Recovery of Function and Adult Clinical Populations Flashcards
What is ankylosing spondylitis?
- Inflammatory disease of the spine and SI joints
- Early symptoms: chronic pain
- Later symptoms: new bone formation/spine segments fuse
What spinal changes occur in ankylosing spondylitis?
- Loss of lumbar lordosis
- Increased thoracic kyphosis
- Head protraction
- Loss of spinal flexibility in all planes
- Hip flexion
What postural changes occur with ankylosing spondylitis?
- Forward shift of COM
- Lowered COG
- Impacts postural responses and postural control due to increased standing knee flexion and posterior pelvic tilt
How is steady state postural control effected with ankylosing spondylitis?
- Increased A-P sway
- COP displacement
- Rely on vision for balance
How is anticipatory and reactive postural control effected with ankylosing spondylitis?
- Limited data available
- Worsens with severity of the disease
- Poorer with eyes closed
- Higher incidence of dizziness
- Impacts gait
How do vestibular disorders effect information processing?
- 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
How is steady state postural control effected in vestibular disorders?
Increased sway and loss of balance when altering visual and somatosensory input when tested using CTSIB
How is anticipatory postural control effected in vestibular disorders?
- Decreased balance with dynamic movements that stimulate the vestibular system
- Head turns, bending, turning around, scanning environment
How is reactive postural control effected in vestibular disorders?
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)
What is alzheimer’s disease?
- 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
How is information processing effected by alzheimer’s disease?
- Slower reaction times
- Impaired choice reaction time
- Decreased ability to use advanced cues to anticipate
- Decreased ability to inhibit non-regulatory stimuli
How is attention effected by alzheimer’s disease?
- Poor selective and divided attention
- Decreased performance on dual tasks
- No improvement with training
- Associated with risk of falls
How is steady state postural control effected in alzheimer’s disease?
- Decreased control of postural sway
- Decrease performance with eyes closed, relies on vision
How is anticipatory postural control effected in alzheimer’s disease?
- Reduced limits of stability and functional reach
- Instability associated with dual task activity
How is memory effected in alzheimer’s disease?
- Early impairments: working memory, episodic memory, semantic memory
- Procedural memory is spared
How is motor learning effected in alzheimer’s disease?
- 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
What is a stroke?
- Disruption of blood flow to area of the CNS
- Symptoms depend on area of lesion
- Potential issues with: sensation, motor, cognition, speech, language, vision
How is information processing effected in a stroke?
- Decreased sensory input
- Homonymous hemianopia effects visual input
- Decreased vestibular input if lesion is in brainstem
- Somatosensory loss
How is attention effected in a stroke?
- Right-sided stroke can lead to left hemineglect
- Decreased ability to sustain, shift, and divide attention
How is motor control effected in a stroke?
- 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
How is steady state postural control effected in a stroke?
- Impairments in both sitting and standing postural control
- Asymmetrical alignment
- Increased asymmetrical sway
How is anticipatory postural control effected in a stroke?
- 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
How is reactive postural control effected in a stroke?
- 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
How is memory effect in a stroke?
- Dependent upon location of lesion
- Potentially: decreased short-term and long-term memory
How is motor learning effected in a stroke?
- 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
What is parkinson’s disease?
- Progressive disorder of the CNS
- Loss of dopamine producing neurons in the substantia nigra of the basal ganglia
- Hypokinetic movement disorder
How is information processing effected in parkinson’s disease?
- Difficulty adapting to sudden environmental changes
- Difficulty organizing and selecting sensory information
How is attention effected in parkinson’s disease?
- Difficulty selecting what sensory cues to attend to
- Benefits from attentional cuing
- Decreased performance under dual task conditions
How is motor control effected in parkinson’s disease?
- Bradykinesia
- Hypokinesia
- Akinesia
- Rigidity
- Secondary impairments: decreased ROM in flexors, weakening of extensors
How is steady state postural control effected in parkinson’s disease?
- Stooped posture impacts alignment
- Increased area and velocity of sway
How is anticipatory postural control effected in parkinson’s disease?
- Smaller anticipatory adjustments
- Decreased velocity
How is reactive postural control effected in parkinson’s disease?
- 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
How is memory effected in parkinson’s disease?
- Decreased working memory (STM) that worsens with disease progression and improves with dopamine
- Decreased encoding and retrieval in long-term memory
How is motor learning effected in parkinson’s disease?
- 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
What conditions may cause a cerebellar pathology?
- Multiple sclerosis
- Stroke
- Tumor
- Brain injury
- Cerebral palsy
- Neurodegenerative conditions
- Genetic conditions
- Alcohol abuse
How is information processing effected in cerebellar pathologies?
- 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
How is attention effected in cerebellar pathology?
-Must rely more on conscious, attention demanding pathways for movement adaptation
- Performance may deteriorate with other demands for attention (dual task, fatigue)
How is motor control effected in cerebellar pathology?
