Neuro rehab
Inti Rahman
Created on November 21, 2023
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Transcript
Part one
Part two
Neuro Assessment
Physiology
Exercise
Neuroplasticity
Key Features
Assessment
Parkinson's Disease
Multiple Sclerosis
Assessment
Key Features
Rarer Neuro Conditions
MND, MSA, PSP/CBS, GBS, HD
Further Reading
Summary
Neuro plasticity Principles
Motor Learning
Principles
Neuroplasticity and Assessment
- An educational process
- Central involvement of the disabled person in programme planning
- Key involvement of family, friends, and colleagues
- A process that requires clear goals to be set and measured
- An interdisciplinary process
- A process based on the concepts of disability (activity) and handicap (participation)
- Approaches that reduce disability
- Approaches designed to acquire new skills and strategies, which will maximize activity
- Approaches that help to alter the environment, both physical and social, so that a given disability carries with it minimal consequent handicap
The Rehabilitation Process
Basic orientation and cognition
Communication/Swallow
Vision
Next
Oculomotor
- Oculomotor ROM
- Cover – uncover / Cross-cover (skew deviation - vertical movements are pathological, horizontal are benign)
- Gaze holding nystagmus (Primary gaze / Gaze evoked elicited @ 30 deg up/down/left/right -Gaze evoked is CNS driven)
- Smooth pursuit
- Vergence
- Saccades
- VOR (Dolls Head)/VOR Cancellation (VOR cancellation mediated by cerebellum)
- Dynamic visual acuity
- Head thrust test (need Snellen chart)
- Head shaking (need frenzel lenses) indicates asymmetry in vestibular circuits; beats to stronger side
- Dix Hallpike (Nystagmus, latency, vertigo, resolution of symptoms)
Sensation
Proprioception
- Cuneocerebellar tract – Upper limbs
- Rostral spinocerebellar / tract –Upper limbs
- Anterior spinocerebellar tract – Lower limbs
- Posterior spinocerebellar tract – Lower limbs
Motor
Hypotonia
Hypotonia
Hypertonia
Tone
An awesome title
Spasticity
Rigidity
Did you know? We retain 42% more information when the content has movement. It may be the most effective resource for capturing your audience’s attention.
Coordination
DDK
Reflexes
Rehabilitation focuses on empowering the individual to learn to maximise their residual function, with a goal of minimising the impact of the impairment on the day to day activity
- Use dependent plasticity
- Specificity
- Repetition
- Intensity
- Timing
- Sensory and environmental enrichment
- Adaptive plasticity
- Cross-model plasticity
- Cognitive and emotional influence
- Age-Dependent
- Spontaneous movements, generally reduced in PD- Hands gestures while talking, usually reduced or absent - Eyeblink, whose spontaneous rate is reduced - Resting tremor, usually affecting one hand only - Fidgeting and crossing/uncrossing of the legs, that may indicate dyskinesia, a complication of chronic Levodopa therapy
Bradykinesia-Finger tapping-Fist open close-Toe/Heel tapping- Monitor during a periodRigdigty -Passsive movement: Lead pipe/Cogwheel-Wrist/Elbow + contralateral tapping (unmasking)-Ankle/Knee + TappingTremor-Resting: Pill-rolling-Postural: Position against gravity- Shoulder flexion-Kinetic (action): Finger- nose static
Motor adaptation & Skill acquisition
Practice
Transfer of learning
Feedback
Attentional Focus
Individual Differences
Mental Practice
Feedback Timing
Task Specifcity
Cueing
Variability
Retention
Motor Learning stages
Immediate Delayed
Repetition Distribution
Positive TransferNegative Transfer
Variable Random
Knowledge of Results Knowledge of Performance
Retention Interval
VerbalVisual
External Internal
Adaptability
Visualisation
Cognitive Associative Autonomous
Specificity of practice
Power
Tone
Reflexes
Coordination
Vision
Motor
Spasticity
Gait
Emontional and mood
Speech and Swallow
Fatigue
Sensory changes
Balance/Coordination
Bladder and Bowel
Cognitive
Sexual Dysfunction
MS
Did you know? We retain 42% more information when the content has movement. It may be the most effective resource for capturing your audience’s attention.
Did you know? We retain 42% more information when the content has movement. It may be the most effective resource for capturing your audience’s attention.
Did you know? We retain 42% more information when the content has movement. It may be the most effective resource for capturing your audience’s attention.
Did you know? We retain 42% more information when the content has movement. It may be the most effective resource for capturing your audience’s attention.
Note: In Genially, we use AI (Awesome interactivity) in all our designs so that you can level up with interactivity and turn your content into something that engages and provides value.
Note: In Genially, we use AI (Awesome interactivity) in all our designs so that you can level up with interactivity and turn your content into something that engages and provides value.
Note: In Genially, we use AI (Awesome interactivity) in all our designs so that you can level up with interactivity and turn your content into something that engages and provides value.
Note: In Genially, we use AI (Awesome interactivity) in all our designs so that you can level up with interactivity and turn your content into something that engages and provides value.
Did you know? We retain 42% more information when the content has movement. It may be the most effective resource for capturing your audience’s attention.
Note: In Genially, we use AI (Awesome interactivity) in all our designs so that you can level up with interactivity and turn your content into something that engages and provides value.
Did you know? We retain 42% more information when the content has movement. It may be the most effective resource for capturing your audience’s attention.
Note: In Genially, we use AI (Awesome interactivity) in all our designs so that you can level up with interactivity and turn your content into something that engages and provides value.
- Activates tropomyosin-related receptor kinase B - Influences neuronal dendritic spine growth (synaptogenesis) , ultimately increasing post-synaptic drive to the motor neuron and improving nervous system communication.
- Elevates insulin-like growth factor-1 - facilitates exercise-induced growth of blood vessels (angiogenesis) and the formation of new neurons (neurogenesis)
- Promotes vascular endothelial growth factor - linked to the proliferation of neurons and the growth of blood vessels
Brain Derived Neurotrophic Factor
Cerebellar function tests:
- Finger-nose
- Heel-shin
- Dysdiadokinesia
- Arm push-down
Expanded Disability Status Scale (EDSS): This widely used scale assesses disability in MS by evaluating various functions, including mobility, coordination, sensory functions, bowel and bladder function, and visual function.
Features
Autonomic
Cognitive
Tremor
Mood/psychiatric
Bradykinesia
Postural Instability
Rigidty
Gait
Dyskinesia
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TBC
Links/Resources
Involves a complex interplay of coordinated neurotransmitter release, including acetylcholine, nor/adrenaline, dopamine brain-derived neurotrophic Factor (BDNF)Changes in both white and gray matter through neurogenesis, synaptogenesis, angiogenesis, and gliogenesis create stronger and more efficient connections within the relevant neural pathways
CNS's ability to forge, reinforce, and restructure neural connections in response to changes in sensory inputs or motor demands
Fundamental components of exercise that enhance neuroplasticity and promote brain reorganization, including specificity, intensity, repetition, and salience of treatment
Overall concepts not to achieve a cardiovascular or metabolic challenge, but to engage the brain with specific, complex, and coordinated activity that demands a higher degree of cortical involvement
Cognition
Communication
Vision
Proprioception
Sensation
Motor Neuron Disease
Upper and lower motor Neuron
Multiple System Atrophy
Alpha-Synuclionopathy
Progressive Supranuclear Palsy
Tauopathy
Guillian-Bare Syndrome
Acute Demylinating Polyneuropahy
Huntington's Disease
Genetic Disease
Traumatic Brain Injury/Spinal Cord injury