Neuro Quiz 2

define neurorehabilitation

the practice of physical therapy in which we utilize human and animal studies to best translate evidence to improving function following some sort of neurological accident, injury, or disease

what variables influence stroke recovery

-infarct size

-prestroke medical comorbidities

-prestroke experience and education

-severity of intial stroke deficits

-acute stroke interventions

-amount of post stroke therapy

-medical complications after stroke

-depression

-genetics

-infarct location

-prestroke disability

-age

-breadth of stroke deficits

-medications during stroke recovery period

-types of poststroke therapy

-socioeconomic status

-caregiver status

using the ICF health conditions (neuronal) differentiate between recovery and compensation

-recovery: restoring function in neural tissue that was initially lost after injury

-compensation: neural tissue acquires a function that it did not have prior to injury

using the ICF body functions/structure (performance) differentiate between recovery and compensation

-recovery: restoring the ability to perform a movement in the same manner as it was performed before injury

-compensation: performing an old movement in a new manner

using the ICF activity (functional) differentiate between recovery and compensation

-recovery: successful task accomplishment using limbs or end effectors typically used by non disabled individuals

-compensation: successful task accomplishment using alternative limbs or end effectors

what are the principles of neuroplasticity

-use it or lose it

-use it and improve it

-specificity

-repetition matters

-intensity matters

-time matters

-salience matters

-age matters

-transference

-interference

what are the number of reps that should be performed for an UE task

400-800

what are the number of reps that should be performed for a LE task

1000-2000

what are components of intensity

-rate of work performed

-frequency (# of reps)

-duration (time spent in therapy)

define transference

change in function as a result of one training experience can lead to learning other similar skills

define interference

when "bad habits" can interfere with learning "good habits"

what are the pros of early mobilization

-bed rest negatively affects MSK, CV, respiratory and immune systems

-immobility related complications are common early after stroke at a time when patients are very inactive

-there might be a narrow window for brain plasticity and repair and the optimum period for chance could be early after stroke

what are the cons of early mobilization

-damage to the ischemic penumbra associated with reduced cerebral blood flow when the head position is raised

-increased BP associated with activity that might also worsen outcome

-increase risk of falls with increased out of bed activity

what are the direct neuroprotective effects of aerobic exercise

-increase neurotrophic growth factors like BDNF

-increase neurotransmitters like dopamine or serotonin

-increase neuroplasticity

-increase neurogenesis

-increase neuroprotection

what are the indirect effects of aerobic exercise with stroke patients

-increase physical fitness

-decreases systemic and CNS inflammation

-increase cerebral blood flow

what are the combined effects of both indirect and direct effects of aerobic exercise for stroke patients

-increased cognitive function

-increased mood

-increased arousal

-decrease neurodegeneration

recommended activity guidelines for stroke survivors

-aerobic exercise: 3-5x/wk. 20-40 min per sessions/ moderate intensity

-resistance: 2-3x/wk/ 1-3 sets of 8-15 reps/ 30-50% of 1RM

what is considered light intensity

- <40% HRR

- <64% HRMax

-RPE <4 (0-10 scale)

- RPE <12 (6-20 scale)

what is considered moderate intensity

-40-60% HRR

-64-76% HRMax

-RPE 4-5 (scale 0-10)

-RPE 12-13 (Scale 6-20)

what is considered vigorous intensity

- >60% HRR

-64-76% HRMax

-RPE >6 (scale 0-10)

-RPE >14 (scale 6-20)

define SODH

-written and unwritten rules that create, maintain, or eliminate durable and hierarchical patterns of advantage among socially constructed groups in the conditions that affect health

-the manifestation of power relations in that people and groups with more power based on current social structures work -implicitly and explicitly- to maintain their advantage by reinforcing or modifying these rules

Animal Models show approximately how many reps of UE activity are required for cortical changes?

a. 50-75

b. 150-300

c. 400-800

d. 1000-1500

400-800

which of the following principles of neuroplasticity focuses on the importance of the task to the patient?

a. use it or lose it

b. salience

c. age

d. interference

salience

which principle of neuroplasticity asserts functional and cortical remapping can occur with the provision of rehabilitation services post neurological injury?

a. time matters

b. use it and improve it

c. use it or lose it

d. age

use it and improve it

which principle of neuroplasticity lets us explain the positive impact of one activity on improving function in another

a. salience

b. repetition matters

c. transference

d. interference

transference

when should a stroke survivor be screen for aerobic activity?

when the patient is medically stable

when should screen be repeated for stroke survivors?

at transition points along the continuum of care based on changing neuromotor and cardiopulmonary capacities

who should determine if an individual post stroke or TIA is ready to begin aerobic training?

qualified health care professionals

what information is needed to determine if an individual post stroke or TIA is ready to begin aerobic training?

-general information

-PMH

-assessment of contraindications to exercise testing and training

-evaluating motor function, mobility, balance, sweallowing, cognition, and communication

when is an exercise stress test indicated in pre-participation screening for aerobic training after stroke or TIA?

a symptom-limited or submax exercise test should be performed whenever feasible

what should the patient do to prepare for exercise testing

-stay on usual meds

-avoid any strenuous activity for 24 hours prior to testing

-avoid heavy meal, caffeine, or nicotine within 2-3 hours of testing

what should be monitored during a screening exercise test?