- Hypotonia
- Decreased coordination/ataxia: impaired timing and grading of muscle contractions, dysmetria, dysdiadochokinesia
- Intention tremor
- Moves via isolated joint movements rather than multijoint movements
How is steady state postural control effected in cerebellar pathology?
- Increased postural sway
- Direction of sway is link to the side of the lesion
- Wide BOS
- Rely on vision and somatosensation
How is anticipatory postural control effected by cerebellar pathology?
- Postural adjustments have abnormal timing and mismatched scaling
- Decreased ability to develop new APC adjustments for novel tasks
How is reactive postural control effected in cerebellar pathology?
- 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
How is memory effected by cerebellar pathology?
- Decreased verbal working memory
- Decreased flexibility in previously acquired procedural memories
- Decreased consolidation of new procedural memories
How is motor learning effected in cerebellar pathology?
- 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
What is huntington’s disease?
- Hyperkinetic movement disorder
- Symptoms: progressive movement disorder, cognitive deficits, behavioral changes
How is information processing effected by huntington’s disease?
- Slower response times
- Difficulty selecting between relevant and irrelevant stimuli
- Problems with visuospatial awareness
- Difficulty inhibiting inappropriate responses
- Difficulty anticipating due to overstimulating abilities
How is attention effected by huntington’s disease?
- Decreased ability to shift attention
- Decreased dual task ability
How is motor control effected by huntington’s disease?
- Hypotonia
- Chorea: irregular, rapid, jerky, involuntary movements
- Weakness and decreased ROM as the condition progresses
How is anticipatory postural control effected by huntington’s disease?
- Reduced limits of stability
- Limb movements deviate significantly from planned trajectories
- Inability to anticipate leads to reliance on reactive postural control strategies
How is memory effected by huntington’s disease?
Difficulty retrieving memories, distant or recent
How is motor learning effected by huntington’s disease?
- Better with part practice
- Needs increase guidance to put parts together
- Avoid distractions and dual tasks
In general, what are the symptoms to a spinal cord injury?
- 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
How is motor control effect by spinal cord injury?
- Motor impairments
- Spasticity
- Sensory impairments
- Compensatory movements: use head to move hips and core, rely on momentum, muscle substitution, task modification
How is steady state postural control effected by spinal cord injury?
- Increased sway in sitting
- Higher lesions demonstrate larger and faster sway
- Need supported sitting for stability
How is anticipatory postural control effected by spinal cord injury?
- Compensatory strategies lack core muscular activation and counterbalance
- Decreased limits of stability
How is information processing effected by spinal cord injury?
- Limited somatosensory input
- Must rely more heavily on vision and vestiblar system
How is attention effected by spinal cord injury?
- Require more attentions to maintain postural control
- Negatively impacts dual task ability
- Potential to improve with practice
How is motor learning effected by spinal cord injury
- 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
How is memory effected by spinal cord inury?
No direct memory impairment
What is a concussion?
Mild traumatic brain injury that can result in difficulties related to: headaches, concentration, memory, balance, coordination
How is information processing effected by concussion?
- Dizziness from impaired vestibular system
- Noise/light sensitivity
- Blurred/double vision
- Impaired sensory integration
- Slowed processing
How is postural control effected by concussion?
- 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
The BESS test can be used for pts with a concussion, what is the BESS test?
- 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
How is attention effected by concussion?
- Difficulty dividing attention
- Deficits persistent up to 2 months post injury
How is memory effected by concussion?
Decreased accuracy and verbal fluency of working memory
How is motor learning effected by concussion?
- Recall and new task acquisition impacted
- Attempts at learning can prolong recovery, pts need cognitive rest
What types of symptoms may be present in a traumatic brain injury?
- Motor
- Sensory
- Cognitive
- Behavioral
- Communication
How is motor control effected by traumatic brain injury?
- Weakness (UMN lesion causes spasticity)
- Ataxia
- Cranial nerve function
- ROM
- Motor planning deficits
How is postural control effected by traumatic brain injury?
Steady state: increased sway, asymmetrical weight-bearing
Anticipatory: high incidence of vestibular dysfunction
Reactive: limited info
How is information processing effected by traumatic brain injury?
- Reduced sensory input
- Decreased executive functions
- Large decrease in processing speed, increase in reaction time
How is attention effected by traumatic brain injury?
Deficits in selective and sustained attention
How is motor learning effected by traumatic brain injury?
- Practice: distributed with frequent rests, blocked progressing to random
- Feedback: explicit feedback may beneficial early on, avoid overwhelming with feedback, self-modeling, self- generation
What is multiple sclerosis?
- Immune mediated disease that causes demyelination and degeneration within the CNS
- Sensory, cognitive, and motor symptoms
How is motor control effected by multiple sclerosis?
- Weakness/paralysis
- Spasticity
- Incoordination/ataxia
- Loss of ROM
How is postural control effected by multiple sclerosis?
- 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
How is information processing effected by multiple sclerosis?
- Sensory deficits are common
- Slow conduction speeds may increase response time
