Principles of Neurorehabilitation Flashcards
What are the guiding principles of neurological rehabilitation?
- The ICF
- Teamwork
- Person-centred care
- Prognosis
- Neural plasticity
- Systems model of motor control
- Functional movement re-education
- Skill acquisition - motor learning
- Exercise prescription
- Self-management
- Health promotion
- Mindset
- Behaviour change
How does person-centred care lead into neurological rehabilitation?
- Patient + their wishes + situation take priority
- Feeds into neuroplasticity
- Everyone is individual
How does prognosis lead into neurological rehabilitation?
- Based on understanding of pathology, anatomy, physiology & neuroplasticity
- Often patients with life limiting conditions (MS, PD, MND)
- Some patients may not make a ‘full recovery’/are permanently affected (stroke, brain injury, spinal cord injury)
- Often involve decisions about end of life/feeding/moral & ethical medical debates
- Based on best available evidence
How does neural plasticity lead into neurological rehabilitation?
- Ability of CNS to reorganise after injury or disease
- Task specific
- Salient
- Reps (#100 reps)
- Intensity – suitably changing
How does functional movement re-education lead into neurological rehabilitation?
- Basis of treatment is the ability to practice functional tasks or movement (e.g.: rolling, lying, sit to stand, walking, balance)
- Analyse + recognise normal movement patterns
- Kinematic ranges of normal movement patterns + anatomy + biomechanics
- Training of movement (instead of pure ‘exercise’)
How does exercise prescription lead into neurological rehabilitation?
- Improving cardiovascular endurance, muscular fitness or flexibility
- FITT
How does self-management lead into neurological rehabilitation?
Most neurological conditions have ongoing consequences – need support to manage their disease
E.g.:
- Manage own catheters
- Home exercises
- Fatigue management
- Self-efficacy
- Checking skin if poor sensation
How does health promotion lead into neurological rehabilitation?
- Many people with neurological conditions don’t meet recommendations for a healthy lifestyle (for many reasons)
- Cardiovascular risk factors + secondary prevention is an important component of their long-term management
- Face additional barriers to active healthy lifestyle that may require support in overcoming
- Need to support exercise, diet, smoking cessation, mental health/wellbeing
How does mindset lead into neurological rehabilitation?
- Thoughts, beliefs + expectations that influence recovery
- Adopting strategies to foster motivation, resilience + hope with service users + bring a positive mindset
+ Communication – active listening
+ Goal setting
+ Self-management
+ Praise
How does behaviour change lead into neurological rehabilitation?
Facilitating behaviour change to enable individuals to live
- Health promotion
- Self-management
- Habit formation
What are some influencing factors in neuro clinical reasoning?
- Individual patient (wants, needs + beliefs)
- Assessment findings
- Fluctuation + variability in clinical presentation over time
- Long-term nature of most neurological conditions
- Psychological impact of neurological disease
- Underpinning knowledge of anatomy, pathology, normal movement + physiology
- Evidence base withing field of neuroscience _ neurorehabilitation
What are some underlying principles of neurological physiotherapy?
- Team working
- Self management
- WHO ICF
What are the levels of the WHO ICF?
- Body structure/function
- Participation
- Activity
- Personal factors
- Environmental factors
What is neuroplasticity?
the ability of the CNS to adapt & reorganise
What is denervation supersensitivity?
a post-synaptic membrane that is more sensitive
What does “cells that wire together fire together” relate to?
Short term potentiation
What are the methods of neuroplasticity?
- Cortical remapping
- Collateral sprouting
- Denervation supersensitivity
What enhances neuroplasticity?
- Salience
- Size of lesion
- Repetition
When working with neuroplasticity principles, what are you directly trying to effect?
Neurones & Synapses
How do muscles change with disuse?
- Reduced cross sectional area
- Greatest atrophy in antigravity/postural muscles (mainly type I)
-Depending on position of disuse:
~ Lengthened position – increase in number of sarcomeres but shorter
~ Shortened position – decrease in number of sarcomeres but longer - Reducedpennationangle (due to reduction in sarcomeres) allows greatershortening but less sustained contraction (Postural muscles again)
- Changes in length tension relationship
- Decreased protein synthesis
- Alteration in connective tissue (extracellular matrix) decreased extensibility (titin)
- Increased tendon stiffness leads to alteration in force transfer from muscle fibres tomuscle attachment
Without management of soft tissue, what may patients experience?
- Difficulty with wheelchair position or mobility
- Feeding problems
- Pain
- Hygiene (groin, axilla), self care
- Communication difficulties
- Skin integrity
- Impact on functional tasks
- Osteoporosis
- Influence sleep
- Cosmetic deformities
- Development of contractures
