The Aging Neuromuscular System Flashcards
What 2 major mechanisms underlie the potential for improved neuromuscular performance?
Exercise and task practice
what accounts for the most of the gain in strength over the first 6-8 weeks of strength training?
Neuromotor adaptation, e.g. Improved motor unit recruitment, improved synchronization of motor unit firing.
How does task practice affect neurons?
Dendritic arborization, increased dendritic spine density, collateral axon sprouting, interneuronal synaptogenesis, improved function of existing synapses, improved cortical representation of the body parts used to complete the task.
Successful aging has been defined as the ability to maintain which 3 key behaviors?
Low risk of disease and disease related disability, high mental and physical function, and active engagement in life
Primary part of the brain that loses mass and what enlarges as a result?
Frontal lobe, lateral and 3rd ventricles
Histological changes of brain include what?
Decreased number of dendrites and accumulation of liposuction, fatty pigment that is a marker of wear and tear
A decrease in nerve conduction velocity in the PNS in people in 70s is ____ percent
15
3 cognitive changes (losses) that occur with aging
Speed, reasoning, memory, linear relationship, and not shown to be variable between-person, not individualized change, everyone declines. Motivation, persistence, and personal characteristics may hide this, and older people tend to accommodate to changes making it less obvious
Kluding et al found that exercise improved what in people post stroke
Working memory and attention
Pedroso et al found what in terms of Alzheimer’s and dual-task physical activity
Improved balance and executive function
The vestibular system demonstrates declining function in the face of losses of _____% of the hair and nerve cells by the age of 70
- Increased vibratory sensation threshold (bad) increased visual threshold (bad-amount of light needed to visualize an object)
What decade does sarcopenia typically begin?
50
What did Coelho et al find to be the biological difference between pre-frail and normal older women
Lower brain-derived neurotrophic factor-neuroprotective protein, increases with progressive resistance exercise
What is the most critical clinical indicator of CNS dysfunction?
Altered level of consciousness
Alteration in mood/emotions can occur with damage to which parts of the brain? 4
limbic system, hypothalamus, frontal and temporal lobes
P 5 Sullivan
Emergent vs non-emergent neurologic signs and symptoms
Signs and symptoms of a thyroid storm
Excessively high BP, HR, body temp
What type of drug can induce rhabdomyolysis?
Statins
Sudden or progressive severe headache can be a sign of what?
Intracranial hemorrhage or meningitis
What type of hemorrhage associated with acute onset thunderclap headache?
Subarachnoid hemorrhage
A headache of severe intensity is only present in 30-40 percent of ________ hemorrhages
Intracerebral (intraparenchymal) so headache can be a red flag even if not severe
A chronic subdural hematoma presents with what signs?
Constant headache that worsens over time, can also have change in mental status, not emergent right away
Risk of stroke following TIA is ____ to ____% first 7 days and ____ to _____% within 90 days
4-10
8-12
Signs of symptoms of systemic illness should be treated as emergent for intractable or highly elevated fever combine with clinical features suggesting the possibility of what 4 medical conditions?
Meningitis, encephalitis, pneumonia, UTI
Rapid fatigue
Athenia
Hypotonia occurs with which disorders 2
Cerebellar lesions (along with ataxia and intention tremor )Huntington
Katalinic et al found what about stretching and spasticity?
Regular stretch does not produce clinically important changes in joint mobility, pain, spasticity, or activity limitation
Agency for Healthcare Research and Quality of the US Department of Health and Human services recommended what for CP
Strength training, task specific
Rigidity is due to damage of what part of the brain. 2 types of rigidity
Basal ganglia, lead-pipe, resistance consistent throughout ROM, cogwheel, resistance is characterized by a ratchet-like series of releases or interruptions. Rigidity is NOT velocity dependent unlike spasticity.
Plesia vs paresis
Plagiarism is full paralysis, paresis is partial
Upper motor neuron syndrome are caused by damage to the __________ system and related pathways and predominantly affect which muscle group in UEs and which in LEs?
Pyramidal (corticospinal)
Flexors in UE
Extensors in LE
Lower motor neuron syndromes are due to damage to the ___________________ system, ________________ spinal cord, and associated axons
Motor nuclei of the brain stem
Anterior horn of spinal cord
Chorea
Athetosis
Ballism
And what is the term for motor restlessness
Twitching, jerking
Writhing, twisting
Violent jerking, flinging
Akathisia
2 types of postural tremor
Physiological (such as associated with hyperthyroidism)
Essential
2 types of kinetic tremor
Simple kinetic (not associate with target) Intention-indicates cerebellar damage
Hypermimesis
Pathological laughing or crying
Hypomimesis
Loss of emotional expression in language known as aprosody
Apraxia
Inability to perform purposeful or skilled motor acts in absence of paralysis, sensory loss, abnormal posture/tone, abnormal involuntary movement, in coordination, or in attentiveness. Represents problem with conceptualization and execution of a task.
Cerebellar motor syndrome usually manifest with ipsi or contralateral signs
Ipsi
Look up general exercise recommendations for older adults
From the Section on Geriatrics
Exercise precautions for post-polio
20-40% of perceived effort, frequent rest breaks 1-5 minutes, withholding exercise on muscles <3/5 or with new onset weakness or fasciculations
Guillain-Barré syndrome exercise recommendations
Sub max strength training, progress aerobic only to moderate, submax eccentric to begin after achievement of antigravity strength.
