Module 4 Kinesiology

Parts of a neuron

• Dendrite

• Cell body (soma)

• Axon hillock

• Axon

• Axon terminal

Central Nervous System

• Brain

• Spinal cord

The cell body (soma) is within these structures

• ascending (going up - from muscles to brain)

• descending (going down - from brain to muscles)

Upper motor neurons carry the message where?

to lower motor neurons

Lower motor neurons originate where

spinal cord

Lower motor neurons originate innervates what?

the skeletal muscles

Lower motor neurons are also known as

the peripheral nervous system

• includes sensory and motor nerves

E___ = motor

Efferent

A___ = sensory

Afferent

Neurological “danger zones”

Nerves

• loss of myelin (the outside insulation of the nerve)

• compression (injury)

Neuromuscular Junction

• synaptic transmission (nerve tells muscles to contract

Babinski’s reflex

Flexing toes when sole is touched

CVA also means?

Stroke

Hemiplegia

half of the body is effected

• right stroke → left hemiplegia

• left stroke → right hemiplegia

Stroke recovery is done by?

redundancy and retraining

Spinal Cord Injury (SCI)

• all neuromuscular activity occurs below the level of the injury - no communication to the brain (acknowledgement or volitional)

• results in quadriplegia or paraplegia

• major cause = trauma

  • gunshot

  • sports

SCI Levels

• level of injury associated with function

• partial vs. complete

• depends on the initial care…Luck?

• recovery - maximize what you can - can’t regenerate

Multiple Sclerosis (MS)

• characterized by exacerbation and remission

• cold weather

• inflammatory - demyelinating of the CNS

• cause - viral?

• In adults

MS Treatment Goals

• focus on speeding the recover from attack

• maintain function - exercise

• immunotherapies, steroid (powerful anti-inflammatory), palliative care

• cognitive decline can occur when the disease advances

Clinical Signs

• weakness, poor cough, retained airway secretion

• inability to lift extremities

• muscle wasting

• low tone (hypotonia)

• poor feeding/swallowing

• failure to thrive

• increased respiratory rate

• use of accessory muscles in respiration

• infections (recurrent)

• night sweats

Diagnostic Workups

• Clinical Eval — muscle testing, reflexes, tone

• CK — creatine kinase

• EMG — electromyogram

• NCS — nerve conduction study

• ECG — cardiac muscle involvement

• Muscle/nerve biopsy

• Genetic Testing

Infants

• Paradoxical breathing

• Tachypnea (fast breathing)

• Head bobbing

• Poor feeding

• Floppiness - low tone

Older Children

• Sleep disordered breathing

• Behavioral and neurocognitive problems

• Hyperactivity

• Tiredness

• Headaches

• Anorexia

Muscular Distrophies

• Duchenne MD

• Beckers MD

• Myotonic

• Most are boys (carried on the X chromosome)

• Genetic testing

Anterior Horn Disorders

• Poliomyelitis

• Motor neuron disease — amyotrophic lateral sclerosis

• Spinal Muscle Atrophy (SMA) (genetic)

Treatment

• Genetic intervention (?)\

  • CRISPR

• Pharmacology

• Physical Therapy - Occupational Therapy

• Respiratory Therapy

PT/OT Strategies

• POSTURE

• Evaluate function

• Improve proximal (core) stability

• The more functional/mobile, the better

Respiratory Function

• Posture

• Low tidal volume - weakness

• Scoliosis (lateral curvature of the spine)

• Impaired cough

• Airway closure

Types of breathing machines

• Negative Pressure Ventilation

• Invasive respiratory support

  • Tube inserted directly to trachea

• CPAP

Muscular Dystrophy (MD)

• Duchenne is the most notable

  • X related chromosomal disorder (manifests in boys)

• Absence of dystrophin (protein responsible for muscle contraction)

• Appears between the age 3-5

• Progressive disability

  • poor recovery from muscle contraction

  • progressive replacement of muscle tissue with fat

  • Duchenne’s life expectancy < 20

Myesthenia Gravis

• Blockage of acetylcholine receptor

  • neuromuscular junction (synapse) begins, but does not allow propagation of the action potential in the muscle

