Recovery After ABI

Pathology of ICF Post Stroke

Ischemic stroke (80%)

Hemorraghic Stroke (15%): Intracerebral accounts for 10% and subarachnoid accounts for 5%.

Unspecified: 5%

Body Function and Structure of ICF Post Stroke

Affected:

Consciousness, orientation and intellectual, temperament/personality, energy and drive, memory, sensory (touch, proprioception, vision), motor, autonomic, muscle endurance, muscle power tone and reflexes, sexual

What are the most affected structures affected in Body Function and Structure of ICF Post stroke?

Brain, CV, leg and arm, shoulder region

Activities (Limitations) of ICF post stroke

Communicating, reading, writing, solving problems, moving, toileting, dressing, walking, moving around community, meal prep, housekeeping, use of transportation

Participation Restrictions of ICF Post stroke

Doing housework, recreation/leisure activities, employment, relationships, shopping, Return to work

Contextual Factors of ICF Post stroke

technology, health professionals, health services, coping strategies, support, cost of services

ICF Health Condition (Neuronal)

Restoring function in neural tissue that was initially lost after injury. May be seen as reactivation in brain areas previously inactivated due to stroke.

Example: This can occur when surrounding tissue starts firing again as swelling resolves

Compensation during Neuronal Recovery

New brain areas take on functions they didn't previously control. Known as cortical reorganization

Where can restoring function occur after being temporarily inactive?

Penumbra and Diaschisis zones. Not the core

ICF Body Functions (Performance)

Restoring the ability to perform a movement in the same manner as it was performed before injury.

Example: Restoring elbow extension with normal timing and range

ICF Body Functions Compensation

Performing an old movement in a new manner, may be seen as an appearance of alternative movement patterns (different degrees of freedom, increased agonist/antagonist co-contraction

Example: Trunk or shoulder motion to achieve elbow ROM

ICF Activity (Functional)

Successful task accomplishment using limbs or end effectors typically used by non disabled individuals

Example: Tasks like getting out of bed recover

ICF Activity Compensation

Successful task accomplishment using alternate limbs or end effectors. Overhead trapeze could be useful here

Example: Opening a package of chips with 1 hand and mouth instead of 2

Motor Recovery

Improvement in strength, speed, or the accuracy of arm/leg movements (getting better)

What improves with motor recovery?

MMT scores, coordination is improved

Functional Recovery

Improvement in performance like selfcare or walking (doing better)

What improves with functional recovery?

Compensations manly occur due to motor recovery not improving. AFOs, would help someone with gait

If DF approves to grade 0 to 1, would thatbhelp functional recovery?

No, motor recovery may be improving but doesn't mean functionally they are

Early recovery of stroke and TBI involves?

Synaptic effectiveness, reperfusion and Diaschsis reversal

Late recovery of stroke and TBI involves?

Cortical reorganization

Where does most recovery occur in Stroke and TBI?

First 6 months

Within hours of stroke, what helps spontaneous neurological recovery?

Medical stabilization

During hours to days of stroke, what is crucial?

Early mobilization to prevent complications

During days to weeks, what is important after stroke?

Restoring impairments In order to regain activities

During days to months, what is important after stroke?

Task-oriented practice with adaptive learning and compensation strategies with specific rehab interventions ti improve ADLs and social interaction

Weeks to months, what is crucial after stroke?

Environmental adaptations and services at home

Months to years, what is crucial after stroke?

Continue formal rehab, and monitoring QOL

Synaptic Effectiveness happens during what phase of stroke?

Acute Phase

Edema results in ___ Synapses?

Silent Synapses, they are blocked and A to B communication is silent (neurons)

Synaptic Effectiveness

Restoration of neural transmission at synapses that were temporarily blocked due to local factors like edema, inflammation, or metabolic disruption.

Can continue for up to 8 weeks post-injury.

Once edema resolves, it underlies?

Recovery

Reperfusion

Return of adequate blood supply may lead to resumption of neural activity

What brain area is the goal to reperfuse?

Penumbra, goal is to isolate as much damage to the core as possible

What is Diaschisis Reversal?

Temporary remote brain dysfunction due to focal injury.

Reversal = recovery of remote function as inflammation, edema, and connectivity normalize.

Diaschisis at Rest

Lesion causes reduced metabolism in distant but connected regions.

Example: Frontal stroke → metabolic suppression in the thalamus

Functional Diaschisis

Normal brain activations during a selected task may be altered (increased leading to compensatory or decreased due to impairments) after a lesion

Connectional Diaschisis

Distant strengths and directions of connections in a selected network may be increased or decreased

Brain talks differently across regions now

Connectomal Diaschisis

Lesion of the connectome induces widespread changes in brain network organization including increased or decrease in connectivity

Global network changes or reorganization of the brain's connectome

Diaschisis reversal may be related to?

Resolution of edema

Cortical Reorganization

use dependent changes in cortical maps/representations based on how often and how intensely they’re used.

Key Mechanisms of Cortical Reorganization

1. Increase in the absolute number and concentration of synapses on dendrites (Synaptogenesis)

2. Unmasking of latent neural networks (Silent synapses become active

3. Rewiring of Spared Motor Cortices (Adjacent or contralateral motor areas take over lost functions)

Principles of Neural Plasticity

use it or lose it, use it and improve it, specificity, repetition, intensity, time, salience, age, transference, interference

Pre-Stroke Cortical Reorganization

All neurons have a balanced number of synapses from both sides (ipsilateral and contralateral cortex) this is where ipsilateral dominates but contralateral side contributes

Post Stroke Cortical Reorganization

Ipsilateral cortical neurons are atrophied, but contralateral cortex is intact but not responding

Reorganized Cortical Reorganization

Ipsilateral side neurons begin to show increased synapses, while the contralateral cortex shows increased projections to help compensate