Neurological Rehabilitation Flashcards

Week 1: Intro to Nervous System

• Cells of the Nervous System
  • Neurons: Transmit electrical impulses.
  • Glial Cells: Support neurons (e.g., astrocytes, oligodendrocytes, Schwann cells, microglia).
• Basic Structure of Neurons
  • Dendrites: Receive input.
  • Cell body (soma): Integrates signals.
  • Axon: Transmits signal.
  • Myelin sheath: Insulation, speeds conduction.
  • Axon terminals: Synapse with next cell.
• Neuronal Communication
  • Electrical signal (action potential) travels down axon.
  • Chemical signal (neurotransmitter) released at synapse.
• Subdivisions of the Nervous System
  • CNS: Brain + spinal cord.
  • PNS: Cranial and spinal nerves.
• Terminology
  • Nuclei: Cluster of neurons in CNS.
  • Ganglia: Cluster in PNS.
  • Tracts: Bundles of axons in CNS.
  • Nerves: Bundles in PNS.

Week 2: Motor Systems

• Types of Neurons
  • Sensory neurons: Afferent
  • Motor neurons: Efferent
  • Interneurons: Connect neurons within CNS
• Motor Control Circuits
  • Voluntary: Conscious (e.g., writing).
  • Postural: Automatic maintenance of posture.
  • Reflexes: Automatic responses to stimuli.
• Motor System Subdivisions
  • Corticospinal/Corticobulbar tracts: Voluntary movement.
  • Reticulospinal tract: Posture, locomotion.
  • Vestibulospinal tract: Balance and head position.
• Motor Neurons
  • UMN (Upper): Brain to spinal cord.
  • LMN (Lower): Spinal cord to muscles.
• Muscle Tone Abnormalities
  • Hypertonicity: Spasticity, rigid muscles.
  • Hypotonicity: Floppy, low tone.
• Primitive Reflexes: Automatic at birth, disappear with development (e.g., grasp, Moro).

Week 3: Functional Mobility in Neuro Conditions

• Barriers and Enablers: Stairs, uneven surfaces, ramps, automatic doors.
• Common Mobility Issues: Weakness, spasticity, poor balance.
• OT Interventions: Assistive devices, retraining, home mods.
• Resources: TransportNSW, AT Aust, NDIS.
• Hands-on Practice: Wheelchair handling, mobility aids, real-world navigation.

Week 4: Vestibular System

• Vestibular System Components
  • Inner ear (semicircular canals, otolith organs).
  • Detects head position and movement.
• Disorders: Vertigo, balance issues, dizziness.

Week 5: Accessibility Case Study (Sargood Excursion)

• Transport to Collaroy:
  • Train to Wynyard, then B-Line bus (accessible).
• Playground:
  • Barriers: Sand, uneven surfaces, no ramp.
  • Enablers: Wheelchair-friendly paths, shade.
• Movie at Collaroy:
  • Barriers: Steps, tight spaces.
  • Enablers: Accessible seating, entry.

Week 6: Sensory Systems & Interventions

• Types of Sensation:
  • Protective: Pain, temperature.
  • Discriminative: Touch, proprioception, vibration.
• Sensory Neuron Pathways:
  • 1^0 (primary), 2^0 (spinal cord/brainstem), 3^0 (thalamus to cortex).
• Subdivisions:
  • Dorsal Column: Fine touch, proprioception.
  • Anterolateral/Spinothalamic: Pain, temp.
  • Trigeminal: Face sensation.
• Assessment Tools: Semmes-Weinstein, 2-point discrimination, localisation.
• Interventions:
  • Desensitisation: For hypersensitivity.
  • Sensory re-education: Retraining perception.
  • Compensation: Visual or auditory substitution.

Week 7: Vision & Cognition

• Visual Disorders: hemianopia, diplopia, neglect.
• Cognitive/Perceptual Disorders: apraxia, agnosia, neglect.
• Assessments: MoCA, MMSE, PRPP, BIT.
• Approaches: Restorative, compensatory, metacognitive.
• Interventions: Errorless learning, cueing, strategy training.

Week 8: Technology & Intervention Exposure

• Examples of Equipment:
  • TENS, Saebo, robotic arms, functional e-stim.
• Application:
  • Pain, motor retraining, strengthening, function.

