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Motor Control and Learning > Recovery of Function and Adult Clinical Populations > Flashcards

Recovery of Function and Adult Clinical Populations Flashcards

1
Q

What is ankylosing spondylitis?

A
  • Inflammatory disease of the spine and SI joints
  • Early symptoms: chronic pain
  • Later symptoms: new bone formation/spine segments fuse
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2
Q

What spinal changes occur in ankylosing spondylitis?

A
  • Loss of lumbar lordosis
  • Increased thoracic kyphosis
  • Head protraction
  • Loss of spinal flexibility in all planes
  • Hip flexion
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3
Q

What postural changes occur with ankylosing spondylitis?

A
  • Forward shift of COM
  • Lowered COG
  • Impacts postural responses and postural control due to increased standing knee flexion and posterior pelvic tilt
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4
Q

How is steady state postural control effected with ankylosing spondylitis?

A
  • Increased A-P sway
  • COP displacement
  • Rely on vision for balance
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5
Q

How is anticipatory and reactive postural control effected with ankylosing spondylitis?

A
  • Limited data available
  • Worsens with severity of the disease
  • Poorer with eyes closed
  • Higher incidence of dizziness
  • Impacts gait
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6
Q

How do vestibular disorders effect information processing?

A
  • Inaccurate vestibular input: pt needs to learn to select accurate input and ignore inaccurate input
  • Decreased vestibular input: pt instead needs to rely heavily on somatosensation and vision
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7
Q

How is steady state postural control effected in vestibular disorders?

A

Increased sway and loss of balance when altering visual and somatosensory input when tested using CTSIB

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8
Q

How is anticipatory postural control effected in vestibular disorders?

A
  • Decreased balance with dynamic movements that stimulate the vestibular system
  • Head turns, bending, turning around, scanning environment
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9
Q

How is reactive postural control effected in vestibular disorders?

A

Pts use ankle strategy but not hip strategy (even if hip strategy is more appropriate, it is avoided as it will disturb the vestibular system more as it is a large movement)

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10
Q

What is alzheimer’s disease?

A
  • Progressive disease process typically causing dementia
  • Slow decline in: memory, language, visuospatial skills, personality, cognition
  • Neuropathic: amyloid plaques, neurofibrillary tangles
  • Loss of neurons and synapses in cerebral cortex and subcortical regions leading to brain atrophy
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11
Q

How is information processing effected by alzheimer’s disease?

A
  • Slower reaction times
  • Impaired choice reaction time
  • Decreased ability to use advanced cues to anticipate
  • Decreased ability to inhibit non-regulatory stimuli
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12
Q

How is attention effected by alzheimer’s disease?

A
  • Poor selective and divided attention
  • Decreased performance on dual tasks
  • No improvement with training
  • Associated with risk of falls
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13
Q

How is steady state postural control effected in alzheimer’s disease?

A
  • Decreased control of postural sway
  • Decrease performance with eyes closed, relies on vision
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14
Q

How is anticipatory postural control effected in alzheimer’s disease?

A
  • Reduced limits of stability and functional reach
  • Instability associated with dual task activity
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15
Q

How is memory effected in alzheimer’s disease?

A
  • Early impairments: working memory, episodic memory, semantic memory
  • Procedural memory is spared
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16
Q

How is motor learning effected in alzheimer’s disease?

A
  • Respond to both implicit and explicit learning strategies but learning is reduced: repeated practice, observational learning better than guided learning, requires mental effort, errorless learning
  • Practice should be: constant, specific to task, avoid random practice
  • Respond well to visual feedback
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17
Q

What is a stroke?

A
  • Disruption of blood flow to area of the CNS
  • Symptoms depend on area of lesion
  • Potential issues with: sensation, motor, cognition, speech, language, vision
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18
Q

How is information processing effected in a stroke?

A
  • Decreased sensory input
  • Homonymous hemianopia effects visual input
  • Decreased vestibular input if lesion is in brainstem
  • Somatosensory loss
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19
Q

How is attention effected in a stroke?

