Pratique - Questions de fin de cours Flashcards
- How does the brain integrate multi-sensory information to control posture and gait?
Brain will receive sensory information which will go through S1, Unimodal associative area, multimodal associative area which will lead to the creation of the body schema. All process of postural control and motor control (gait) will be based on the creation of the body schema.
Clinical practice: Need to update the sensory information through hands-on facilitation to update the body schema.
- What are the core tasks used for movement analysis in physical therapy ?
- Walking
- Standing
- Sit to stand
- Sitting
- Reaching and grasping
- Step up/down
They are used to assess the functional level of the patient.
Clinical Practice: This will allow us to identify on which task we should focus on first, but keep in mind the needs of the patient (ADL’s).
- How does impaired prediction of sensory consequences contribute to spastic movement disorders?
An impaired prediction of sensory consequences will lead to a reduced ability to selectively activate muscles in coordination with each other (intra and inter-limb coordination) and the use of co-activation as an adaptation.
Clinical Practice: Negative features such as sensory deficit should be addressed through hand-on treatment. More globally all negative features identified should be focused first as they will lead to an improvement of the positive features.
- Why is it important to standardize environmental conditions during movement analysis?
During movements analysis the environment should be standardized, so the assessment will be reproducible in the future re-assessments. Analysis should be conducted in a validated way
Clinical Practice: Use standardized conditions and write them down to reproduce them in re-assesments.
- How does the movement continuum framework help in assessing movement dysfunction?
The movement continuum framework will help you in the formulation of your movement diagnosis by understanding which sequence is affected (initiation..). Is the outcome associated with the movement achieved yes/no ?
- Why is it important to distinguish between movement constructs such as stability, alignment, and sequencing?
Making the distinction between stability, alignment, symmetry and sequencing will help in identifying which of those constructs will need to be worked on.
Clinical practice: Example: After having identified that the alignment of the feet is wrong through hand-on treatment you’ll realign the feet and improve the movement in the patient.
- How can movement analysis contribute to developing movement system diagnoses?
During a movement analysis you are assessing the BOS, COM, and how they are distributing their Body Weight (BW) while they execute the movement without physio instructions. Based on this you can create a framework on how you’ll treat the identified problems that your patient just showed.
Clinical Practice: During completely independent movement you’ll identify which component (BOS, COM, BW) can be changed to either add regression or progression to the movement.
- Define the Center of Mass.
The point that is at the center of the total body mass, controlling this center of mass in relation with the BOS during movement is essential.
Clinical Practice: Example:
- Standing straight = center of mass over center of BOS
- Bending forward: = center of mass on the front of the BOS
- Define the Lateral Stability Limits.
The stability Limits are the boundaries within which the body can maintain stability. The limits are not fixed they depend on the task and individuals characteristics (strength, ROM, environment…).
- Define the Base of Support.
The area of the body that is in contact with the support surface.
Clinical Practice:
- in standing regression = widening BOS
- progression = reducing the BOS
- What is the definition of postural control, and how does it integrate sensory and motor components?
Is the coordinated, sequenced organization of stability and mobility of the multi-link kinetic chain in order to maintain, achieve or restore balance for efficient performance of a motor task.
Postural control integrate the sensory information through links between the sensory homunculus, the creation of the body schema, and the activation of the APA’s (SMA).
Clinical Practice: In practice you should prepare your patient with sensory motor preparation to movement.
- Define the Anticipatory Postural Adjustments (APAs) and explain how they support movement, and what mechanisms are involved?
APA’s are unconscious preemptive measure taken by the CNS to counteract expected postural perturbations and are critical for functional behaviors. APA’s occur in both self and externally induced perturbations to posture and stability.
APA’s will help plan movement better by activating the required muscle and engaging in the good procedure of movement.
Initiation of movement: Feedforward mechanism (Corticulo Reticulo Spinal Pontine system)
-> S1, Unimodal associative area, multimodal associative area, creation of body schema with Anterior associative area, PMC, SMA -> (APAs’)
Execution: Corticospinal system
-> M1
Termination: Feedback mechanism (Vestibulo Spinal Tract)
Clinical Practice: Work systematically on the alignment, symmetry, activating the sensory motor homunculus to see a change in the patient.