Week 11: Stroke (Cerebrovascular Disorders)

• Disorders: Ischaemic, haemorrhagic strokes.
• Deficits: hemiplegia, dysphagia, dysarthria, neglect.
• Screening: swallow test, speech clarity, motor tests.
• Rehab Approaches: task-specific training, CIMT, mirror therapy.
• Team: OT, PT, SP, SW, neuropsych, dietitian.

Week 13: Degenerative & Traumatic Conditions

• Conditions: MS, Parkinson's, TBI, SCI.
• Deficits: tremors, rigidity, spasticity, memory loss.
• Rehab Approaches: education, adaptive devices, routine building.
• Interventions: cognitive training, environmental mods, caregiver training.
• Team Roles: OT, PT, GP, neuro, social worker, rehab engineer.

IPL Case Study: Josh

• C7 Complete SCI, high function but dependent on upper body.
• OT Role: pressure care, transfer training, home mods, energy conservation, assistive devices for parenting.
• PT Role: strength, mobility, fall prevention, pressure relief techniques, posture management.

Overarching Learning Objectives

• CNS & PNS structure/function: understand pathways, systems.
• Explain presentations: relate injury to function.
• Movement/sensation/cognition: trace anatomy to function.
• OT Management: assessments, interventions, evidence-based practice.
• Team roles: collaboration with PT, SP, nurses, etc.

Detailed Notes (Weeks 1-7, 11, 13)