A
  • Right-sided stroke can lead to left hemineglect
  • Decreased ability to sustain, shift, and divide attention
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20
Q

How is motor control effected in a stroke?

A
  • UMN lesion can result in increased tone
  • Abnormal synergies: massed patterns of movement, unable to selectively activate individual muscles, results from increased recruitment of brainstem pathways
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21
Q

How is steady state postural control effected in a stroke?

A
  • Impairments in both sitting and standing postural control
  • Asymmetrical alignment
  • Increased asymmetrical sway
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22
Q

How is anticipatory postural control effected in a stroke?

A
  • Lesions to motor cortex, basal ganglia, and cerebellum can effect APC
  • delayed and reduced muscle activity in trunk on the effected side
  • External trunk support can improve performance
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23
Q

How is reactive postural control effected in a stroke?

A
  • Impaired sequencing, timing, and amplitude in paretic limb in response to perturbation
  • compensate for delays in distal muscles of paretic limb with early proximal activation for non-paretic limb
  • Stepping strategy: delays in non-paretic limb associated with falls
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24
Q

How is memory effect in a stroke?

A
  • Dependent upon location of lesion
  • Potentially: decreased short-term and long-term memory
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25
Q

How is motor learning effected in a stroke?

A
  • Explicit learning is impaired with medial temporal lobe damage
  • Learned non-use of effected limbs
  • Ideal practice conditions depend on the type of stroke
  • MCA and basal ganglia: explicit instruction decreases learning
  • Cerebellar stroke: explicit instruction increases learning
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26
Q

What is parkinson’s disease?

A
  • Progressive disorder of the CNS
  • Loss of dopamine producing neurons in the substantia nigra of the basal ganglia
  • Hypokinetic movement disorder
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27
Q

How is information processing effected in parkinson’s disease?

A
  • Difficulty adapting to sudden environmental changes
  • Difficulty organizing and selecting sensory information
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28
Q

How is attention effected in parkinson’s disease?

A
  • Difficulty selecting what sensory cues to attend to
  • Benefits from attentional cuing
  • Decreased performance under dual task conditions
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29
Q

How is motor control effected in parkinson’s disease?

A
  • Bradykinesia
  • Hypokinesia
  • Akinesia
  • Rigidity
  • Secondary impairments: decreased ROM in flexors, weakening of extensors
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30
Q

How is steady state postural control effected in parkinson’s disease?

A
  • Stooped posture impacts alignment
  • Increased area and velocity of sway
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31
Q

How is anticipatory postural control effected in parkinson’s disease?

A
  • Smaller anticipatory adjustments
  • Decreased velocity
32
Q

How is reactive postural control effected in parkinson’s disease?

A
  • Abnormal co-contraction of hip and knee musculature
  • Decreased adaptation of postural strategies to environmental and task demands
  • Decreased weight-shift before reactive stepping strategy
  • Slower to initiate stepping strategy
  • Pt requires multiple steps to recover balance
  • Increased risk of falls
33
Q

How is memory effected in parkinson’s disease?

A
  • Decreased working memory (STM) that worsens with disease progression and improves with dopamine
  • Decreased encoding and retrieval in long-term memory
34
Q

How is motor learning effected in parkinson’s disease?

A
  • Slower rate of learning
  • Worsens with disease progression
  • Difficultly learning sequential tasks
  • Blocked practice improves acquisition and retention
  • External focus of attention improves performance and learning
  • Auditory or visual cuing can improve performance
35
Q

What conditions may cause a cerebellar pathology?

A
  • Multiple sclerosis
  • Stroke
  • Tumor
  • Brain injury
  • Cerebral palsy
  • Neurodegenerative conditions
  • Genetic conditions
  • Alcohol abuse
36
Q

How is information processing effected in cerebellar pathologies?

