018)
4
key aims of neuro physiotherapy
all affect optimal function
1. restore
2. adapt
3. maintain
4. prevent
restore
- aim to restore functional activities and increase participation as identified by patient led goals (edwards 2002)
- current evidence suggents that practice of motor skills needs to be both task and contex specific
- if impairments make it difficult to practice the task directly, address impairments ensuring theres carry over into functional activity
adapt
- can be viewed both negatively and positivly
- promotes compensatory startergies that are neccessary for function and discourgae thoses that may be detrimental
- initiaition of compensation stratergies may vary
maintain
- maintance of function can be as important as therapy
- in progressive conditions eg. MS, PD, physiotherapy can help maintain functional ability despite deteriorating impairments
prevent
- impairements there may be an increased risk of developing secondary complications
- contractures
- pressure areas and reduced skin integrity
- respiratory or urine infections
Bobath
aims to stimulate sensory and motor pathways to encourage normal movement patterns and the recovery of selective movement as a prerequisite for efficient postural control, alignment, and function.
Rehabilitation is a process of learning to regain motor control and should not be the promotion of compensation
Carr and Shepherd / Movement Science
improves functional ability by making treatment task-specific and encouraging active involvement throughout the rehabilitation process, as with Bobath the development of compensatory movement patterns that may hinder recovery are avoided
context or goal & reference
The presence of a meaningful context or goal has been shown to enhance motor learning (Ma 1999; Wu 2000)
extrinsic feeback & reference
Extrinsic feedback enhances motor learning after stroke (van Vliet 2006)
