Week 1 Exam Questions Flashcards
what is salience
the brain will pay attention to what is important!
can we say things are weak after a stroke
no, because there is nothing wrong with the muscles, it is really an issue with activation and initiation and coordination, meaning that there is an issue in the network. We must increase motor firing rates
why does a decrease in torque production after stroke matter
the decrease in torque is from with a decreased speed of production, or because the muscle is at a shortened length. We must train people at that shortened length and train speed and power after a stroke
what is spasticity
velocity dependent hypertonicity. We have it when it is on one side of the joint, and there is resistance to externally imposed moments.
what is the controversy around spasticity
spasticity is often described as a movement disorder, but we test this is a static resting position. so how can we assume there is disordered movement if we do not test it while moving
after a stroke what must we manipulate to get normal movement
task, environment or the person ( we can make the environment more or less challenging, we can decrease the DOF, we can also increase their capacity to move by strengthening or practice)
what is recovery
permanent changes in organizations and structure and getting back what was lost
is the goal recovery or compensation
recovery: restore the function of tissue, and get them back to premorbid levels
what is compensation
something we self teach, and something we did not have before the injury. doing something old in a new way and using alternative parts
what is learned non use
comenation! we learn to not use one side, and figure out a way to do the task in a different way
what may be the primary reason that a motor deficit still remains
compensation, they have learned to not use it.
what is positive and what is negative neuroplasticity
positive: recovery
negative: compensation
what category does restoration, recruitment and retraining fall under, compensation or recovery
restoration is recovery
recruitment and retraining are compensation
what is a reversal of diaschisis
the spontaneous recovery, think about spinal shock. we get a sudden loss of function, and then we get it back with or without treatment
how do we get neuroanatomical reorganization
changing neural networks, altering NT levels, branching, sprouting, neurogenesis
neuroplasticity definition
brain can adapt, but changes function and structure of neurons, an growing new neurons, and reorganizing them. reorganize networks, and representations, and access latent circuits
for a therapist, what does neuroplasticity mean
that there is a way to train the brain to perform old functions
what are the structural and functional mechanisms of neuroplasticity
functional: increasing activity, excitability, and postsynaptic potential.
structural: more connections, axon growth, receptor density
what are some examples of non synaptic neuroplasticity
changing the number of ion channels, increasing responsiveness of synaptic inputs.
what happens when we rely on the less-affected limb, to reorganization
there is growth in the non-affected hemisphere, which we do not want. this is maladaptive, and can hurt our chances of changing the affected hemisphere.
with learning dependent plasticity, what leads to the rewiring of the motor cortex
skill learning!
what is an important stimulant for neuroplastic change
task specific motor learning
what is our best hope for brain remodeling.
learning
when someone has many concussions, and learning is impaired what does this mean for neuroplasticity
there is a decrease in plasticity. bottom line, brain injury interferes with learning
recovery is a ___ process
relearning
which leads to increased number of synapses in motor cortex? motor learning or activity
learning.
TF: the brain does not rely on the same neurobiological processes it used to acquire a skill initially
false, it does rely on the same
what should our first therapeutic effort be
to recover those specific behaviors that were disrupted by the brain injury
in cat and rat experiments, what can we say is good for recovery
task specific and high reps, and a good intensity.
what two things make therapy effective
intensive therapy and task specificity
what are some characteristics of a task that are important for plasticity
complexity, intensity, specificity, sensory experience (like an enriched environment)
what are the 10 principles of experience dependent plasticity
- use it or lose it
- use and improve
- specificity
- repetition matters
- intensity matters
- time matters
- salience
- age matters
- transferene
- interference.
what kind of environment do we want
a complex one, and an enriched one
is CIMT therapy beneficial to motor learning
yes, constraining the good limb and focusing attention on the bad one is a good way to treat and get results
TF: exercise dose in the first matters after a stroke
true
TF: speed of the exercise matters
true
what are some components of intensity
reps, sets, time, RPE, environments, distractions, load, cardio response, challenge
what is the FITT principle
frequency is the number of days a week
intensity: lets say the weight to do 8-10 reps
time: lets say each set takes 30 seconds, do it in a 30 minute timeframe
type: the gym equipment we use
TF: we can continue to improve patients if they have reached a plateau with changing the intensity
true, the more intense, we can still see results
TF: the study with walking and steps, by changing the dose and increasing the number of steps a lot shows a larger response
true
what are some important things for practice
challenging, motivating,
what are some characteristics of a skilled clinician
listen will patient centered always changing hypothesis thinking about what the patient is saying hypothesis early on
what does skilled decision making incorporate
goals prevention and optimizing health patient centered holistic evidence based carryover to Home
what are the 5 conditions we look at before we get to the outcomes
initial conditions (posture, enviro) preparation (what do they do before?) initiation (timing, direction and smooth) execution (amplitude, speed, smooth) and termination (timing, stability)
what did animal models show us
that high reps are great
what do the AHA/ASA guidelines say about stroke rehab
it takes a big team and communication
TF: dose and duration and intensity matters
true
what two things make therapy effective
intensity and task specific
if patients plateau, is there anything we can do
yes! change the dose, have them walk more, and get them going!
what does an enhanced environment do for people
motivates them more, and lies likely to be alone and inactive
TF: 50% of patients stay in bed
true
TF: people are alone 60% of the day, and 30% stay in bed with no activity
true
TF: functional capacity appears to affect therapeutic activity
false, there is no correlation between mild, moderate or severe in jury with activity levels
what was the average treatment time for treatment in a 60 minute session
averaged 36 minutes
how many reps were patents getting in UE and LE? steps?
12 and 8
less than 300 steps
TF: functional UE movements happened in all sessions
false, only in 50%
TF: differences in the amount of practice were correlated to age, patient level of function and therapist experience
false
how many minutes were patients at their target HR zone
2.8 minutes
are we doing enough for neuroplasticity
no
