Psych 403 quiz 6

Common rodent rehab tasks

running, skills training, cognitive rehab, general enrichment

cognitive rehab for rodents usually consists of

mazes

BLANK rehab is often combined with other therapies

cognitive

common treatment parameters in rodent rehab studies

intervention delay, duration and intensity

most animal rehab studies examine

the mechanism of action

EE is

environmental enrichment

a modified montoya box is

an example of skilled teaching training

key treatment parameters in any study are

timing and intensity

what is the assumption of looking at timing and intensity of rehab in studies

we need to target the sensitive period to maximally take advantage of brain plasticity

when should rehab begin

within two days as long as the patient is stable, able, and willing

most clinicians believe that rehab is given BLANK, and begins BLANK

at one time, sooner and at higher intensity than is achievable

in an experimental study using young male rats training on reaching tasks after an MCAO, rats that got rehab sooner did

better

BLANK is a common complication to stroke recovery

pneumonia

in a mild stroke people will move from hospital to BLANK in a timeframe of BLANK

home, days

with a moderate stroke patients will move from hospital to BLANK in a timeframe of BLANK, and BLANK to home in a timeline of BLANK

rehab hospital, weeks, rehab weeks to months

with a severe stroke patients will move from hospital to BLANK in a timeline of BLANK, and then the assisted living

a transition unit, days to months

predictors of recovery

family support, injury size and location

why might cerebellar infarcts be hard to rehab

cerebellum is central to posture and balance, and full of white matter

possible assesments of funciton

bed mobility, transfers, stairs, walking, sitting and standing, balance

hypertonia

more muscle tone, harder to move

hypotonia

less muscle tone, floppy limbs

assessments of impairments after stroke are done in the following areas

strength, sensation, reflexes, tone, coordination, range of motion

what impairments contribute to the following walking deficits: strength, balance, bracing and stretching

weakness, balance deficits, spasticity

what factors make a patient a good candidate for rehab

they are making progress in acute care, they have enough cognition, language, and motivation to participate, requires one person assistance, can tolerate 2 hours sitting and 1 hour activity, has a discharge plan

external factors that effect rehab potential and outcome

age, stroke severity, aphasia and perception, motivation, family support, advocacy

major challenges of rehab

communication issues, limited resources, emotionally and physically taxing, struggle for practitioners to keep up with evidence

generally, starting rehab BLANK is a better approach

earlier

why not do an RTC when studying effects of delayed rehab

ethics

adverse effects can be seen when starting rehab within BLANK after stroke

1 month

youtube prompt: intention to treat analysis

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AVERT trials mean

a very early rehabilitation trial

advantages of early mobilization

avoids harmful effect of bed rest, avoids immobility complications, takes advantage of neuroplasticity

risks of early mobilization

effects on BP and CBF, higher risk of fall, risk of bleeding

in general early mobilization is BLANK to recovery

detrimental

early rehab doesn’t really help anybody, but is especially harmful to BLANK and BLANK

hemorrhages, severe strokes

why do we do secondary analysis

the more you look for something the more likely you are to find something

youtube prompt: secondary analysis

* \

how did the avert authors explain their findings

initial data suggested harm to those with severe stroke and ICH, rehab interactions with stroke type and severity expected, re analysis suggests more frequent and briefer mobilization was helpful but longer was not

exceeding a certain level of reaching is a BLANK

critical threshold

what is the implication of the finding that allowing rats unlimited reaching in rehab inproved outcomes

maybe a lot of rehab just isn’t often enough to make a difference

you need a certain amount of therapy to drive plasticity, without the right intensity

you don’t get enough to rewire the brain

in this type of stroke, researchers are unable o find benefit to rehab

striatal ICH

why does rehab protocal fail in striatal ICH

when you damage the striatum it damages the corticospinal tract going through it

when talking about rehab intensity, generally

more is better

problems with studying rehab intensity in animals

patients get less intense rehab than animals ( a few dozen vs 100s), human rehab focuses on ADLs where rodents may just use forced running

translational research issues in rehab studies

quality issues, insufficient consideration to species effect, clinically unrealistic treatment protocols, focus on endpoints not quality of movement, inability and diminished ability to account for stroke effects in animal models, forgetting medical stability effects, mismatch in terminology, animal studies are not strong evidence

impact of exercise varies by

personal factors, exercise type, duration

exercise, especially aerobic exercise, improves BLANK, BLANK, and BLANK

mood, cognition, memory

exercise decreases many risk factors, for example BLANK

vascular damage

exercise causes reductions in BLANK, better BLANK, less BLANK, enhanced BLANK, greater BLANK, and fewer BLANK

stress, sleep, anxiety and depression, muscle mass, flexibility, disorders

exercise results in better glucose BLANK, enhanced BLANK protection, greater BLANK defenses, better BLANK function, and alterations in BLANK pathways