- How do sensory inputs such as proprioception, exteroception, and vestibular information contribute to postural orientation?
Proprioception, exteroception and vestibular information contribute to postural orientation by giving conscious awareness of our own body (proprioception), the direct information to identify our environment (exteroception), and the position of our body in space (vestibular).
Clinical Practice: Those inputs can be given through facilitation (manual, verbal and environmental)
- What is the role of the vestibulo spinal and reticulo spinal tracts in postural stability?
1) The reticulo spinal tract receives proprioceptive visceral, visual, vestibular and auditory sensations, inputs from the cerebellar cortex, limbic system, basal ganglia, cerebellum and spinal cord. The fast-conducting reticulo spinal neurons may be involved in the activation of the Central Pattern Generators (CPG’s) in spinal cord to start locomotion.
The reticulospinal tract is part of the feedforward mechanism predicting posture needs to the environment (predicted perturbation) and task.
2)The vestibulo spinal tract is a non-voluntary pathway controlled by the cerebellum it regulates our body response to gravity.
The vestibulo spinal tract is part of the feedback mechanism adjusting on-line posture needs to the environment (unpredicted perturbation) and task.
- What is the role of the vestibulo spinal and reticulo spinal tracts in postural stability?
-> Clinical practice application
Clinical Practice: After identifying the patient need you can choose which tract and which mechanism (feedforward/feedback) you want to train.
Eg: Reticulo spinal tract: prepare the patient for anticipated perturbations.
Vestibulo spinal tract: train patient on unpredicted perturbations.
- What is the role of graviceptors?
The graviceptors contribute to the perception of postural verticality, increase of intra-abdominal pressure stimulates graviceptors.
Clinical practice: Visceral cues to increase intra-abdominal pressure will help building a internal model of verticality.
- List and divide the descending systems based on their functions?
Dorsolateral systems = Cortico spinal lateral & Rubro spinal -> Sensory motor systems, expecting a sensation (reaching for an ice-cube = cold)
Ventro medial system = Reticulospinal pontine & medullar, Vestibulospinal lateral & medial, Tectospinal, and Corticospinal medial pathway -> Postural control
Clinical Practice: depending on the lesion some of those tract might be damaged and knowing their function allows to identify to potential issues.
- What is the neuroanatomy and function of the cortico-reticulo-spinal?
Both,
Pontine (medial): ipsilateral
Medullary (lateral): bilateral
Originates from the SMA and PMC areas, split at the cortico-reticular projections and join motoneurons at different levels of the spine.
Function : postural control, generation of CPGs that’s when activated at SC linitiate locomotion
They will both gather Visual, auditory, vestibular, proprioceptive visceral information’s to control postural muscle tone and locomotion.
- What is the neuroanatomy and function of the cortico-spinal?
It originates from the cerebral cortex goes through the internal capsule, midbrain, pons medulla then decussates at the medulla-spinal cord junction and will form interneurons connections in the spine (coordination of larger groups of muscles).
The motor information is significantly modulated
by sensory information.
- What are the clinical features of Upper Motor Neuron Syndrome (UMNS) and how do they impact functional movement?
- Positive features :
- Spasticity, Dystonia, Clonus, Spasm, Co-contraction, Associate reactions, tendon reflex, Babinski response - Negative features
- Weakness, Loss of dexterity & coord, fatigue, sensory deficit, postural control deficit, fasciculations - Biomechanical features :
- Muscle stiffness, contractures
What are the clinical features of Upper Motor Neuron Syndrome (UMNS) and how do they impact functional movement?
-> Clinical practice implication?
Clinical Practice: You’ll need to work on the negatives features first because they have a worsening impact on the positive features. (treat – features to treat + features)
- How does spasticity differ from other forms of motor over activity, such as spastic dystonia and spastic co-contraction?
Spasticity (spastic movement disorder) is characterized by a reduced ability to selectively activate muscles, often with significant co-activation of antagonist muscles. It’s pathophysiology shows a lack of descending motor command (strength of signal), inhibition of brainstem activity, followed by adaptative changes in spinal cord neural network, which leads to an inappropriate prediction of sensory consequences of movement.