A
  • Decreased ability to subconsciously compare sensory information to intended motor output
  • Decreased ability to subconsciously respond to sensory feedback
  • Slower to respond to unexpected sensory information
37
Q

How is attention effected in cerebellar pathology?

A

-Must rely more on conscious, attention demanding pathways for movement adaptation
- Performance may deteriorate with other demands for attention (dual task, fatigue)

38
Q

How is motor control effected in cerebellar pathology?

A
  • Hypotonia
  • Decreased coordination/ataxia: impaired timing and grading of muscle contractions, dysmetria, dysdiadochokinesia
  • Intention tremor
  • Moves via isolated joint movements rather than multijoint movements
39
Q

How is steady state postural control effected in cerebellar pathology?

A
  • Increased postural sway
  • Direction of sway is link to the side of the lesion
  • Wide BOS
  • Rely on vision and somatosensation
40
Q

How is anticipatory postural control effected by cerebellar pathology?

A
  • Postural adjustments have abnormal timing and mismatched scaling
  • Decreased ability to develop new APC adjustments for novel tasks
41
Q

How is reactive postural control effected in cerebellar pathology?

A
  • Decreased ability to grade force of output to match perturbation
  • Responses have larger amplitude and longer duration
  • Excessive compensatory sway in direction opposite to lesion
  • Stepping strategies require more than one step due to initial misplacement of the foot
42
Q

How is memory effected by cerebellar pathology?

A
  • Decreased verbal working memory
  • Decreased flexibility in previously acquired procedural memories
  • Decreased consolidation of new procedural memories
43
Q

How is motor learning effected in cerebellar pathology?

A
  • Decreased extent and rate of adaptation of movement
  • Decreased error based learning
  • Declarative learning intact
  • Limited ability to consolidate new skills
  • Practice: avoid trial and error, repetition, verbal prompts, increased intensity, massed practice, decreased retention
  • Feedback: verbal cues, KP and KR for error recognition, intermittent better than constant
44
Q

What is huntington’s disease?

A
  • Hyperkinetic movement disorder
  • Symptoms: progressive movement disorder, cognitive deficits, behavioral changes
45
Q

How is information processing effected by huntington’s disease?

A
  • Slower response times
  • Difficulty selecting between relevant and irrelevant stimuli
  • Problems with visuospatial awareness
  • Difficulty inhibiting inappropriate responses
  • Difficulty anticipating due to overstimulating abilities
46
Q

How is attention effected by huntington’s disease?

A
  • Decreased ability to shift attention
  • Decreased dual task ability
47
Q

How is motor control effected by huntington’s disease?

A
  • Hypotonia
  • Chorea: irregular, rapid, jerky, involuntary movements
  • Weakness and decreased ROM as the condition progresses
48
Q

How is anticipatory postural control effected by huntington’s disease?

A
  • Reduced limits of stability
  • Limb movements deviate significantly from planned trajectories
  • Inability to anticipate leads to reliance on reactive postural control strategies
49
Q

How is memory effected by huntington’s disease?

A

Difficulty retrieving memories, distant or recent

50
Q

How is motor learning effected by huntington’s disease?

A
  • Better with part practice
  • Needs increase guidance to put parts together
  • Avoid distractions and dual tasks
51
Q

In general, what are the symptoms to a spinal cord injury?

A
  • Reduced or absent sensory information from below the level of the lesion
  • Reduced or absent motor signals to the muscles activated below the level of lesion
52
Q

How is motor control effect by spinal cord injury?

A
  • Motor impairments
  • Spasticity
  • Sensory impairments
  • Compensatory movements: use head to move hips and core, rely on momentum, muscle substitution, task modification
53
Q

How is steady state postural control effected by spinal cord injury?

A
  • Increased sway in sitting
  • Higher lesions demonstrate larger and faster sway
  • Need supported sitting for stability
54
Q

How is anticipatory postural control effected by spinal cord injury?

