Neuro rehab

Neuroplasticity and Assessment

Neuro plasticity Principles

Neuroplasticity

Principles

Physiology

Motor Learning

Exercise

Key Features

Neuro Assessment

Part one

Multiple Sclerosis

Assessment

Part two

Rarer Neuro Conditions

MND, MSA, PSP/CBS, GBS, HD

Summary

Parkinson's Disease

Key Features

Further Reading

Assessment

The Rehabilitation Process

• 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

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

Motor

Spasticity

Hypotonia

Hypertonia

Tone

Rigidity

An awesome title

Hypotonia

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

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

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

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

Feedback Timing

Retention

Cueing

Attentional Focus

Practice

Motor adaptation & Skill acquisition

Individual Differences

Transfer of learning

Feedback

Mental Practice

Task Specifcity

Variability

Motor Learning stages

Power

Tone

Coordination

Reflexes

Sexual Dysfunction

Speech and Swallow

Balance/Coordination

Fatigue

Vision

Spasticity

MS

Bladder and Bowel

Sensory changes

Motor

Gait

Cognitive

Emontional and mood

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

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

Mood/psychiatric

Autonomic

Cognitive

Postural Instability

Gait

Rigidty

Tremor

Bradykinesia

Dyskinesia

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

Cognition

Communication

Vision

Sensation

Proprioception

Multiple System Atrophy

Motor Neuron Disease

Upper and lower motor Neuron

Alpha-Synuclionopathy

Progressive Supranuclear Palsy

Guillian-Bare Syndrome

Acute Demylinating Polyneuropahy

Tauopathy

Traumatic Brain Injury/Spinal Cord injury

Huntington's Disease

Genetic Disease