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EXMD3070 > WK5-6 - Brain Impairment and PA > Flashcards

WK5-6 - Brain Impairment and PA Flashcards

1
Q

What is the role of the parietal lobe?

A

Processes/interprets sensory info: perception, spatial awareness, manipulating objects and spelling

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2
Q

What is the role of the occipital lobe?

A

vision reception, processing and intepretation

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3
Q

What is the role of the cerebellum?

A

coordination of smooth voluntry movement

Maintains balance/equilibrium

Some memory for reflex motor activity

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4
Q

What is the role of the frontal lobe?

A
  • planning/organising
  • attention
  • problem solving
  • emotional and behaviour control
  • social skills
  • skilled motor performance
  • expressing language (Broca’s area)
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5
Q

What is the role of the temporal lobe?

A
  • hearing
  • memory acquisition
  • understanding language (Wernicke’s area)
  • visual perception (recognition&categorising objects)
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6
Q

What is the role of the brain stem (pons, midbrain and medulla)?

A
  • breathing
  • HR
  • swallowing
  • reflex responses to visual/auditory input
  • level of alertness
  • regulating sleep/wake cycle
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7
Q

Expain the general organisation of motor control. Why is it important?

A

3 levels of control: SC, brain steam and forebrain
- organised both serially and parallel
- motor areas of cerebral cortex influence SC directly or indirectly through descending systems of brain stem

  • all motor systems receive sensory inputs and under influence of 2 independent subcortical systems: basal ganglia and cerebellum

Ganglia & cerebellum act on cerebral cortex through relay nuclei in thalamus.

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8
Q

what are the 3 broad causes of BI?

A
  1. Dysgenesis - abnormal organ development during embryonic development (in womb) / disordered development of malformation
  2. trauma/injury - TBI
  3. disease / infection - may lead to a stroke, MS or parkinson’s
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9
Q

What is the aetiology / common features between CP and TBI?

A
  • non-progressive
  • can affect physical, cognitive and behavioural functioning (proportions different)
  • in relation to Ex and PA for post-acute clients, there are common areas: benefits, Ax, prescription/programming, methods of promotion

Ex effects are treated collectively under BI in EXMD3070

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10
Q

What is CP?

A

Cerebral = brain
Palsy = paralysis

  • umbrella term covering group of non-progressive (but changing) disorders of movements or posture 2ndary to lesion or abnormality in motor areas of developing brain

Lesion may occur (all overlap):
* antenatally - anytime prior to birth
* perinatally - during/immediately after birth (20-28wks) (4wks post birth is perinatal area
* postnatally - anytime after work

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11
Q

When does CP occur (%), provide timeline and aetiology?

A

Antenatal: ~80%
- Conception to pregnancy
- abnormal chromosomal, cerebral dysgenesis, fetal hypoxia ischaemia, foetal infection

Perinatal: ~6-10%
- labour/4wks after birth
- intrapartum hypoxia-ischaemia

Postnatal: ~15%
- neonatal complications
- postneonatal trauma or infection

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12
Q

What are the CP risk factors?

A
  • cause is still rather unknown
  1. infection
    - cytomegalovirus, rubella, herpes, syphilis, toxoplasmosis, zika virus, intrauterine infections, toxin exposure
  2. infant illness
    - bacterial meningitis, viral encephalitis, severe/untreated jaundice, bleeding in brain
  3. pregnancy/birth
    - low birth weight (incl. pre-term birth) - babies born <33wks = up to 30x higher CP rate
    - intrauterine growth restriction e.g. due to foetal infection, multiple births, maternal smoking
    - in utero death of co-foetus e.g. twin or triplet
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13
Q

What is the prevalence of CP?

A
  • in developed countries, 2-2.5/1000 for past 40y
  • in AUS, est. 33k in total pop.
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14
Q

What are the similarities between Spastic, Ataxic and Dyskinetic CP?

A

Abnormal pattern of posture/movement

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15
Q

What is the Manual Ability Classification System (MACS)?

A

Measures child’s ability to handly objects in important ADLs e.g. during play/leisure, eating and dressing

  1. hand objects easily/successfully
  2. handles most objects but with somewhat reduced quality/speed of movement
  3. handles objects with difficulty, needs help to prepare/modify activity
  4. handles limited selection of easily managed objects in adapted situations
  5. does not handle objects, has severely limited ability to perform simple actions
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16
Q

What is the distinction between Levels I and II of the MACS?

