Rehabilitation Flashcards

1
Q

What are the 3 main mechanisms of neural plasticity?

A
  • Unmasking of existing but previously inactive connection
  • Axonal sprouting with development of new synaptic connections
  • Redundant pathways subserving the same function (i.e. alternative pathway takes over when another has been damaged)
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2
Q

What evidence regarding cortical injuries has been determined from studies on monkeys?

A
  • Peripheral & cortical injuries result in reorganisation of cortical representations
  • Differential skin use results in cortical map remodelling
  • Monkeys left to recover spontaneously had a further loss of cortical territory in the non-injured area
  • Pre-injury level achieved within 4 weeks of repetitive practice
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3
Q

What is the evidence for the use of exercises and mental practice in developing neural plasticity?

A
  • Compared practicing 5 finger exercises on piano to only mental practice
  • Resulted in the same increase in cortical area
  • Physical performance regarding speed & accuracy better in the manual group
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4
Q

What is the evidence regarding the effects of immobilisation on cortical representation?

A

Immobilisation of ankle for 4-16 weeks resulted in loss of cortical representation of ankle muscles

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5
Q

What is the evidence for manipulation training?

A

1 45min session of manipulation training caused a significant increase in the hand area of the motor cortex & motor performance

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6
Q

What is the evidence regarding forced hand use & passive training?

A
  • Compared 1 week of passive training with 1 week UL forced use training
  • Forced use resulted in significant enlargement in hand motor area in cortex, increased grip strength & 9 hole peg test
  • Passive training had no effect on motor cortex or 9 hole peg test
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7
Q

How many repetitions are required to make a significant cortical change according to evidence?

A

Approx 15,000 reps

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8
Q

What are the clinical implications of the research regarding neural plasticity?

A
  • Post-injury experience is key to modulating changes in undamaged tissue
  • Motor performance & cortical changes can occur with 1 intensive physio session
  • Specific task practice, repetition, mental practice & forced use are important factors for promoting cortical change
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9
Q

What evidence is there regarding the physical activity of stroke survivors in rehab & the community?

A

Patients in rehab are mostly inactive, alone & in bedrooms

Stroke survivors in the community:

  • Do low levels of PA
  • Are sedentary for 63-90% of the time
  • Take few steps per day
  • Only walk at light intensity
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10
Q

What did the AVERT trial by Bernhardt et al 2015 find?

A
  • Acute stroke survivors
  • Compared early/frequent mobilisation with usual care
  • No difference for adverse events or walking
  • Shorter/more frequent sessions improved outcomes
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11
Q

What are the clinical implications of the AVERT trial?

A
  • Probably need to leave stroke patients alone for first 24 hours to rest
  • After that, need to get them out of bed as often as possible, even if it is only for 5 minutes (short & frequent sessions)
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12
Q

What is the evidence for exercise dose for acute stroke survivors?

A
  • Exercise dose in first week after stroke predicted discharge walking ability
  • > 703 reps in first week = faster independent walking
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13
Q

Why is PA so important for stroke survivors?

A
  • Maintains activity performance
  • Minimises risk of secondary stroke
  • Improvements in activities are possible > 10 years after stroke (never too late)
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14
Q

What does the evidence show regarding time vs amount of practice?

A

Scrivener et al 2011
- 30 mins = range of 4-369 reps

Lang et al 2009
- 36 mins = range of 1-802 reps

Time is not the same as amount of practice

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15
Q

What are some of the strategies for increasing opportunities for practice?

A
  • Classes
  • Forced use
  • Video modelling
  • Covert monitoring
  • Re-organising the therapy area
  • Practice books
  • Protocol
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16
Q

What are the benefits of rehab classes?

A
  • Allow greater practice opportunities
  • Significantly increase mobility & upper limb outcomes
  • Efficient use of therapist time
17
Q

What are the considerations for rehab classes?

A
  • Work stations set up for common problems
  • Clear instructions & feedback
  • Provision for recording practice (e.g. clicker)
  • Exercise progressions
  • Use physio aids, volunteers, family, students to assist
  • Use group dynamics, group people with similar disability level
  • Use different activities
18
Q

What is the evidence for stroke rehab?

A
  • Daily group sessions of patients with similar levels of disability
  • Increased PT by 42 mins/day
  • Increased self-directed exercises
  • Decreased time spent alone
19
Q

What is the evidence for task related circuit training?

A
  • Compared with placebo in stroke patients

- Significant improvement in walking speed/endurance, maintained at 2 months follow up

20
Q

What is forced use?

A
  • Any activity that forces the patient to perform repetitive task practice
  • Includes constraint induced therapy (unaffected hand restrained) & treadmill training
21
Q

What does video modelling involve?

A

Modelling demonstrations from therapist, another patient or the patient themselves (usually most effective)

22
Q

What is the evidence for video modelling?

A
  • Videoed patients doing exercises then sent them home, compared to placebo
  • Significant improvement in standing balance
  • Efficient use of resources
23
Q

What is covert monitoring?

A
  • Patient’s performance is monitored by unknown members of the rehab team (feel like they’re being watched, do it more often)
  • Patient must be able to perform the task criterion
  • Results graphed to improve motivation
  • Aim is to counteract deterioration of performance outside therapy
24
Q

What is the evidence for covert monitoring?

A
  • Monitoring of stroke patients whose walking had deteriorated outside therapy
  • Assess gait length & width
  • Patients improved step length & width daily, reaching consistently normal parameters after 12 ays
25
Q

What does reorganisation of the unity & therapy area involve?

A
  • Patient & family orientation to the unit
  • ADLs scheduled to be part of rehab
  • Patients to help each other
  • Patients to attend therapy area for most of the day
  • Should ensure specific practice areas (e.g. walking, balance)
26
Q

What should practice books include?

A
  • Diagrams & instructions of key elements, common errors, number of reps/sets & sessions
  • Space for recording practice
  • Method for discontinuing exercises when no longer appropriate
27
Q

What are the benefits of protocols?

A
  • Allow interventions to be standardised based on best evidence
  • Can improve efficiency of therapists’ time
  • Allows use of family & volunteers to assist
28
Q

What is the evidence for progressive sitting training protocols?

A
  • Patients given a progressive sitting training protocol to follow
  • Patients achieved up to 400 reaches in 45 mins
  • Efficient resource strategy for practicing over a longer time period