Neuro rehab

Neuroplasticity and Assessment

Principles

Motor Learning

Neuro plasticity Principles

Summary

Further Reading

MND, MSA, PSP/CBS, GBS, HD

Rarer Neuro Conditions

Key Features

Assessment

Multiple Sclerosis

Parkinson's Disease

Assessment

Key Features

Neuroplasticity

Exercise

Physiology

Neuro Assessment

Part two

Part one

The Rehabilitation Process

• 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

• 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)

Basic orientation and cognition

Communication/Swallow

Next

Vision

• 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)

Oculomotor

Sensation

Proprioception

Motor

Rigidity

Spasticity

An awesome title

Tone

Hypertonia

Hypotonia

Hypotonia

DDK

Coordination

Reflexes

• Sensory and environmental enrichment
• Adaptive plasticity
• Cross-model plasticity
• Cognitive and emotional influence
• Age-Dependent

• Use dependent plasticity
• Specificity
• Repetition
• Intensity
• Timing

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

Bradykinesia-Finger tapping-Fist open close-Toe/Heel tapping- Monitor during a period Rigdigty -Passsive movement: Lead pipe/Cogwheel-Wrist/Elbow + contralateral tapping (unmasking)-Ankle/Knee + Tapping Tremor-Resting: Pill-rolling-Postural: Position against gravity- Shoulder flexion-Kinetic (action): Finger- nose static

- 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

Motor Learning stages

Retention

Variability

Cueing

Task Specifcity

Feedback Timing

Mental Practice

Individual Differences

Attentional Focus

Feedback

Transfer of learning

Practice

Motor adaptation & Skill acquisition

Coordination

Reflexes

Tone

Power

MS

Sexual Dysfunction

Cognitive

Bladder and Bowel

Balance/Coordination

Sensory changes

Fatigue

Speech and Swallow

Emontional and mood

Gait

Spasticity

Motor

Vision

Brain Derived Neurotrophic Factor

• 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

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.

Cerebellar function tests:

• Finger-nose
• Heel-shin
• Dysdiadokinesia
• Arm push-down

Dyskinesia

Gait

Rigidty

Postural Instability

Bradykinesia

Mood/psychiatric

Tremor

Cognitive

Autonomic

Features

Links/Resources

TBC

CNS's ability to forge, reinforce, and restructure neural connections in response to changes in sensory inputs or motor demands

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

Sensation

Proprioception

Vision

Communication

Cognition

Traumatic Brain Injury/Spinal Cord injury

Genetic Disease

Huntington's Disease

Acute Demylinating Polyneuropahy

Guillian-Bare Syndrome

Tauopathy

Progressive Supranuclear Palsy

Alpha-Synuclionopathy

Multiple System Atrophy

Upper and lower motor Neuron

Motor Neuron Disease