Spastic dystonia: involuntary muscle activity at rest (muscle is stuck in contraction).
Spastic Co-Contraction: issue of timing of antagonist muscle activation (antagonist muscle will contract too when we need agonist only).
- How does spasticity differ from other forms of motor over activity, such as spastic dystonia and spastic co-contraction?
-> Clinical implication practice
Clinical Practice: To work on the spastic movement disorder you need to work on the Initiation phase (APA’s) by preparing the desired muscles to activate.
- How do non-neural changes, such as muscle and tendon alterations, contribute to movement limitations in UMNS?
Tendon and muscles alteration on the non-neural level will limit movement as those structures aren’t ready to be moved immediately, they will need preparation to be recruited in the best way for the movement.
Clinical Practice: Hands-on treatment will allow to realign and the fibres and change the muscles/tendons properties.
- What are the main anatomical divisions of the cerebellum?
- Anterio lobe (spinocerebellum)
-> top part + spine of the cerebellum
Function: Somatosensory and Proprioceptive input from SC (touch, pressure, limb position) - Cerebellar cortex (cerebrocerebellum)
-> posterior part of the cerebellum
Function: Motor coordination and planning.
On-line modification of motor information’s (changing the motor plan based on the other lobes information’s) - Flocculonodular lobe (Vestibulocerebellum)
-> bottom part of the cerebellum
Function: Balance and Equilibrium.
Inputs from semicircular canals and otoliths organs and visual input from mossy fibers
What are the main anatomical divisions of the cerebellum?
-> Clinical practice application
Clinical Practice: Work on proprioception and somatosensory stimulation to prepare the patient. Consider the environment so head is stable (to avoid over stimulating Vestibulocerebellum) and ask patient to explore the mvmt (hand-eye coordination)
- What are the primary symptoms of cerebella’s disorders, and how do they impact movement and coordination?
- Hypotonia: low tone (reduced resistance to passive limbs mobilizations)
- Atasia: loss of ability to maintain a steady limb or body posture across multiple joints
Abasia: loss of ability to maintain upright stance against gravity - Ataxia: issue in initiating movement on the affected limb + controlling the amplitude of a movement.
- Action/intention tremor: tremor due to series of erroneous movement corrections
Clinical practice: work preparing the best you can the patient (feedforward mechanism ready), then make modification in the environment regularly to challenge the feedback mechanism.
- How do the different functional areas of the cerebellum (vestibulocerebellum, spinocerebellum, cerebrocerebellum) contribute to balance, coordination, and voluntary movement?
All 3 lobes will work together adding their information.
- Balance will be mainly regulated by Vestibulocerebellum, but it will need somatosensory and proprioceptive information as well as on-line modification to be achieved.
- Coordination (intra/inter) will be mainly regulated by Spinocerebellum, but will need Vestibulocerebellum to know the body/limbs position in relation with gravity, and online modification to adjust muscle activation timing, order of movement.
- Voluntary movement will be mainly regulated by Cerebrocerebellum, but it will need the spinocerebellum for intra/inter coordination and Vestibulocerebellum for adaptation of balance and equilibrium.
- How do the different functional areas of the cerebellum (vestibulocerebellum, spinocerebellum, cerebrocerebellum) contribute to balance, coordination, and voluntary movement?
-> Clinical practice application
Clinical Practice: Identify and isolate the issue work specifically on the impaired function knowing all 3 parts of the cerebellum will be working together.
- Describe what cerebellar learning is ?
Cerebellar learning is when a correction of movement happens (online modification of motor plan)
- Describe the oculo-vestibular reflex neuroanatomy and function.
The Vestibulo Ocular reflex, happens when the head is moving but the eyes stay stable (or opposite), is part of the feedback mechanism as the head movement and eye stability can’t be anticipated.
Anatomy: originates from the Oculomotor nucleus, joins the vestibulo cerebellar pathway
Clinical practice: Patient need to work on environment exploration with the eye’s moving and head stable ( easier) and the head moving with eye’s stable (more complicated). Promote dissociation of eye and neck
- Describe what the connectome is.
Comprehensive map of all neural connections in the brain