-clinical sxs

-HR

-BP

-RPE

how long should an aerobic training program be conducted for?

8 weeks

what is the recommended frequency for aerobic training program

minimum 3 days/week

how long should each aerobic training session last?

- >20 minutes

-warm up and cool down: 3-5 minutes

typically how would you progress an aerobic training program?

-duration increased by 5-10 minutes every 1-2 weeks for the first 4-6 weeks

-intensity 5%-10% of HRR every 1-4 weeks

what are the 3 components important to improve ambulation post stroke, iSCI, and TBI

-specificity

-intensity

-repeition

what should considers do when looking to improve walking function in ambulatory chronic CVA, iSCI, and TBI

-walking training at mod to high aerobic intensities

-walking training with virtual reality

what is considered mod to high intensity

-60-80% HRR

-70-85% HRMax

-14-17 RPE

what should clinicians considered doing when looking to improve walking function in ambulatory chronic CVA, iSCI, and TBI patients?

-strength training at >70% 1RM

-circuit training, cycling, or recumbent stepping at 75-85% HRMax

-balance training with VR

what should clinicians NOT perform to improve walking function in ambulatory chronic CVA, iSCI, and TBI patients

-static or dynamic standing balance activities pre-gait

-BWSTT with emphasis on kinematics

-robot-assisted gait training

what was the purpose of the CPG to improve locomotor function following stroke, incomplete SCI, and brain injury?

evaluate available evidence of the efficacy of various PT interventions to improve walking function

will i harm my patients when delivering high intensity gait training?

adverse events of HIGT are no greater than conventional therapy

should i be concerned I am causing orthopedic issues when doing HIGT

there is negligible evidence in adults in acute-onset CNS injury that HIGT exacerbates pain

should i be concerned about my patient's movement quality while performing HIGT?

-prioritization of movement quality during walking training can reduce the amount of intensity of practice

-recommendation is to prioritize intensity and amount of practice

-recommended to allow errors in movement to promote motor learning

what if my patient needs to work on activities like standing balance and transfers

HIGT improves non-locomotor tasks like transfers and standing balance without their explicit practice

what additional equipment could be required to perform HIGT safely?

-HR monitor

-walking space or treadmill

-safety harness system/devices

task variability for limb swing

-start with physical assistance

-advance to no manual assistance

-advance to stepping over obstacles

task variability for WB during stance

-BWS to no BWS

-UE support to no UE support

-weight walking

task variability for propulsion

-increase speed on TM

-inclined surfaces

-weight walking

task variability for frontal plane stability

-BWS to no BWS

-UE support to no UE support

-backward/side stepping

-compliant/narrow surfaces

-dual task interventions

aerobic exercise prescription screening: WHO?

a. only stroke survivors under the age of 65

b. only stroke survivors with no other CV comorbidities

c. stroke survivors that are bothu nder the age of 65 and have no other CV comorbidities

d. all stroke survivors regardless of age or comorbidities

all stroke survivors regardless of age or comorbidities

aerobic exercise prescription screening: when?

a. immediately post stroke in the ICU

b. at set and routine time intervals

c. at transition points along the continuum of care

d. outpatient eval once d/c from hospital

at transition points along the continuum of care

how should aerobic exercise prescription screening be completed?

a. symptom limited with ECG with warm up and cool down

b. maximal stress test on incline treadmill with supplemental O2

c. supine or prone activities like bed mobility with monitoring of RPE

d. patient should conduct the test after a full fast of 24 hours

e. the patient should avoid taking all meds 8hrs prior to testing

symptom limited with ECG with warm up and cool down

HIGT: what is a safe and effective example of task variability to increase demand?

a. removing safety harness to challenge balance reactions for an individual with high fall risk scores

b. stepping over obstacles walking backwards at 75% of max forward speed

c. transition from BW support to walking without BW support

d. reduction of walking speed and training duration

transition from BW support to walking without BW support

what are the stages of stroke recovery

-flaccidity

-spasticity appears

-increased spasticity

-decreased spasticity

-spasticity continues to decrease

-spasticity disappears and coordination reappears

-normal function returns

when performing UE training what is the goal percent of errors?

20%

what is CIMT

perform activities within the constraint of a set of rules that induce intensive and consistent use of affected limbs

what characteristics should the patient possess to perform CIMT

-should have at least 20* of active wrist extension

-at least 10* of MCP/IP extension

what occurs with signature therapy for CIMT

-patients wears constraint for 90% of waking hours for 14 days

-patient participates in supervised activities for 6 hours for 10 of the 14 days

what is the evidence for CIMT

-CIMT in the acute/subacute phase may be beneficial for improving spasticity and muscle strength but not motor function. the literature is mised regarding improvement on ADLS and dexterity

-CIMT may be beneficial for improving motor function, ADLs, and muscle strength in the chronic following stroke