• Week 1
  • Cells of the Nervous System
    • Neurons = the main cells that send messages in your brain and body.
    • Glial cells = the helper cells. They:
      • Feed and protect neurons.
      • Make myelin (which helps messages move faster).
      • Clean up waste and fight infections.
  • Parts of a Neuron
    • Dendrites = receive messages.
    • Cell body (soma) = the control center, has the nucleus.
    • Axon = sends messages away from the cell.
    • Myelin sheath = a layer that covers the axon so messages travel quickly.
    • Axon terminals = the ends where messages leave to talk to the next cell.
  • How Neurons Communicate
    • Neurons talk using chemicals called neurotransmitters.
    • The gap between two neurons is called a synapse.
    • Messages are sent through electrical signals (called action potentials) down the axon, then turn into chemicals to jump to the next neuron.
  • Parts of the Nervous System
    • Central Nervous System (CNS) = brain + spinal cord.
    • Peripheral Nervous System (PNS) = all the nerves outside the brain and spinal cord (e.g., in your arms, legs).
  • Terminology (Names for Groups)
    • In the CNS:
      • Group of neuron cell bodies = Nucleus.
      • Bundle of axons = Tract.
    • In the PNS:
      • Group of neuron cell bodies = Ganglion.
      • Bundle of axons = Nerve.
• Week 2
  • Types of Neurons
    • Sensory neurons: bring information into the brain (e.g., pain, touch).
    • Motor neurons: send messages out from the brain to muscles.
    • Interneurons: connect neurons to each other (mostly found in the brain and spinal cord).
  • Basic Motor Control Circuits These are the ways our body controls movement:
    • Voluntary movements: things you choose to do, like waving or walking.
    • Postural movements: keep your body balanced and upright (automatic).
    • Reflexes: quick automatic reactions, like pulling your hand away from something hot.
  • Subdivisions of the Motor System (Pathways/Tracts) These are the roads messages take from the brain to muscles:
    • Corticobulbospinal tract: helps with fine motor control, especially for your face and limbs.
    • Reticulospinal tract: helps with posture and walking.
    • Vestibulospinal tract: helps keep your balance (linked to your inner ear).
  • Motor Neurons
    • Upper Motor Neurons (UMNs):
      • Start in the brain and travel down the spinal cord.
      • Send messages to lower motor neurons.
    • Lower Motor Neurons (LMNs):
      • Start in the spinal cord and go out to the muscles.
      • Make the muscles move.
      • 🧠 UMN damage = spasticity, hyperreflexia.
      • 💪 LMN damage = weakness, muscle wasting, low tone.
• Primitive Reflexes
  • These are automatic movements babies have (like sucking or grasping).
  • They usually disappear as the brain matures.
  • If they don’t disappear or come back in adults, it can be a sign of brain damage.
• Hypertonicity vs Hypotonicity
  • Hypertonicity = muscles are too tight (common in brain injuries).
  • Hypotonicity = muscles are too floppy (often seen in babies or after nerve injuries).
• Week 3
  • Barriers and Enablers to Occupational Performance
    • Barriers = things that make it harder for people to move or do daily tasks.
      • E.g., stairs with no rail, uneven footpaths, tight spaces.
    • Enablers = things that support independence and safe movement.
      • E.g., ramps, grab rails, accessible transport.
  • Common Mobility Issues in Neuro Disorders
    • Weakness, poor balance, fatigue, spasticity, pain, sensory loss.
    • Conditions like stroke, MS, CP, or spinal cord injury can affect how people walk or transfer.
  • OT Interventions for Functional Mobility
    • Training to improve safe walking, wheelchair use, or transfers.
    • Mobility aids: walkers, crutches, wheelchairs.
    • Home modifications: grab bars, rails, ramps.
    • Education for safe movement and energy conservation.
  • Hands-On Experience in the Tutorial
    • You got to try using mobility aids and navigating the environment in a manual wheelchair.
    • Practiced spotting accessibility issues (e.g., narrow doorways, ramps too steep).
    • Gained insight into real-life challenges faced by people with mobility issues.
• Week 4
  • What is the Vestibular System? It’s the part of your inner ear and brain that helps you:
    • Keep your balance
    • Know your head position
    • Stay upright and stable
    • Coordinate eye movement with head movement
  • 🎯 Main Functions:
    1. Balance (postural control)
    2. Orientation (knowing where your head/body is in space)
    3. Stabilising vision during movement (so your eyes don’t bounce when you walk)
  • 🦴 Where is it? Located in the inner ear (part of the PNS) but connects to the CNS (brainstem + cerebellum).
  • What Happens if It’s Damaged?
    • Dizziness / vertigo
    • Balance problems
    • Nausea
    • Unsteady walking
    • Blurred vision when moving
  • 🔧 OT Role (Simple)
    • Help with balance training
    • Suggest home safety changes
    • Teach compensatory strategies (e.g., using vision or touch)
    • Gradual movement retraining (Vestibular Rehab Techniques)
• Week 5
  • Public Transport Options (Hurstville → Collaroy)
    • Use Transport NSW tools to plan an accessible trip:
      • Train from Hurstville to Wynyard (wheelchair accessible)
      • B-Line bus (e.g., B1) from Wynyard to Collaroy – low-floor buses with ramps
      • Staff at stations can assist with ramps and transfers
    • ✅ Enabler: Real-time accessible transport info, ramps, wheelchair spaces
    • 🚫 Barrier: Long journey, possible platform gaps
  • Playground Barriers & Enablers
    • ✅ Enablers:
      • Soft surfaces (rubber)
      • Inclusive swings/slides
      • Wide paths
      • Ramps
    • 🚫 Barriers:
      • Sandpits or bark chips (hard for wheelchairs)
      • Narrow gates or steps
      • No shade/rest areas
  • Going to the Movies – Barriers & Enablers
    • ✅ Enablers:
      • Accessible entry (ramp/lift)
      • Wheelchair seating options
      • Companion seating for mum
      • Hearing loops or captions (bonus)