• Symptoms increase over the day (fatigue)

• Multiple sites of involvement resulting in different symptom pattern

  • can be facial or throughout the extremities

Upper motor neuron lesions vs lower motor neuron lesions

Upper motor:

• hyper-reflexia

• spasticity

• babinski sign

Lower motor:

• hypo-relfexia

• flaccid

• fasciculations (twitching)

• atrophy

Amyotrophic  Lateral Sclerosis

• “Low Gherig’s Disease”

• Motor Neuron Disease

  • UMN — spasticity, hyper-reflexia from degeneration of the motor tracts in spinal cord

  • LMN — denervation — weakness, atrophy

ALS

• Loss of motor neurons in the cortex, brainstem, and spinal cord

• Progressive — affects all musculature except eye movement

• Etiology (cause) unknown but many hypotheses

Guillain-Barré Syndrome

• Idiopathic (causes unknown — arises spontaneously)

• May be triggered by bacterial or viral infection

• Ascending paralysis

• Symptoms start as tingling and weakness in feet

• Respiratory failure can occur

Treatment for NM diseases

• Most therapies involve treatment of impairments

  • Adaptive therapy

  • Exercise to promote bone and cardiovascular health (kidneys and all organs depend on this)

  • Motion and position reduce deadly compromise in lung function

• Pharmacological interventions treat the site of breakdown

Causes of Developmental Disability

• Genetic conditions

• Problems before, during, or immediately after birth

• Poverty and cultural deprivation

• Accident or injury

• Drug/alcohol use

Examples of Disabilities

• Intellectual Disability (ID)

• Autism

• Cerebral Palsy (CP)

• Stroke (CVA - cerebral vascular accident)

• Traumatic Brain Injury (TBI)

• Genetic Syndromes

Understanding Functional Limitations

• Communication

• Self-care

• Home living

• Social skills

• Leisure

• Community use

• Health & safety

• Self-direction

• Functional academics

• Work

Goals for disabled children

• Maximize function — cognitive, motor, sensory, “activities of daily living” ADLs

• Promote an environment for safety, learning, and community

• Integrate into society — appreciate their (and their family’s HRQOL)

Disability Definition

A condition which may be characterized by severe disorders in communication and behavior, resulting in limited ability to communicate, understand, learn, and participate in social relationships

Intellectual Disability (ID)

• Typically below normal IQ (2 standard deviations below normal)

• Varied ability to process information

• Varied presentation of emotional quotient

ID and motor function are not parallel or exclusive

• Inability to speak (APHASIA) may be a 

  • brain issue

  • language issue

  • hearing issue

  • mouth/tongue issue

• Inability to move limits sensory exploration BUT cognitive development can be very high in some individuals

• Cognitive function does not always equal motor function (ex. Stephen Hawking)

Syndrome definition

• A collection of signs (others can see it too)/symptoms (something you can feel) that are representative of a single condition

  • Sometimes they make sense, other times they are presented as a grouping

• Carefully categorize (when describing someone)

Types of syndromes

• Down syndrome (Trisomy 21)

• Fetal alcohol syndrome

• Marfan’s syndrome (connective tissues)

• Kleinfelter’s syndrome (XXY)

• Not all syndromes lead to developmental disabilities

Autism

• Inability to relate to other people

• Delayed communication skills

• Language comprehension is impaired

• Highly sensitive to sensory input, noise, levels, and touch

• May react indifferently or with emotional outbursts

• Difficulty in dealing with changes

• Obsessive or compulsive behavior

Brain Damage

• Defect of the brain occurring from injury before, during, or anytime after birth

• It may affect any brain function, but is especially related to movement, thinking, and learning

• May result from bleeding or HYPOXIA (oxygen deficiency)

Vascular Injury - Brain

• Stroke - Cerebral vascular accident (CVA)