A

L1: limitations in handling very small/fragile/heavy objects require fine motor control, efficient coordination in both hands.

L2: perform same actvities in L1 but quality of performance decreased/slower. Commonly try to simplify handling objects e.g. using surface for support instead of holding it in hands.

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17
Q

What is the distinction between L2 and L3 of MACS?

A
  • L2: handle most objects althoguh slower/reduced quality
  • L3 commonly need help to prepare for activity/require adjustments to environment as ability to reach/handly objects are limited

Degree of independence related to supportiveness of environment

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18
Q

What is the distinction between L3 and L4 in MACS?

A
  • L3 can perform selected activities if situatoin is prearranged, supervised with plenty of time.
  • L4 need continuous help during activity, can at best participate meaningfully in parts of activity
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19
Q

What is the distinction between L4 and L5 in MACS?

A
  • L4 can perform part of activity, need help continuously
  • L5 might at best participate with simple movement in special situations. E.g. pushing buttons, occasionally hold undemanding objects.
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20
Q

What is dyskinetic movement?

A
  • involuntary, uncontrolled, recurring occasionally stereotyped
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21
Q

what are the two types of dyskinetic movement?

A
  1. Choreo-athetotic (or athetoid) movement
    - “unwanted/involuntary movements
    - slow/writhing/relatively continuous movements
    - affect distal parts more than prox
    - affects face muscles and speech - may have characteristic grimacing
    - muscle tone fluctuates
  2. dystonic movement
    - reduced activity
    - No single dominant pattern (flex/ext), patterns fluctuate
    - can be focal/generalised
    - affects prox parts more
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22
Q

What is ataxic movement?

A

Poor musc control=clumsy voluntary movements
* issues with balance/depth perception
* difficulty walking - characteristic pattern
* intention tremor
* fine motor movements difficult
* 5-10% CP have ataxic movements

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23
Q

What does “mixed” movement disorders mean?

A
  • many people with CP have more than one movement disorder, esp. as severity of BI increases
  • spasticity + athetosis = most common mixed presentation
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24
Q

What conditions are associated with CP?

A

Conditions present in some not all!

  • more extensive the BI / motor disturbances = more likely to occur e.g. primitive reflexes
  1. retention of primitive reflexes
  2. sensory impairment
  3. proprioceptive impairment
  4. perceptual impairment
  5. cognitive/intellectual impairment
  6. speech impairment
  7. seizure disorders
25
Q

What are primitive reflexes?

A
  • present in infants, normal part of development
  • forerunner of normal voluntary movement = aid to survival
  • normal development - reflexes become integrated. In CP, MAY NOT be integrated
  • unintegrated reflexes = difficult execution of functional movements
  • in PA, reinforcement of reflexes not good

If they don’t have these reflexes they’re less likely to move quickly into the stage of their movement pattern needed e.g. walking, throwing, jumping/ADLS

26
Q

What is the ATNR and STNR under primitive reflexes?

A

Asymmetrical Tonic Neck Reflex = turning baby’s head sideways, arm/leg on that side will straighten while opposite arm/leg bends

Symmetric Tonic Neck Reflex = infants head moves forwards, arms bend, legs straight. Opposite happens when head flexes backwards

27
Q

What is TBI? Is there a difference with ABI?

A

TBI = primary/2ndary neurologic consequences of insult to brain from external force
A(acquired)BI - more common in aus
* refers to “impairment to brain regardless of cause”
* incl. TBI + non-trauma (e.g. near-drowning, asphyxiation, substance abuse etc).
–> impaired function+resulting service need = lots of overlap across conditions
* incl. stroke + MS and PD, but from Ex pov, these conditions have specific implications –> so they receive specific Tx in this course.

28
Q

What is the incidence/prevalence of ABI?

A
  • 1 in 45 aus experiences ABI = 2.2% of pop.
  • 70% <65y, highest incidence 15-25y
  • approx. 3/4 with ABI = male
  • > 40% of people <65y with ABI, live outside major cities
29
Q

What is the aetiology of ABI?

A
  • trauma causes >50% cases
  • MVA leading cause of TBI, falls are 2nd (20-30%)
  • alcohol associated with 50% TBI
30
Q

Provide 2 facts regarding aetiology/prevalence/incidence of ABI.

A
  • people <65y with ABI, 97% lived in households and 3% in care accommodations
  • people with ABI, often have multiple disabilities - 26% rep 4 or more disability groups
31
Q

Why is incidence of ABI more common outside of major cities?