Callahan describes skilled movement what-3 principles
Movement that achieves a specific goal with consistency ,flexibility, efficiency
APTA defines patient/client management as an ongoing process comprised of which 5 elements
Examination Evaluation Diagnosis Prognosis Intervention
5 systems examined in the systems review
Cardiopulmonary Neuromuscular Musculoskeletal Integumentary Communication ability (affect, cognition, consciousness, orientation, learning preferences, ability to make needs known, expected emotional and behavioral responses)
Additional systems recommended for screening 3
GI, genitourinary, general health (fatigue, malaise, fever, chills, nausea, vomiting, dizziness, unexplained weight change, numbness.
When is a SBP drop of >10mmHg an absolute vs relative indication for terminating exercise?
Absolute if presence of ischemia signs
Relative if not
Resting and active BP value that is relative indication for terminating exercise testing according to ACSM
> 200/110 (stop if risks outweigh benefits)
>250/115
Goodman an Fuller present what guidelines for BP with exercise
Abnormal if SBP increase >20 with with min-mod exercise and >40-50 with intensive, no change in SBP with reconditioned individual, decrease in DBP >10
How does the hypothesis oriented algorithm for clinicians II work? HOAC II
Identify patient identified problems (PIPs) and non-patient identified problems (NPIPs) then further classify them into existing versus anticipated problems. Important contribution of this model is that it incorporates prevention with anticipated problems.
5 components of a conceptual framework for clinical practice proposed by Shumway-Cook and Woollacott
Model of practice (e.g. The Guide)
Model of function and disability (e.g. The ICF model)
Hypothesis-oriented clinical practice (always testing)
Principles of motor control and learning
Evidence based practice
What comprises the Shenkman clinical decision making algorithm
Hypothesis oriented clinical practice The Guide's elements of patient/client management Disablement and enablement perspectives HOAC II Focus on task analysis
Shenkman’s 2 models of task analysis
Task and environment 4 conditions: Stationary patient in stationary environment, moving patient in stationary environment, etc. Other attributes include periodicity (discrete, continuous, serial) and manner in which performed e.g. Base of support, use of UE, use of AD
Temporal sequence: Initial conditions, preparation, initiation, execution, and termination
Parkinson’s versus progressive nuclear palsy
Similarities:
Late middle age onset bradykinesia , rigidity,
Differences:
Parkinson’s: tremor, response to levodopa, alpha-synuclein protein in brain, forward posture
PNP: Progresses faster, no tremor, abnormal eye movements, tau protein, stand exceptionally straight (axial rigidity) Problems with speech and swallowing more common and severe
the 3 elements important to address within any intervention approach (Schenkman)
Environment, Learning variables, and Dose for each remediation, compensation, prevention p16
Under Plan of Care, Patient centered goals, what are the 3 following elements
Consultation, education, intervention
5 characteristics inherent to autonomous practice
Excellence Communication Collaboration Advocacy Caring
Simple algorithm for geriatric and neurologic PT
P 17!
Rise and Shine model for goals, what do the “e”s stand for?
Consider from beginning to end all the tasks the client must perform in a day, starting with bed mobility
The es represent need for equipment, and need for education for patient, caregivers, family, and exercise
Fell’s 3 progression parameters to help clinician with progression of intervention
This related to motor learning e.g. Task variability, feedback, environmental progression
Those related to characteristics of the movement e.g. Amplitude, velocity, amount of work, edurance
Those related to other considerations such as assistance given, supportive device, developmental sequence
Why is it important to introduce variability to task practice after initial blocked practice?
For skill retention, refinement, and transfer
2 theories that Taub used to develop constraint induced therapy
Concept of learned nonuse
Later, negative plasticity complemented this, furthers the damage caused by the original CNS legion
CI therapy then is considered positive plasticity and use-dependent cortical reorganization, in the individual’s motor cortex, occurs
The 3 categories of elements for CI therapy, how many consecutive weekdays is it delivered over?
Repetitive task-oriented training
The transfer package e.g. Behavioral strategies to enhance adherence
Constraint of the use of more affected UE
10-15 days
How has the time of dose of CI changed over time?
Went from 6 to 3 hours per day
what did the EXCITE trial find in terms of CI therapy
Improvements lasted for at least one year, and later found benefits persisted at the 2 year mark as well. Helped dispel the traditional notion of the 6 month plateau. Participants had similar gains whether participated in a window of 6-9 months or 15-21 months.
What did the LEAPS trial find about body-supported treadmill training?
People who did home therapy improved just as much.
Which disorders does the Agency for Healthcare Research Quality of the US Dept of Health and Human services believe could benefit from body-weight supported treadmill training?
CP, SCI, acquired brain injury
Benefits of treadmill training
Can be given in higher dose than overground, so higher intensity, so more likely to induce neuroplastic changes.
Evidence levels for post-stroke, severe hemiparesis
Robotics
E-Stim
Motor imagery (mental task practice)
Strong but not sure if translates into true functional improvement
Limited
Limited-unclear if benefits or not based on different studies
4 msk conditions that may lead to progressive issues in aging individuals with CP
Patella Alta, spondylolysis, OA, cervical stenosis