    • 🚫 Barriers:
      • Stairs only (no lift/ramp)
      • Poor seating location (e.g., too close to screen)
      • No space for mum to sit next to Jesse
• Week 6
  • OT Sensory Tests (What we use to assess)
    • Monofilaments → tests light touch (can you feel this poke?)
    • 2-point test → can you tell if 1 or 2 things touched you?
    • Moberg test → can you pick up small objects with your eyes open and closed?
  • Desensitisation (when normal touch hurts)
    • For people who are too sensitive to touch (like after nerve injury)
    • What OTs do:
      • Rub skin with soft → rough textures
      • Tapping, massage
      • Mirror therapy
      • Slowly increase what they can tolerate
  • Re-education (when someone can’t feel)
    • For people who’ve lost feeling in an area (e.g., after stroke)
    • What OTs do:
      • Rub different textures on skin
      • Ask them to name what’s touching them
      • Play games like “guess the object”
      • Use vision and sound to help
  • If Sensation Doesn’t Come Back (Compensate)
    • We teach:
      • Use your eyes more
      • Use the other hand if it's working better
      • Check skin for cuts/burns
      • Change how you do things (e.g., use special tools)
  • Types of Neurons
    • Sensory = body → brain (feeling something)
    • Motor = brain → body (moving something)
    • Interneurons = connect everything inside the brain and spinal cord
  • How it All Works (Simple steps)
    1. Receptor feels something (e.g., hand touches hot mug)
    2. Info goes to spinal cord (via primary neuron)
    3. Then to brainstem/thalamus (secondary neuron)
    4. Finally to brain’s sensory area (tertiary neuron)
• Week 7
  • Vision — How We See and What Can Go Wrong
    • Anatomy basics:
      • Cornea + lens → focus light
      • Retina → sends info to brain
      • Optic nerve → carries info to brain
      • Occipital lobe → where the brain processes what we see
    • Common Vision Issues:
      • Hemianopia → loss of half the visual field (e.g., can't see to the left side of both eyes)
      • Neglect → brain ignores one side (e.g., won't eat food on left plate)
  • Cognition — Thinking Skills
    • Cognition includes:
      • Attention – focusing on a task
      • Memory – remembering info
      • Problem solving – figuring things out
      • Executive function – planning, organising, switching between tasks
  • Perception — How We Make Sense of What We See/Feel
    • Examples of perceptual problems:
      • Agnosia – can't recognise objects, sounds, faces even though vision is okay
      • Apraxia – can't do motor tasks (e.g., can’t brush hair even though muscles are fine)
      • Neglect – doesn’t notice one side (usually left)
  • OT Cognitive-Perceptual Assessments
    1. MoCA – general screening (memory, language, attention)
    2. MMSE – another screening tool (less sensitive than MoCA)
• Week 8
  • What You Saw & Tried
    • 🔌 TENS Machine
      • Tiny electrical pulses to reduce pain or improve muscle activity
      • Used for sensory input or muscle re-education
      • Often used in stroke, spinal cord injury, or pain management
    • 🖐 Saebo Equipment
      • SaeboFlex: a glove that helps fingers move (for people with weak hands)
      • Helps with functional grasp and release in people after stroke or brain injury
      • Used for motor recovery and neuroplasticity (brain learning new paths)
    • Why This Matters for OT
      • We want to:
        • Maximise function: help clients use their hands, walk better, or stay active
        • Promote independence: so they can do everyday tasks without help
        • Work with technology: to support recovery, adaptation or compensation
• Week 13
  • WEEK 13 — Degenerative & Traumatic Neurological Disorders (Simple Version)
    1. What are they?
       • Degenerative disorders = get worse over time, like Parkinson’s Disease, Alzheimer’s, ALS
       • Traumatic disorders = caused by injury like traumatic brain injury (TBI), spinal cord injury (SCI)
    2. What problems do they cause?
       • Movement issues: weak muscles, tremors, balance problems
       • Cognition: memory loss, attention problems, confusion
       • Sensation: numbness, pain
       • Emotional changes: depression, anxiety
    3. How do we help? (Rehabilitation approaches)
       • Exercise and physical therapy to keep muscles strong
       • Task training: practice daily activities step-by-step
       • Assistive devices: wheelchairs, communication aids
       • Cognitive rehab: memory strategies, attention exercises
       • Emotional support: counselling, support groups
    4. OT Intervention strategies
       • Help improve independence in daily life
       • Modify home or work environments for safety
       • Teach energy conservation techniques
       • Train use of adaptive equipment
    5. Teamwork matters!
       • Work closely with physios, speech therapists, doctors, social workers
       • Everyone plays a role in helping people function better and live well
• WEEK 11 — Stroke & Cerebrovascular Disorders (Quick Recap)
  1. What is stroke?
     • Blood flow blocked (ischemic) or bleeding in brain (hemorrhagic)
     • Causes sudden brain damage
  2. What problems happen after stroke?
     • Weakness or paralysis (usually one side)
     • Speech problems (aphasia, dysarthria)
     • Swallowing problems (dysphagia)
     • Cognitive and perception issues
  3. Screening & assessments
     • Check for swallowing, speech, and motor function early
     • Use tools like MoCA, FIM, NIH Stroke Scale
  4. Rehab strategies
     • Task-specific training and exercises
     • Speech therapy for language and swallowing
     • Positioning and muscle tone management
  5. Interprofessional team
     • OT, physio, speech pathologist, dietitian, nurse, doctor
     • Work together to support recovery and independence
• 🏁 Summary
  • Degenerative and traumatic disorders both affect movement, thinking, and daily function. OTs help by teaching skills, adapting environments, and coordinating care with other professionals to improve quality of life.