Neurological Flashcards Week 1 Notes

All Flashcards from Week 1 of Neuro

What types of patients due Neuro physios see?

Those with movement problems or other complications due to spinal cord injury and brain injury

Common Conditions for Neuro

Treated by neuro physios include stroke, multiple sclerosis, Parkinson's disease, and traumatic brain injuries.

What are the clinical reasoning steps in Neuro physio

Using our knowledge as practitioners

Looking at research

Using ICF model

Taking into account the person and famliy

promoting active participation from the patient

5 Steps during an Appointment which includes clinical reasoning

Assessment, Interpretation, Goal Setting, Treatment and Evaluation

Describe Synaptic Plasticity

This is the production and improvement of synapses between neurons, Influences how neurons communicate with each other.

What can Influence Synaptic Plasticity

Activity and stimuli can improve or worsen synaptic plasticity. For both short term or long term

Describe Structural Plasticity

This is changing the overall structure and connections. This can include neurogenesis, synaptogenesis, synaptic pruning.

What is BDNF

Brain Derived Neurotropic Factor. In the hippocampus influences Nuerogenesis

Describe Neuroplasticity. What influences it?

This is the CNS and its ability to create, strengthen or weaken synaptic connections. Internal and external stimuli

3 Parts of Neuroplasticity changes

Neurochemical changes, neuroreceptive changes, neurostructural changes

What are intercellular changes that occur after brain injury

Synpatogenesis, Neurogenesis, Synpatic pruning, More axon production, More post synpatic receptors available

What is the main activity or factor for synaptic plasticity?

Motor movements or activity, especially specific ones

How is grey matter produced

WIth synaptogenesis , neurogenesis, synaptic plasticity

What are the 3 Mechnical recovery ways someone can recovery after brain injury

Recruitment, Retraining, Restoration

Describe Restoration

This is when functions are returned to an area of the brain where there was no loss or damage but more lack of functioning. Usually via retraining

Describe recreuitment

Requesting parts of the brain to do or aid in a movement

Describe Retraining

An area of the brain adapting to and being able to perform a novel function

What are the 10 principles of experience dependant Nueuroplasticity

use it or lose it, use it and improve it, intensitty and difficulty matters, age matters, timing matters, specificity ot task and timing matters, salience, transferability, interference, Repetition

What Stimulation based factors can positively influence movement execution and neurplasticity

TENS, NMES, ESTIM

What are non stimulting factors for neuroplasticity

Mirror Imagery, Mental imaging, aerobic activity

For acute patients what are 7 parts to an appointment

Chart Reading, Obs/Palp, Subjective, Resp assessment, func assessment, Sensorimotor assessment, clinical/chart notes

How can small ischemic attacks positively influence Nueroplasticity?

It can lead to more upregulation of genes that help with neural growth.

Help with synaptic plasticity, can help strengthen a synapse, help with neurotransmission

Key Prognosis Factors

Patient Factors (Age), Environmental and social factors, Our clinical assessment, condition specific factors (such as severity), Psychological and mental factors, Rehab timing and intensity

Describe RAMP

Recovery- Helping them get back to PLOF

Adaptation- Utilizing compensations for certain movements

Maintence- Trying to not get worse with debilitating problems

Prevention- Trying to minimize secondary complications

3 Types of goals people often set

Activity Based, participation based, Body structure or function

Activity Based goal?

This would be like wanting to walk 50 M

Participation Based goal?

For example wanting to go on a bus

What is a body structure or function based goal?

For example wanting to improve strength

3 Types of Goals coming from physios

Short term, long term, session goal

Describe Motor Recovery

This is when someone has a recovery of their function to their PLOF without accessory muscles and limbs

Describe Adaptation/compensation for recovery

This is when someone utilizes other limbs or muscles to help with the process of re doing a movement

5 Key components and 2 Bonus parts of a rehab program?

Task Specificity, Neuromuscular Training, Flexibility, Cardiovascular Fitness, Any other modality that could work 

Advice and education, Equipment Prescription

Task Specific or Task Orientation Skill

We want to train skill very specifically, we look to refine movement sequences. We practice real world skills, Need to make it motivational for the person, make it personal.

Neuromuscular Training

We want to Train muscles either strength or endurance

Flexibility

Looking into active and passive range. ROM work.

CardioVascular Fitness Description

Doing cardio exercise often those who are having a neurological disease are often less active. It can improve QOL, imprve general health. 

Extra/Specific Modalities

Anything else that could possibly help the individual. 