  • Blood flow to a portion of the brain is stopped = ISCHEMIC

  • A blood vessel ruptures causing bleeding and pressure on brain structures = HEMORRHAGIC

CVA

• Most remarkable deficits are motor (single sided = hemiplegia)

• Aphagia common with L sided stroke (R sided hemiplegia)

Cerebral Palsy

• A permanently disabling condition resulting from damage to the developing brain which may occur before, during, or after birth, and results in loos or impairment of control over voluntary muscles

• Hemiplegia vs quadriplegia

Traumatic Brain Injury (TBI)

• Diffuse or focal

• Bleeding results in pressure within the cranium

• In children, TBI often halts development (permanently or temporarily)

Common syndromes associated with ID

• Fetal alcohol syndrome

  • caused by drinking during pregnancy

  • severe learning disabilities and behavioral disorders

  • small eyes, thin upper lip, large ears, shortened fingers

• Fragile X syndrome

  • Inherited disorder; males more affected than females

  • Short attention span, repetitive speech, lack of eye contact

  • Large ears, loose joints, long face, prominent forehead and chin

• Down syndrome

  • chromosome disorder

  • risk of developing severe behaviors disorders is low

  • slanting or eyelids, depressed nasal bridge, small mouth, hands and feet

How to communicate with those with developmental disabilities

• Speak directly, slowly, clearly

• Keep sentences short

• Use simple language

• Ask for concrete descriptions

• Break complicated instructions down into smaller parts

• Use pictures, symbols, and actions to convey meaning

• Take time giving/asking for information

• Repeat questions more than once

• Avoid confusing questions about reasons for behavior

• Don’t speak louder in an effort to increase the person’s understanding

• Use firm and calm persistence if the person is non-compliant

• Avoid “yes” or “no” answers

Keep an open mind

• Don’t assume he or she can’t understand or communicate

• Be genuine in your desire to understand him or her

• Demonstrate the same respect given to others without a disability

Health Related Qualities of Life (HRQOL)

• Personal

• Based on goals and expectations

• Are they realistic

• How do injuries, pathologies, or conditions alter the HRQOL?

HRQOL defined?

Health-related quality of life has been defined in line the World Health Organization’s definition of health as a state of complete physical, mental, and social well-being, not merely the absence of disease

What are disablement models and some examples?

Comprehensive assessment of the impact of a disease of injury based on disablement models

• Nagi’s model

• IDIDH (international classification of impairment, disability, and handicap) model

• NCMRR (national center for medical rehabilitation research) model

Nagi Model

• Developed by sociologist (Nagi)

• First developed in 1965, then modified in 1991

• First model developed

• Basis for Guide to Physical Therapist Practice

Pathology

• Diseases

• Injury

• Congenital or developmental condition

Impairments

• Dysfunction and structural abnormalities in specific body systems

  • Musculoskeletal

  • Cardiovascular

  • Neurological

Functional limitations

• Restrictions in basic physical and mental actions

  • Ambulate

  • Reach

  • Stoop

  • Climb stairs

  • Speak

  • See print

Disability

• Difficulty doing activities of daily life

  • Job/sport

  • Household management

  • Personal care

  • Hobbies

  • Recreational activities

  • Socializing

  • Sleep, childcare, run errands, etc.

Disablement models are not…?

Linear

Why should I care about these disablement models?

• More holistic perspective to provide an assessment structure that moves the focus on the impact of the disease on a patient

• Helps prioritize a treatment plant that is not focused solely on the improvement of identified impairments; thus not treating problems but rather treating people

• It helps us to consider that functional loss and disability (Nagi Model) as one of the primary outcome measures of treatment

Functional Outcomes

• Non-linear relationship of the factors

• Pathology does not always lead to impairment, then to function loss, etc.