control, growth factor, anxti-oxidant, mitochondrial, cell death

in general with exercise we see less BLANK, enhanced BLANK, and greater BLANK

inflammation, synaptic plasticity, stem cell response

true/false exercise promotes angiogenesis, maintains blood flow,and prevents the accumulation of protein aggregates and damaged mitochondria

true

whole brain benefits to exercise

greater cognitive reserve from enhanced synaptic plasticity, improved electrophysiological function, increases in brain volume

mechanisms of post stroke rehab vary by

patient factors, type of insult, treatment type, therapy parameters

mechanisms of normal learning and spontaneous recovery are BLANK by rehab

enhanced

dendritic and spine growth, formation of new terminals, and changed in neurotramsmitters and receptors act to

modify synaptic transmission and alter physiological function

what are some actions resulting from modifying synaptic transmission and altering physiological function

map reorganization, unmasking dormant pathways, removal of diaschisis

possible mechanisms of improvement in blood flow

opening of collateral vessels, angiogenesis

improvements in blood flow can sustain penumbral tissue and heighten activity in rewired circuits, also known as

neuroprotection

transcriptional changes leading to elevations in BDNF promote

dendritic growth and synapse formation

true/false rehab therapies are sometimes neuroprotective

true

rehab drives a lot of the same effects as

spontaneous recovery

rehab can be neuroprotective or

damaging

rehab increases dendritic BLANK after focal ischemia and ICH in rats

arborization

rehab will drive dendritic growth through BLANK

remaining structures, including distal structures

early rehab is associated with greater BLANK in the undamaged motor cortex

dendritic branching

greater dendritic branching in the undamaged motor cortex is an example of these mechanisms

unmasking and reorganization

study groups:

animals with no BNDF and rehab BLANK

animals with blocked BDNF BLANK

animals with blocked rehab BLANK

got better, did not get better, did not get better

what does it mean that if you block BDNF recovery goes down

blocking bdnf prevents rehab effects

question: is there evidence that aerobic exercise can influence recovery

yes

was forced or voluntary aerobic exercise harmful in animal rehab studies

no

will forced or voluntary aerobic exercise reduce lesion volume

forced

is early or later treatment better in animal rehab

earlier

when should rehab start in animal models for best results

a few days

exercise in animal models lessens BLANK, BLANK, and BLANK while increasing BLANK and BLANK

cell death, inflammation, oxidative injury, neurogenesis, angiogenesis

components of constraint induced movement theraopy

forced use, massed practice (5-6 hours per day), transfer package (practice on ADLS)

prompt: watch a video on constraint induced movement therapy

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research on constraint induced movement therapy findings

mixed but positive findings

broad mechanisms of constraint induced movement therapy

neural changes like axonal sprouting, cortical re-organization and thickening, counteracting learning non-use

during learned non use…

use of the good hand is reinforced, impaired hand is punished

learned non use develops during

initial period with the greatest neurological impairment

forced use therapy timeline

2 weeks, 80% of waking hours, massed practice 506 hours a day, transfer package for ADLs

why does constraint induced movement therapy work

counteracts learned non use

true/false many studies demonstrate the benefit of CIMT models of sensory deafferentation, cerebral ischemia, hemorrage, and TBI

true

one problem with CIMT

very early CIMT in animals not demonstrated in patients

one study found that casting the good limb in animals

greatly increased brain damage

mechanisms of use dependent injury

use dependent effects are model and timing dependent with effects mediated by stress and/or excitotoxicity

in CIMT early forced use was BLANK and delayed was BLANK

harmful, not

how does use dependent injury drive exitotoxicity

using impaired circuits releases glutamate

alternative hypothesis to use dependent injury model

using a limb drives up brain temperature and hyperthermia is harmful in early stages of stroke, stress induced fever causes damage

a rat study found that restraining an impaired limb, bit not a ipsilateral limb, while forcing brain temp higher had this effect

worsened brain injury

why might fever be a mechanism of injury after rehab

infection because if gut is degrading more likely to get bacteria into your bloodstream, or temperature regulating areas like hypothalamus are damaged

when is fever damaging after stroke

the first few days

the combination of CIMT and BLANK drives progress in rehab

exercise

possible reasons that clinical data on CIMT do not match with animal studies

timing issue, poor quality studies

illustrate a group breakdown for a study in which you test timing, intensity or rehabilitation in a rat model of ICH. Provide specific hypothesis regarding the individual impact of timing and intensity on recovery

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what is constraint induced movement therapy often used for (type and location) state the underlying mechanisms that CIMT is counteracting. State 3 components of CIMT. Does clinical data support the use of CIMT after stroke

why does the type of stroke matter in rehab

risk factors and risk for death are different, response to treatment is different

should we assume that plasticity responses are the same in ishcemia and hemorrhage

likely not because of differences in pathophisiology and outcome