What is a Stroke/CVA (What does it stand for)

Cerebrovascular Accident. Neurological deficit due to injury to the CNS by a vascular cause

Describe a TIA and What does it stand for

Transient Ischemic Attack. Episode of neurologic dysfunction caused by focal brain, spinal cord or ischemia without acute infarction

Describe The 2 Ischaemic Stroke

Thrombus, Embolus

What are 2 main factors in an ischemic stroke

Large Artery Athesclerosis, Cardioembolism

Define Atherosclerosis

Slowly progressing inflammatory disease in the artery

How does platelet activation influence a stroke?

It contributes to athesclerosis and can lead to secretion of inflammatory agents. 

How does collagen and thromben influence a stroke?

If enough thrombin builds up it reduces the blood flow to a tissue

What is a Cerebral Embolus?

This is a blood clot that moves up to the brain and causes vessel occlusion

What type of tissue is the ischaemic core?

Brain Tissue is destined to die

Describe the Penumbra

Salvageable brain area

Describe a Haemorrhage stroke?

Haemorrhage is a blood leaks into the brain tissue. 

Caused by the rupture of a blood vessel

2 Types of Haemorrhage Strokes

Intracerebral and Subarachnoid

Describe an Intracererbal Haemorrhage?

Bleeding inside the cerebral space

Describe a Subarachnoid Haemorrhage?

Bleeding in the subarachnoid space caused by cerebral aneurysm

What are the 3 most common causes of a haemorrhage stroke?

Raised Blood Pressure (acute or chronic), Cerebral amyloid angiopathy (Brain material is deposite in the cerebral arteries), If there is vessel malformation

How does an Ischaemic stroke get managed medically?

With ischaemic the goal is to dissolve the clot, tried the anti platelet drugs. can take intravenous thrombolysis Need to do it within 24 hours. 

How does Haemorrage stroke get managed?

Monitor ICP, Lower BP, look to reverse the anti coagulant drug affect. 

What is Alteplase?

It is a Thrombylytic agent, Goal is to dissolve blood clots.

Does a Haemorrage stroke show up on CT?

WIll show Haemorrage but not Ischemic stroke

DOes an ischemic stroke show up on a CTA

It does as it shows the dye which shows blood vessel disease

What can an ultrasound of carotid arteries show us?

Carotid stenosis

What does ECG and Holter monitory shows us

Heart arryhtmias

What does angiogram of blood vessels show us?

Possible aneurysms or arteriovenous malformations

Describe a TACS

Total Anterior Circulation Syndrome. This is a large MCA infarction. Essentially blockage becomes ischemic.

What are the 3 factors someone must have to have a TACI

Hemianopia, Severe sensorimotor deficit, Either Neglect (Right hemisphere dysfucntion), or Aphasia (L Hemisphere Dysfunction)

WHat is the most common artery for a stroke?

Middle Cerebral Artery

Describe a PACI?

Partial Anterior Ciricular Infarction. 2/3 of the requirements of a TACI. Higher Dysfunction, Limited sensory or motor deficits, and Hemianopia

Describe a POCI, and what are the factors?

Posterior Circulation Infarction. It is in the back of the brain. Could be a cranial Nerve palsy, Bilateral motor sensory deficits, cerebellar dysfunction, isolated hemianopia. conjugate eye movement problems. 

Describe a Lacunar Infarction?

It is due to small vessel disease.

Can be a pure motor stroke, Pure sensory stroke, sensori-motor stroke, Ataxic hemiparesis

What are the fixes for haemorrage stroke?

Surgical clipping, Coil to fill up the space.

What are primary impairments of a stroke?

Conciousness changes, muscle power changes, tone and reflexes,

Sleep changes, vision changes, proprioception and sensation

Language or swallowing, personality changes, bowel bladded changes

Motor planning and learning

Secondary complications

Paralysis Cerberal due to brain damage, General due to immoblilty. 

What are factors of poor functional outcomes

Previous stroke, smoker, older age, comorbidities present, Severe stroke, prolonged unconsciousness, cognitive defects, motor defects. Depression

What factors showed a slower return to ind walking

Size of stroke, Motor deficits post stroke, older age, Right Hemi stroke, Haemorrage stroke.

What are some components of a neuro exam when it come to impairments?

Visual, PROM, AROM, Strength of upper and lower limbs, muscle length of upper and lower limbs, Stregnth testing, sensory testing, proprioception, tone/spacticity, co-ordination, shoulder pain.

What is most common factor influencing loss of func post stroke

Poor motor impairment/dysfunction

What are the 5 Early aims of Management for stroke

Improve Resp function, Improve muscle function and length, early mob and retraining, prevent complications, ensure aids are used correctly