SPX412 Exercise for Neurological Rehabilitation and Mental Health

Flashcards for key vocabulary and concepts in neurological rehabilitation.

CNS – central nervous system

Acts as control centre for processing information, coordinating movement, thoughts and emotions. Made up of brain & spinal cord.

PNS – peripheral nervous system

Nerves that branch off the spinal cord and travel to limbs, muscles, skin. Transmits sensory information to the CNS and motor commands from the CNS.

ANS

Autonomic nervous system (involuntary) – heart rate, blood pressure, digestion. In exercise, it regulates responses like HR & BP during effort and recovery.

Sympathetic Nervous System

Fight or flight response

Parasympathetic Nervous System

Rest and digest response

Somatic NS

Somatic nervous system (voluntary) – skeletal muscles

Neurodegenerative

Result from progressive deterioration of neurons, leading to cognitive, sensory and/or motor dysfunction. Parkinsons, Motor Neurone Disease, Huntingdon’s Chorea, Multiple Sclerosis

Exercise (in the context of neurological conditions)

Aims to reduce the impact of impairment or degeneration – effectiveness will vary depending on the condition, age, medications and co-morbidities of the patient. Growing evidence that motor skill training, balance training and/or PRT may influence neural networks

Neural Plasticity

The ability of the adult brain to change, re-organise and improve. The brain’s ability to reorganise itself by forming new neural connections. Happens through repetition, practice and experience

Neurons

Basic building blocks of the nervous system that transmit electrical signals (action potentials) via axons. Three main types: Sensory (afferent), Motor (efferent), Interneurons.

Sensory (afferent) neurons

Send signals to CNS from body

Motor (efferent) neurons

Send commands from CNS to muscles

Interneurons

Relay messages within CNS

Synapses

Junction between two neurons (or a neuron and a muscle). Signal passed via neurotransmitters (chemical messengers). Important for muscle contraction, reflexes, pain signalling and learning/memory

Major Neurotransmitters

Monoamines, Catecholamines, Amino acids, Peptides, Gasotransmitters, Trace amines, Purines, Others

Monoamines

Dopamine (DA), norepinephrine (noradrenaline; NE, NA), epinephrine (adrenaline), histamine, serotonin (SER, 5-HT)

Catecholamines

Dopamine, norepinephrine, epinephrine

Amino acids (as neurotransmitters)

Glutamate, aspartate, D-serine, y-aminobutyric acid (GABA), glycine

Peptides (as neurotransmitters)

Oxytocin, somatostatin, substance P, cocaine and amphetamine regulated transcript, opioid peptides

Gasotransmitters

Nitric oxide (NO), carbon monoxide (CO), hydrogen sulfide (H2S)

Trace amines

phenethylamine, N-methylphenethylamine, tyramine, 3- iodothyronamine, octopamine, tryptamine, etc.

Purines

adenosine triphosphate (ATP), adenosine

Other Neurotransmitters

released by motor neurons (ACh), anandamide, etc.

Excitatory Neurotransmitters

Promote neuron firing

Inhibitory Neurotransmitters

Reduce activity

Primary motor cortex & motor association area (premotor cortex) function

Skeletal muscle movement

Parietal lobe, primary somatic sensory cortex, sensory association area Function

Sensory information from skin, musculoskeletal system, viscera and taste buds

Occipital lobe, visual association area, visual cortex Function

Vision

Temporal lobe Functions

Gustatory cortex – taste, Olfactory cortex – smell, Auditory association area & auditory cortex – hearing

Frontal lobe, prefrontal association area Function

Coordinates information from other association areas, controls some behaviours

Motor Cortex (M1)

Initiates voluntary movement

Premotor Area

Plans movement

Cerebellum

Coordinates balance and fine motor control

Basal Ganglia

Initiates and regulates movement

Sensory Cortex

Processes touch, proprioception, pain

Brainstem

Controls breathing, HR, contains pathways to and from brain and spinal cord.

