Neuroplasticity (lab)

Question 1

cognitive reserve

Answer 1

strucutral changes that support cognitive functioning

Question 2

Positive neuroplasticity

Answer 2

• structural changes in the brain that occur during novel and challenging stimuli

Question 3

Negative neuroplasticity

Answer 3

changes in the brain that occur if one experiences a lack of novel, challenging stimuli and diminished health

Question 4

Recovery after brain injury

types

Answer 4

• spontaneous: results from repair processes post lesion
• function-induced: occurs due to increase use of involved body segments in behaviorally relevant tasks

Question 5

Recovery vs compensation approaches to treatment

Answer 5

• bottom up approach emphasizes practice of desired skills to drive motor recovery of walking and UE functional use for ADLs
• top-down approach involved teaching new compensatory strategies, requiring development of new skills

Question 6

What are the 10 principles of experience-dependent plasticity

Answer 6

1. Use it or lose it
2. use it and improve it
3. specificity
4. repetition matters
5. intensity matters
6. time matters best neuroplasticity is right after event
7. salience matters
8. age matters
9. transference: transfer skills from one activity to another
10. interference: tauhg something in one context and no transfered in another

Question 7

mechanism accounting for superior plasticicty in children

Answer 7

• persistence of neurogenesis in certain parts of brain during postnatal period
• elimination of neurons through apoptosis
• proliferation and runing of synpases
• activity dependent refinement of synpatic connections

Question 8

types of pediatric brain plasticity

Answer 8

• impaired plasticity
• excessive plasticity
• brain’s achilles hell plasticity
• adaptive plasticity

Question 9

Imparied plasticity

Answer 9

• genetic or acquired disorders disrupt plasticity pathways (changes in structures, synpases, NTs) and cause cognitive developmental disorders
• fragile X syndrome
• neurofibromatoisis 1
• tuberous sclerosis
• lead poisioning
• rett syndrome

Question 10

excessive plasticity

Answer 10

• leads to maladaptive brain circuits
• dystonia and rigidity following perinatal injury is related to an imbalance in NT systems that occurs with cortical reorganization in infants
• temporal lobe epilespy: too musch activity in temporal lobe
• Mesial temporal sclerosis: scarring within temporal lobe may be cause or result to TLE

Question 11

Plasticity as the brains achilles tendon

Answer 11

• areas of the brain that are rich in excitatory synpases
• including thalamus
• basal ganlia
• cortex
• are vulnerable to acute near total asphyxia in term infants

Question 12

adaptive plasticity

Answer 12

• activity-dependent changes in synpases and neuronal connections
• assoicated with acquisition of new motor skills
• learning a language or playing an instrument or sport
• also occurs during recovery from an injury or sensory loss

ex:

• eye patching for amblyopia(lazy eye)
• cochlear implants for hearing loss
• hemispherectomy for intractable seziures

Question 13

Neuroplasticity- based training and technologies

Answer 13

• CIMT and mCIMT
• microchips
• robotics
• virtual reality
• functional UE orthoses
• AFOs and LE FES
• locomotor training

Question 14

CIMT: constraint induced movement therapy

Answer 14

• functionally oriented task practice of affected UE and long periods of restraint of unaffected UE
• goal of treatment is pt based no therapist driven
• patients with excessive spasticity or pain in involved UE are exlcuded
• wear the mit for 23 hr/day

Question 15

CIMT: inclusion criteria

Answer 15

• ≥10º of active finger extension and ≥20ºof active wrist extension
• ≥3 months p/CVA nad ambulate without a device
• score ≥ 69 on modified mini mental status examination
• score < 2.5 on motor activity log

Question 16

CIMT: contraindications

Answer 16

• any indication that treatment approach would adversely affect safety
• fractures, significant musculoskeletal deformities or bursn in involved UE
• cognitive deficits that would compromise safety or interfere with HEP compliance

Question 17

modified CIMT (mCIMT)

Answer 17

• this protocol decreases wearing of constraints device frm 23 hours/da 7 days/week to 6 hours/5days a week during active times of day while at home
• patients also participate in outpatient therapy 3days/week for 1hr/day
• therapy consists of therapeutic activities, provided 1:1 and in group setting, designed to improve use of more involved arm and hand

Question 18

AFO: ankle foot orthosis

Answer 18

• address foot drop and stance-phase stability
• limit ankle excursion, may decrease muscle activation and dynamic balance
• may limit transfers and be uncomfortable

Question 19

functional electrical stimulation (FES)

Answer 19

• alternative to AFO for foot drop due to UMN damage
• orthotic effect uring use; potential therapeutic effects after withdrawn
• pain may limit ability to achieve adequate DF for swing
• may be less effective if medial/lateral ankle instability is present
• set up complex, reimbursement limited

Question 20

CPG for use of AFO and FES post stroke

Answer 20

• strong evidence that AFO and FES can increase gait speend, mobility and dynamic balance
• moderate evidence that AFO and FES increase QOL, endurance and muscles activiation
• weak evidence for improving kinematics
• AFO may lead to more compensatory effects while FES may lead to more therapeutic effects

Question 21

body weight support treadmill training

Answer 21

• BSW harness allows a progressive increase in demands for postural control
• treadmill enables systematic control and progression of gait speed
• repetitive training of a complete gait cycle enables a more appropriate pattern of sensory input assoicated with the difference pahses of gait to stimulate the locomotor pattern

Question 22

Locomotor training CPG

Answer 22

clinicians SHOULD preform

• walking training at moderate to high aerobic intensity
• walking training with virtual realtiy

Clinicians MAY consider:

• strength training at ≥ 70% 1 rep max
• circuit training cycling or recumbent stepping at 75085% HRmax
• balance training with virtual realtiy

clinicians SHOULD NOT preform:

• static or dynamic balance activities including pre-gait
• BWST with emphasis on kinematics
• robot-assisted gait training

Question 23

locomotor training and neuroplasticity

Answer 23

• use it or lose it
• use it or improve it
• specificity
• repetition matters
• intensity matters
• salience matters
• transference

Question 24

other uses for harness systems

Answer 24

• pre-gait
• ball exercises
• balance activityes
• transfers
• UE activities in standing
• sidestepping and backward amb.
• crawling