• Many factors contribute to the “health” of the patient

Basic chronological steps of HRQOL

pathology → impairment → functional limitation → disability handicap

• Green = affects the quality of life and is on the personal/social level

• Black = organ/body system level

Affecting factors of impairment

• Predisposing characteristics

• lifestyle (sport) behavioral

• psychological

• environmental

• biological

External treatments of functional limitation

• medical care/rehab

• medications

• external support

• physical/social environment

Internal treatment of functional limitation

• lifestyle/behavioral change

• psychosocial (coping)

• activity accommodations

Disablement models affect treatment options and direct care

• Provides a more evidence-based approach to treatment

• More comprehensive — treats the whole person

• Is not always applicable in athletics, but puts injury diagnosis, treatment, and return to play in context to other data sources

What is sport psychology

The scientific study of people and their behaviors in sport and exercise contexts and the practical application of that knowledge

2 objectives to study sport and exercise psychology

• understand how psychological factors affect an individual’s physical performance

• understand how participation in sport and exercise affects a person’s psychological development, health, and well-being

Psychophysiological orientation

study behavior through its underlying psychophysiological processes in the brain

Social-psychological orientation

study how behavior is determined by a complex interaction between the environment and one’s personal makeup

Cognitive-behavioral orientation

study how behavior is determined b both the environment and cognition

Motivation

The direction and intensity of effort

Direction of effort

whether an individual seeks out, approaches, or is attracted to certain situations

Intensity of effort

how much effort a person puts forth in a particular situation

Attribution theory

High achievers: ascribe success to intrinsic factors they can control

Low achievers: ascribe success to factors outside their control and ascribe failures to internal factors

Goal adoption theory

High achievers: have goals for doing certain tasks (running a good race)

Low achievers: have goals for getting.a certain outcome (winning a race)

Perceived Competence Theory

High achievers: have a high belief in their abilities and feel achievements are in their control

Low achievers: have a low perceived competence and feel achievements are out of their control

Task Choice Theory

High achievers: seek out challenges

Low achievers: avoid challenges and seek out very difficult or very easy tasks

Five guidelines for building motivation

• both situations and traits motivate people

• people have multiple motives for involvement

• change the environment to enhance motivation

• leaders influence motivation

• use behavior modification to change undesirable participant motives

Arousal

general physiological and psychological activation, varying on continuum from deep sleep to intense excitement

Anxiety

negative emotional state in which feelings of nervousness, worry, and apprehension are associated with activation or arousal of the body

State anxiety

temporary, ever changing emotional state of subjective, consciously perceived feelings of apprehension and tension

Trait anxiety

behavioral disposition to perceive non-dangerous events as threatening

What relationship does arousal and performance have?

An inverted U

Increased arousal and state anxiety cause:

• increased muscle tension

• interfere with coordination

Arousal and state anxiety:

• narrow attention field

• decrease environmental scanning

Recognizing signs of arousal that affect performance

• cold, clammy hands

• urinate frequently

• profuse sweating

• negative self-talk

• dazed look in eyes

• increased muscle tension

• butterflies in stomach

• feeling ill

• headache

• cotton mouth

• difficulty sleeping

• inability to concentrate

• consistently better performance in noncompetitive situations

Coping mechanisms for arousal

• breath control

• relaxation response

• thought control (positive self-talk)

• task focus

Reinforcement

The use of rewards and punishments that increase or decrease the likelihood of a similar response occurring in the future

In early stages of learning, what type of reinforcement is desirable

continuous and immediate

In later stages of learning (autonomous), what type of reinforcement is better

Intermittent

How much of reinforcement should be postive

80-90%

Reinforcement can reward..?

• performance

• effort

• emotional and social skills

• successful approximations

Rewards

athletic scholarships can either decrease and increase intrinsic motivation

• depends on if it’s controlling or informational

Overtraining

Refers to short cycle of training with excessive training loads that are near or at maximal capacity

• this is normal (with rest/taper)

• If not proper → leads to deteriorated performance

  • staleness

  • burnout

Staleness

• physiological state of overtraining which manifests as deteriorated athletic readiness

• a stale athlete has difficulty maintaining standard training regimens and can no longer achieve previous performance results

Burnout

an exhaustive psychophysiological response from frequent or extreme excessive training and competitive demands