A
  • limitation of activities available - in major cities lots of safe supervised activities - in rural areas, climbing mountains/trees etc.

There is greater exposure to events that can lead to a traumatic injury in rural areas.

32
Q

What are the 3 common consequences of ABI?

A
  1. Physical impairment
  2. Cognitive impairment
    - memory
    - planning/organisation
    - language/communication
  3. Social/Behavioural Consequences
    - disinhibition
    - low arousal/motivation
    - egocentricity
    - reduced insight/self-awareness
33
Q

What are the 5 additional effects of BI on PA?

A
  1. balance
  2. fatigue
  3. overuse injury
  4. increased skill acquisition time
  5. increased seizure incidence
34
Q

What are the 7 different effects of BI on PA?

A
  1. decreased ROM + contracture
  2. learning styles
  3. intra-personal variability
  4. stereotypical movement
  5. RT
  6. cognitive impairments
  7. behaviorual impairments
35
Q

Define decreased ROM/contracture and provide the mechanism behind it.

A

People with spastic hypertonia= limb ROM sig. reduced

Contractures = complete/high resistance to passive stretch of muscle from fibrosis of connective tissue of muscles/joints

Mechanism:
* Spastic hypertonia prevents movement through full ROM of affected joints
- lack of mvoement = more soft tissue fibrosis around joints (joint capsule, ligaments, tendons and muscles)
- osseous changes may occur in long run
* ataxia and athetosis, less likely cause contracture as ROM not restricted in same way.

36
Q

What are some strategies for decreased ROM/contractures?

A
  • static stretch pre/post Ex is advisable, likely useful in preventing contracture progression - 30sec+ stretch
  • little evidence ROM improved by stretching - absolute changes <10deg and 95% CI mostly include zero
  • Because of this + time involved in stretching properly, do not “over-prescribe” stretching routines
37
Q

Define learning styles and the mechanism of it.

A

The way info is presented to person with BI may strongly influence whether effective learning takes place.

Mechanism:
* BI affects wide array of cerebral functions, incl. perception, spatial awareness, memory, sensory input and intellectual functioning
* which functions impaired/which not determine methods of instruction that are effective.

38
Q

Which areas of the brain affect understanding and following movement instructions?

A
  • Parietal lobe
  • frontal lobe
  • occipital lobe
  • temporal lobe
39
Q

What are some strategies/solutions for learning styles?

A

Experiment with diff methods:
* vid play-back
* demonstration
* verbal
* visualisation
* written
* movement guidance (or brailing)
* tactile input

40
Q

Define intra-personal variability and explain the mechanism.

A

Severity of motor impairments can vary observably from wk-wk/day-day or even single session
mechasnism:
* muscle tone! also ataxia and athetosis affected by:
- movement speed
- head/body position
- exertion level
- temp (cold water pools, hot day)
- mood
- fatigue/lack of sleep
- illness/pain
* fluctuations materially alter ability to perform PA

41
Q

What are some strategies/solutions for intra-personal variability?

A

Generally…
* avoid extreme temps
* movement facilitating position (i.e. head position, COM over BOS, balance aides)

Teaching new skills…
* teach at start of session - fatigue less likely to increase movement difficulty
* create relaxed atmosphere - encourage efforts/reduce fear of failure
* use transition activities - reduce speed/force required to allow person to concetrate on producing movement correctly.

42
Q

Define stereotypical movements and explain the mechanism.

A

People with BI often have less choice in the movement - in order to perform desired movement, certain other movements have to occur at the same time.

Mechanism:
* different “movement patterns” may be affected…
- flex/ext
- poor movement differentiation
- associated reactions/movements
- mirror movement
- reflex movements (STNR and ATNR)

  • neurological mechanisms underpinning - not understood well
43
Q

What are some strategies/solutions for stereotypicaly movements?

A

Should NOT reinforce movement patterns.
Specific strategies…
* movement facilitating positioning
* reduce activity effort
* encourage development of selective/differentiated movements, over stereotypical movements
–> unilat Ex over bilat
–> instead of barbell bicep curl, use DB with alternating flex/ext pattern (avoid general flex pattern)
* strapping or voluntary stabilisation
* make movement functional for person

Be mindful of intensity - can cause tremors, reduced coordination.

44
Q

Why was RT not recommended for people with spastic hypertonia?

A
  • strength gains were thought to be insig.
  • it would exacerbate high muscle tone
  • high effort would reinforce poor posturing/stereotypical (undesirable) movement patterns
45
Q

What does current RT research have for CP, TBI and stroke?