A
  • Compensatory strategies lack core muscular activation and counterbalance
  • Decreased limits of stability
55
Q

How is information processing effected by spinal cord injury?

A
  • Limited somatosensory input
  • Must rely more heavily on vision and vestiblar system
56
Q

How is attention effected by spinal cord injury?

A
  • Require more attentions to maintain postural control
  • Negatively impacts dual task ability
  • Potential to improve with practice
57
Q

How is motor learning effected by spinal cord injury

A
  • Early extrinsic feedback should be faded
  • Later intrinsic feedback feedback to facilitate independence
  • Part to whole practice
  • Variability enhances adaptability of skill
  • Random practice beneficial to learning
58
Q

How is memory effected by spinal cord inury?

A

No direct memory impairment

59
Q

What is a concussion?

A

Mild traumatic brain injury that can result in difficulties related to: headaches, concentration, memory, balance, coordination

60
Q

How is information processing effected by concussion?

A
  • Dizziness from impaired vestibular system
  • Noise/light sensitivity
  • Blurred/double vision
  • Impaired sensory integration
  • Slowed processing
61
Q

How is postural control effected by concussion?

A
  • Steady state: acute increase in sway, related to visual and vestibular integration problems
  • Anticipatory: decreased postural adjustments prior to gait initiation
  • Reactive: increased latency of reactive responses
62
Q

The BESS test can be used for pts with a concussion, what is the BESS test?

A
  • Assume varying positions and attempt to maintain
  • Count the number of errors during each 20 seconds trial
  • Errors: move hand off iliac crest, open eyes, stumble, fall, abduction or hip flexion > 30 degrees, lift forefoot or heel off of surface, remain out of test position for > 5 secs
  • Max of 10 errors per condition
63
Q

How is attention effected by concussion?

A
  • Difficulty dividing attention
  • Deficits persistent up to 2 months post injury
64
Q

How is memory effected by concussion?

A

Decreased accuracy and verbal fluency of working memory

65
Q

How is motor learning effected by concussion?

A
  • Recall and new task acquisition impacted
  • Attempts at learning can prolong recovery, pts need cognitive rest
66
Q

What types of symptoms may be present in a traumatic brain injury?

A
  • Motor
  • Sensory
  • Cognitive
  • Behavioral
  • Communication
67
Q

How is motor control effected by traumatic brain injury?

A
  • Weakness (UMN lesion causes spasticity)
  • Ataxia
  • Cranial nerve function
  • ROM
  • Motor planning deficits
68
Q

How is postural control effected by traumatic brain injury?

A

Steady state: increased sway, asymmetrical weight-bearing
Anticipatory: high incidence of vestibular dysfunction
Reactive: limited info

69
Q

How is information processing effected by traumatic brain injury?

A
  • Reduced sensory input
  • Decreased executive functions
  • Large decrease in processing speed, increase in reaction time
70
Q

How is attention effected by traumatic brain injury?

A

Deficits in selective and sustained attention

71
Q

How is motor learning effected by traumatic brain injury?

A
  • Practice: distributed with frequent rests, blocked progressing to random
  • Feedback: explicit feedback may beneficial early on, avoid overwhelming with feedback, self-modeling, self- generation
72
Q

What is multiple sclerosis?

A
  • Immune mediated disease that causes demyelination and degeneration within the CNS
  • Sensory, cognitive, and motor symptoms
73
Q

How is motor control effected by multiple sclerosis?

A
  • Weakness/paralysis
  • Spasticity
  • Incoordination/ataxia
  • Loss of ROM
74
Q

How is postural control effected by multiple sclerosis?

A
  • Reduced limits of stability
  • Slow activation of postural muscles (slow conduction, slow initiation of APC muscles, slow reactive control)
  • Difficulty under varying or reduced sensory conditions
75
Q

How is information processing effected by multiple sclerosis?

A
  • Sensory deficits are common
  • Slow conduction speeds may increase response time

Motor Control and Learning (9 decks)

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