Rehabilitation And Recovery

Question 1

What is neural recovery?

Answer 1

Restoration of function in damaged neural tissue (i.e. same brain regions engaged pre and post injury)

Question 2

What is neural compensation?

Answer 2

Adaptation to residual neural tissue to take on greater/additional function after brain injury (e.g. different brain region)

Question 3

What is behavioural recovery?

Answer 3

Restoration of the ability to perform task/movement in the same manner as before brain injury

Question 4

What is behavioural compensation?

Answer 4

Adaptation of task or movement performed in a different manner than before the brain injury

Question 5

What does structural damage affect, and what does it result in?

Answer 5

Usually affects a combination of cortex and white matter, resulting in localised and remote effects

Question 6

What is diaschisis?

Answer 6

it is the inhibition of electrical activity and loss of function in an INTACT brain region remote from the site of injury, but anatomically connected to it.
Tends to happen early on after injury but improves with rapid time scale

Question 7

When does oedema peak?

Answer 7

2-3 days post injury

Question 8

What does the growth of glial (support cells) cause?

Answer 8

Scar tissue

Question 9

What is metabolic depression?

Answer 9

Chemical changes in damaged cells that impair function

Question 10

What is neurogenesis?

Answer 10

Growth of new nerve cells

Question 11

What is synaptogenesis?

Answer 11

Formation of new connections between neurons

Question 12

What are the early mechanisms of recovery in an ischameic lesion?

Answer 12

Repurfusion (restoration of blood flow) in the ischemic penumbra

Question 13

What is the early merchandise of recovery in a haemorrhagic lesion?

Answer 13

Breakdown/restoration of blood components and fluid

Question 14

What are the remote mechanisms of recovery?

Answer 14

1. Reduced disconnection effects due to local recovery at the site of the white matter lesions (improved neuronal conjunction through white matter pathway)
2. Reversal of Diaschisis: Resolution of remote suppression (thought to account for a component of early functional recovery)

Question 15

What mechanisms of recovery happen weeks/months after injury?

Answer 15

1. Functional Adaptation (recruitment) - intact brain regions compensating
2. Reorganisation of Neural Systems (retraining) - when intact brain regions take over (e.g. homotopic cortex involvement)

Question 16

What is long term potentiation?

Answer 16

Enhancement of signal transmission between 2 neurones after repeated stimulation
About strengthening the synaptic connections by activating the receptors that allow activation of similar receptors

Question 17

What is long term depression?

Answer 17

Opposite of potentiation - where it is harder for signals to cross

Question 18

Together what do potentiation and depression do?

Answer 18

Provide a balance between strengthening new connections, and pruning connections that are no longer needed. This is the basis for memory and learning

Question 19

Are recovery processes linear?

Answer 19

No

Question 20

When does most rapid recovery tend to occur?

Answer 20

First 3 months

Question 21

Factors that are involved in recovery speed/progress?

Answer 21

Age 
Genetics (how neurones adapt) 
Handedness (more bilateral representation is good 
Lesion site (smaller = better recovery) 
Co-morbidities

Question 22

What is the aim of rehab and how is it achieved?

Answer 22

Aim: to engage and enhanced spontaneous mechanisms of recovery to achieve functional improvements
Through:
Enhancement of neural plasticity
Facilitation of compensatory reorganisation
Currently: task orientated but in the future looking toward drug therapy and cortical stimulation

Question 23

What kind of training is best for neural plasticity?

Answer 23

Intensive and frequent training

Question 24

How does errorless learning work?

Answer 24

By avoiding inadvertent strengthening of neural pathways to unwanted responses by avoiding errors

Question 25

How does constraint induced therapy work?

Answer 25

By restraining the intact limb and focusing on the use of the impaired limb in order to enhance neural recovery and reorganisation