A

Increased strength
* majority of interventions = muscle strength increase in CP, TBI and stroke
* evidence strongest in Stroke –> CP –> TBI
* in CP, some dispute (associated reactions within individuals)

Strength & functioning
* increased strength = increase mobility-related functioning
* strength training + paralympic athletes

46
Q

What are the suggested strength training guidelines?

A

Positioning joints under load in best possible load-bearing position (e.g. leg press). This may mean using unilat movements over bilat; lines of force through optimally aligned load-bearing joints.

47
Q

What are some additional strenght training guidelines for people with spastic hypertonia?

A

Antagonistic pairs strengthen muscles least affected by high tone & stretch muscles most affects (e.g. ham-quad)

Emphasis development of strength through full ROM, esp. end range…
- pre ex - WU + stretching
- During Ex - use stretch-load-stretch pattern
- ensure ROM with Resistance = ROM w/o resistance (e..g leg ext)

Post Ex stretching

48
Q

What are cognitive impairments resulting from ABI and list the 3 principal areas?

A

A primary characteristic of people with TBI/ABI however, people with CP also have relatively high incidence, compared with gen. pop.

Principal areas:
1. memory
2. planning + organisation
3. language +communication

49
Q

Define memory problems and list the type of problems.

A

Almost ubiquitous among people with ABI

Types…
* short-term memory loss - remembering task just asked to do
* remembering things well-established in routine
* remembering appts, dates, schedule changes
* trouble remembering instructions to perform skill –> slow skill acquisition

50
Q

What are some strategies and solutions for memory problems?

A
  • use written program, voice recorder with written instructions - useful
  • home visits, always call day of appt to confirm
  • encourage diary for appts
  • realistic goal-setting and patience with skill acquisition
  • using physical demonstrations over verbal
  • minimise schedule/time changes
  • reminder features of electronic software - useful for computer literate
51
Q

Define planning/organisation problems.

A

people with ABI…
* difficulty with realistic goal-setting for PA program
* planning and organising activty schedule

52
Q

What are some strategies/solutions for planning/organisation problems?

A
  • structured assistance with planning/organising e.g. practitioner should help work through current commitments, logistical consideration + map out written plan that can be adhered to
  • reducing program complexity, esp. initial stages help adherence. (e.g. not too much Ex variety, same venue - establish a routine!)
53
Q

What are some evidence-based BCS (behaviour change strategies) for people with ABI?

A
  • goal setting
  • self-monitoring
  • social support
  • time management
  • prompting practice/follow-up
54
Q

Define language/communication problems.

A
  • overly talkative - talk for long-time, not much info
  • trouble finding right word to express what they menat (dysnomia)
  • speak in disorganised sentences, contain ideas that are tangential to conversation flow
  • speak toorapidly to be easily understood
  • difficulty coordinating muscles of speed (dysarthria)

Receptive language+communication problems relate to comprehension - interfere with fundamental elements of Ex Sci practice, including understanding instructions/gaining consent

55
Q

What are some strategies/solutions to language/communication problems?

A
  • be patient!
  • work with person to help client communicate effectively with you - slow down speech, ask q’s to stay on topic, check to ensure you heard correctly, familiarising person’s speech pattern

*receptive impairments - interfere with informed consent - enlist support from sig. others.

56
Q

Define behavioural characteristics (impairments).

A

Disinhibition:
- be impulsive, make hasty decisions/choices
- be overly friendly, disclose personal info or appear childish
- not considering repercussions of actions
- behave inappropriately in social situations

Lack of motivation/drive:
- not follow through with plans or activities
- not as cooperative or compliant as expected

57
Q

Define egocentricity and reduced insight under behavioural characteristics.

A

egocentricity:
- not consider whether actions affect others
- may not sympathise with others
- may appear selfish or concerned with own need
- may not appear appreciative of others

Reduced insight:
- unaware of their own cognitive and physical limitations (may cause unrealistic expectations, plan, goals)
- appear unmotivated to make changes to routines, esp. in initial stages

58
Q

what are some strategies/solutions for behavioural characteristics?

A

Be patient!!
- maintain standards for personal interaction
- okay to compromise but practitioner must feel safe and comfortable
- if client oversteps, response needs to be proportionate and firm
- entry into group situations done personally (at least first instance) - to determine rate of success
- behaviour issues may be so big, that creating self-managed, community based PA program may be unrealistic

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