relearning locomotion

Question 1

cerebral palsy

Answer 1

• Caused by mis-development –> non-progressive lesion
• impaired motor learning and synergies/CPGs
• less motor innervation and changes in muscle fibre types –> atrophy
• Walking with CP:
  • Increased involvement of arms and trunk (pelvis) to stay balanced
  • Slower
  • Less efficient –> higher energy expenditure
• Spastic CP:
  • Rigidity/hypertonia due to spasticity in the brain (M1 cortex)
  • Less control of movement
  • Can be hemi, di or quadriplegic
• Dyskinetic CP:
  • Involuntary movement
  • Basal ganglia damage
  • 6% of people

-	Ataxic CP:
•	Shaky movement
•	Reduced balance and proprioception
•	Initiation and termination of movement is difficult
•	Cerebellum damage

Question 2

stroke

Answer 2

• Stroke is a neurological disorder characterized by blockage of blood vessels. Clots form in the brain and interrupt blood flow, clogging arteries and causing blood vessels to break, leading to bleeding. Rupture of the arteries leading to the brain during stroke results in the sudden death of brain cells owing to a lack of oxygen
• Ischemic stroke is caused by deficient blood and oxygen supply to the brain; hemorrhagic stroke is caused by bleeding or leaky blood vessels.

Question 3

inactivity cycle

Answer 3

1. CP/stroke
2. muscle weakness
3. limitations in movement and fatigue
4. physical inactivity
5. more muscle weakness

Question 4

types of gait in CP

Answer 4

1. Type 1: Paretic foot
2. Type 2: (hyper)extension knee in midstance and full foot floor contact
3. Type 3: (hyper)extension knee in midstance without full foot floor contact
4. Type 4: flexion knee in midstance and forefoot position > 10 gr
5. Type 5: flexion knee in midstance with floor foot contact ankle >10 gr

Question 5

walking fundamentals

Answer 5

• Walking speed
• Stability of gait
• Floor clearance in swing phase
• Prepositioning of foot in terminal swing
• Step length ( symmetry- asymmetry)
• Cadence (rhythm)
• Propulsion

Question 6

2 stage motor learning model

Answer 6

1.	Cognition
•	Understanding task
•	Bad performance
2.	Integration
•	Comprehend and perform mechanics
•	More fluid movement
3.	Automation
•	Perform task with speed, efficiency and precision
•	Continuous and adaptive

• People with CP have issues with motor learning

Question 7

CP - interventions

Answer 7

• To decrease hypertonia after a stroke or CP Botox can be given to stop contraction
  • Botox toxin cleave snare proteins inside presynaptic axons preventing AcH vesicles from docking onto the membrane which means that it is not released upon an action potential –> paralysis
• Ankle foot orthoses (AFOs) are orthotic devices that can be used to normalize the walking pattern of children with cerebral palsy (CP).
  • One of the aims of orthotic management is to produce a more normal gait pattern by positioning joints in the proper position to reduce pathological reflex or spasticity.
• Both of the previous treatments are often combined with physiotherapy (strenth training) to induce synaptic plasticity and improve neural activation in the affected area