-modified CIMT may be beneficial for improving motor function and ADLs in the chronic phase following stroke

what level of evidence is there for CIMT

Level 1a and 1b

what is the evidence for UE robotics

-arm/shoulder end-effector or exoskeleton, alone or in combo with other therapy approaches, may not be beneficial for UE rehab following stroke

-hand exoskeletons may be beneficial for improving ADLs, spasticity, ROM, and muscle strength. the evidence is mised for hand exoskeletons ability to improve motor function and dexterity

what levels of evidence are available for UE robotics

level 1a, 1b, and 2

what is the evidence for VR

may be more beneficial then conventional therapy for improving motor function and stroke severity, but not ADLs, dexterity, spasticity, or muscle strength

what level of evidence is available for VR

level 1a, 1b, and 2

what evidence is available for FES

may be beneficial for improving dexterity , but not muscle strength. the literature is mixed regarding improvements in motor function, ADLs, spasticity, ROM, and stroke severity

what level of evidence is available for FES

level 1a and 1b

what are the different priming techniques

-motor imagery

-mental practice

-visual imagery

-mirror therapy

-rTMS

what is motor imagery

cognitively producing a motor act without physically performing it

what are the outcomes for motor imagery

outcomes are positive but less significant than physical activity alone or physical activity plus motor imagery

what is the evidence related to motor imagery

mental practice may produce improvements in motor function and muscle strength, but the evidence is mixed regarding improvements in ADLS

what levels of evidence are there for motor imagery

levels 1a and 2

what is mirror therapy

individual observes movements performed by the non-paretic limb reflected in a mirror

what is the evidence for mirror therapy

mirror therapy may improve motor function, dexterity, proprioception, and stroke severity but the literature is mixed regarding improvements in ADLs, spasticity, and muscle strength

what levels of evidence are there for mirror therapy

1a and 1b

what is rTMS

-noninvasive treatment that uses electromagnetic pulses to stimulate nerve cells

-can facilitate or suppress targeted regions of the brain depending on stimulation parameters

what is the evidence for rTMS

-low frequency rTMS may be beneficial for improving motor function, dexterity, ADLs, proprioception, stroke severity, but not spasticity or ROM

-high frequency rTMS may be beneficial for improving dexterity, ADLs, stroke severity, and muscle strength, but not motor function

what level of evidence is there for rTMS

level 1a and 1b

what are potential compensatory techniques for stair training

-AD

-step to gait

-use of railings

-adaptive equipment

-orthotics

what are some strategies often used when someone has difficulty with sit to and from transfers

-start from a higher surface

-work on transfers from a firm surface before working on softer surfaces

-part task practice

-sit or stand in front of patients who are fearful to lean forward

-give the patient a target if they have difficulty leaning forward

what strategies can you use with patients who have difficulty with weight shifting forward when performing STS

-cross arms

-place arms on a large exercise ball

-look at visual target

what are some strategies to facilitate loading on the more affected leg when performing STS

-give tactile input above the knee

-place the lesser affected leg slightly forward

-place the lesser affected leg on a small block

-reach toward more affect side

-use a force platform for visual input

what are some potential compensatory techniques to perform STS

-UE use

-adaptive equipment

-alternate ways to complete the task

what are some strategies to use when someone has difficulty with supine to and from transfers

-start side lying

-place pillow/wedge under back

-start with head up

-turn head and follow hand with their eyes

-work on a firm surface like a mat before a bed

a PT is teaching someone to roll. The PT notices the person is making fewer mistakes and has better endurance. To keep improving, the BEST strategy is to

a. avoid errors before bad habits develop

b. have the patient practice rolling in varying environments

c. provide continuous feedback after every trial

d.continue practicing the same way until the person makes no errors

have the patient practice rolling in varying environments

what are some key principles to promote neuroplasticity

a. facilitate perfect movement

b. rest

c. verbal cueing

d. reps, intensity, specificity, and salience

reps, intensity, specificity, and salience

During which stage of UE motor recovery does spasticity begin to decrease?

a. Stage 2

b. Stage 3

c. Stage 4

d. Stage 5

Stage 4

which of the following is an outcome of mental practice?

a. increase in physical strength

b. improved motor performance

c. improvement better than physical performance

d. no improvements

improved motor performance

which approach is often used in the early stages of rehab to promote recovery of function

a. strength training

b. task specific training

c. avoiding the affected side

d. rest

task specific training

define Use it or Lose It

Neural connections only stay strong if they're used. If the skill isn't practiced, the neural connections fade and weaken over time

define Use it and Improve It

Training that drives specific brain function can lead to enhancement of that function

define Specificity

highlights the importance of tailoring an activity or exercise to produce a result in specific circuitry

define Repetition

400-800 or 1,000-2,000 of this to drive neuroplastic changes

define intensity

AKA the dose

define Time

Early is better than later

define Salience

Motivation and attention are essential to promoting engagement in the task

define Age

define Transference

Plasticity in response to one training experience can enhance acquisition of similar behaviors

define Interference

Plasticity resulting in bad habits can interfere with learning good habits

Training induced plasticity occurs in younger brains

define Transference

Plasticity in response to one training experience can enhance acquisition of similar behaviors

define Interference

Plasticity resulting in bad habits can interfere with learning good habits