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.