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

What are some post stroke symptoms/side effects of muscle weakness

Reduced peak muscle torque, reduced strength, reduced power, reduced velocity of force development, rapid fatigue, ineffective force production

What are some UMN Lesion Symptoms

Hypertonicity, hyperreflexes, tendon or stretch reflex, slowness motor control impairments

Whar are LMN leson symptoms

Muscle weakness, lack of tone, lack of reflex.

After a stroke how much strength does the affected upper limb, lower limb, trunk flexor and extendors have compared to the unaffected side

UL- <30%, LL <50%, Trunk flexor 88% Trunk extensors 64%. 

What leads to the inability to voluntarily produce normal levels of muscle force output

Neural changes, Physiological changes in muscles, Abnormal muscle activation patterns, Passive or active restraint of agonist muscles

What are factors for activation failure

UMN lesions, LMN lesions, Decreased excitability of motor neurons, slower firing of motor neurons.

What are the Physiological changes that occur with tendons getting stiffer?

Decreased number of functioning motor units (Weakness),

Decreased recruitment of motor units with repetitive stimulation (Motor fatigue)

Decrease in tendon stiffness leads to more compliance leads to reduced stored energy and contractile speed (inefficient energy storage of tendons)

What happens to the muscle fibre after a stroke (fast)

Changes in muscle length from fast twitch to slow twitch.

Fast twitch atrophy occurs 

Then increase in slow contracting fibres

Then slow fibres become fatigued

Factors that influence activity (walking) post stroke

Strength, flexibility, ROM, Power,

Why can we not check muscle strength/grading if there is patterned movement

Must be isolated individual movements to get a grade

Describe Strength Training post stroke

Goal is to generate force, used for VERY weak muscles, also may need assistance

Power Training

Leads to an increase in force production, load with high velocity

Endurance Training

Exercises that increase the acpacity for continued reps.

What are some positive effects of eccentric training

Muscle Lengthening,

Less metabolic demand for work,

Helps influence muscle size and firing,

can help with agonist antagonist balance

How do we promote muscle activity

Eccentric muscle contractions

Optomize positioning

Structured environment

enhanceed sensory feedback

ESTIM

assistive technology

What is motor fatigue?

When someone gets physically tired from motor movements

What are the 3 things we look for with motor fatigue

Monitor motor fatigue

Taking lots of breaks in session

Being careful to not overexert and lead to falls

What are the 7 Parts to Elicit Movement Reovery

Task Specific

Positioning

Structured Environment

Use of equipment

Proper instruction and cues

Handling Techniques

Use of external focus of attention

Motor Imagery

Observation and Demonstration

Describe Positioning

We look into if we do side lying vs supine vs prone so looking at gravity. Also are we doing eccecntric or concentric movements, Put it in the mid range

Describe a Structured enviroment

We want to make sure we have aids set up no hazards, Provide safety

Describe use of equipment

Make sure we confirm WB vs no WB, use proper aids if needed, use equipment such as slide sheets

Describe Appropriate Handling techniques

Provide support to unstable joints, provide quality movements, help compensate for missing movements

Describe external attentional focus 

Focusiung on an external target or task eg walk to the end of the wall

Describe provision of sensory input and sensory feedback usage

We can use demonstration, visual cues, tactile input, properioception, auditory or thermal cues

Describe use of mental practice/imagery

Helps enhance movement

Describe Factors towards gait speed

Power, strength, proprioception, sensation, ROM, Coordination