Neurons Function

Receive information from senses, process it and send back messages to exert an action, all through an electrochemical process

Oligodendrocytes Function

They produce the myelin that covers the neuronal axon and that increase the speed of electric impulses through the axon

Astrocytes Function

They take care of the neurons, but also participate in the transmission of messages, cell metabolism and control of blood flow

Microglia Function

Immune cells that can eat the microbes that enter the CNS. They also clean injured brain areas from cell debris.

Extra-pyramidal tracts

Generally associated with balance & tone

Pyramidal tracts

Lateral and anterior corticospinal tracts carry voluntary motor stimuli from the cerebral cortex to motor neurons in the spinal cord. They cross in the pyramids of the medulla.

Ascending tracts (Sensory tracts)

From the spinal cord to the cerebellum. Carry subconscious proprioceptive stimuli. Proprioception is body sense and muscle sense, the perception of body position and muscle position necessary for coordinating movements.

Descending tracts

Motor tracts

Corticospinal tracts

These are the neural tracts which descend in the lateral grey columns of the spinal cord, carrying signals for voluntary movement of skeletal muscle.

Upper Motor Neurons

Neurons that originate in the brain (motor cortex or brainstem) and sends commands down to the spinal cord

Lower Motor Neurons

In the spinal cord (anterior horn) or brainstem (for face and neck). Their axons travel out to the muscles. Act as a direct link between the spinal cord and your muscles Responsible for actually causing movement when you want to move

fMRI Function

Measures blood flow changes (oxygen use) in brain during tasks

PET scan Function

Tracks blood flow/metabolism with radioactive tracer

TMS Function

Uses magnetic pulses to activate neurons. Shows excitability or inhibition.

MEG Function

Records magnetic signals from electrical activity in brain.

Brain Plasticity

The brain and spinal cords ability to adapt, change and reorganise in response to injury, training and experience

4 R’s of Plasticity

Re-activation of old pathways, Re-organisation of brain areas, Recruitment of new neurons, Remodelling of neuron connections

Maladaptive Recovery

If no rehab or poor movement patterns are repeated, the brain can learn maladaptive (unhelpful) strategies

Sensorimotor training

Reconnect movement and sensory awareness.

What gets damaged in Upper Motor Neuron Lesions?

The corticospinal tract, which control voluntary, goal directed movement

Negative signs (UMN Lesions)

Loss or reduction of normal function = weakness, slow movement, poor coordination

Positive signs (UMN Lesions)

Abnormal increases in movement or reflex activity = exaggerated responses = spasticity, hyperreflexia, Babinski sign – caused by disrupted inhibitory control

Adaptive signs (UMN Lesions)

Compensation = using alternative, often inefficient movement strategies to achieve a task when normal movement is impaired, Altered secondary features in muscle and soft tissue– weakness, stiffness & decreased length – due to disuse, impaired activation or spasticity.

Contractures

Muscles that are immobilised in a shortened position lose sarcomeres and become shorter and stiffer

Biomechanical measures

Force plates, EMG, video and motion analysis for posture gait and kinematics

Global clinical tests

Motor Assessment Scale (MAS) for stroke; Rivermead Motor Assessment (RMA) for gross function, leg and trunk, and arm; Fugl-Meyer Assessment (FMA) for 5 domains (motor function, sensory function, balance, joint ROM & joint pain).

Motor Control

Regulation of movement in organisms that possess a nervous system

Neural Plasticity

CNS ability to adapt to new demands and to recover after injury

Neuroprotection

Any process that preserves or restores nerve cells, connections and function after injury or in disease

Automaticity

Activity is performed involuntarily or unconsciously as a reflex, innate process or ingrained pattern

Intentional Movement

Internally initiated decision to move

Dual Tasking

More than one physical task, or challenges

Anticipatory Adjustments (Rehab)

Movements that challenge balance

Forced Movement

A rehab approach where the client is forced to use the affected limb (e.g., arm or leg) by practicing intensive, task-orientated exercises

Adaptive Functions

Substituting muscles, Wider base of support, Smaller, controlled steps, Bracing body segments

Maladaptive Functions

Antalgic gait, Spastic or hypertonic muscles, Contractures