Rehabilitation of Neurological disorders
COURSE 2022-2023
Tanya
KULEUVEN | 1E MASTER KINE
,Inhoud
Lesson 1: Introduction............................................................................................................................3
Neurological rehabilitation.................................................................................................................3
Plasticity in Parkinson.........................................................................................................................6
Levodopa medicatie...........................................................................................................................8
Plasticiteit, herstel en leermogelijkheden in context van acute en chronische pathologie...........10
Lesson 2+3: assessment with UPDRS....................................................................................................13
Introduction......................................................................................................................................13
Secundaire problemen van de ziekte................................................................................................24
Cardiovasculair.............................................................................................................................25
Musculoskeletaal..........................................................................................................................26
Lesson 4: Anatomy and function of the Basal Ganglia..........................................................................28
Parkinson Disease pathology............................................................................................................28
Basal Ganglia anatomy......................................................................................................................29
BG parallel loops...............................................................................................................................31
Neurophysiology of the basal ganglia...............................................................................................31
BG pathways.....................................................................................................................................33
Summary BG.................................................................................................................................35
Role of Dopamine.............................................................................................................................35
Key cortical connections of the BG and their roles...........................................................................37
Neural basis of tremor......................................................................................................................39
Neuro lesson 5: Gait and balance related problems in PD....................................................................40
Introduction......................................................................................................................................40
Continuous gait problems.................................................................................................................41
Episodic problems of gait: falls.........................................................................................................42
Episodic problems of gait: freezing + festination..............................................................................43
Neuro lesson 6: Freezing and cueing....................................................................................................45
Freezing and levodopa......................................................................................................................45
Why does freezing occur?.................................................................................................................46
Motor network dysfunction..........................................................................................................46
Limbic network alterations...........................................................................................................47
Cognitive network dysfunction.....................................................................................................48
Lesson 7: Evicende Based Medicine EBM.............................................................................................55
Introduction......................................................................................................................................55
How to deliver exercise?...................................................................................................................56
1
, Which exercise and what is the evidence?.......................................................................................56
Walking as training.......................................................................................................................57
Progressive strenght training........................................................................................................58
Endurance training – aerobic training...........................................................................................59
High challenge balance training....................................................................................................60
Adding cognitive load...................................................................................................................61
Exercise for falling – skill learning how to get up from the floor...................................................62
High amplitude training: PWR! Moves..........................................................................................64
Lesson 8: Parkinsonism.........................................................................................................................65
Introduction......................................................................................................................................65
Muskuloskeletal deformities.............................................................................................................66
Multiple System Atrophy – MSA.......................................................................................................67
Lewy Body Dementia - LBD...............................................................................................................69
Progressive Supranuclear Palsy - PSP................................................................................................69
Pure akinesia with gait freezing (PAGF).........................................................................................73
Cortical basal degeneration/ syndrome – CBD..................................................................................73
Final remarks....................................................................................................................................74
Lesson 9: Hyperkinetic Movement Disorders.......................................................................................75
Hyperkinetic MD’s: not amenable to PT...........................................................................................75
Tics................................................................................................................................................75
Chorea and athetosis....................................................................................................................76
Dystonia – amenable to PT...............................................................................................................76
Therapeutic approach dystonia........................................................................................................79
Huntington’s disease.........................................................................................................................82
Note: Exam will be written and includes open questions. One question will be dedicated to a case report on
paper. Students will be required to adopt clinical reasoning on the basis of a few given clinical details. On the
basis of this they will be asked to discuss a treatment plan in a written format. This last part will be practised
during the course and scoring criteria presented.
Written 3 open questions:
o Neurophysiological insight (25%)
o Making links between motor and cognitive OR X and Y (broader perspective) (50%)
o Practical application – translation to rehabilitation (25%)
2
, Lesson 1: Introduction
Neurological rehabilitation
- Learning implies neuroplasticity
o Learning = a more or less permanent change of behavior or capacity on the basis of
experience.
o Intervention mostly consists of learning, giving movement experience and practice in
a repeated interaction between patient and therapist and/or the environment
o Learning is central word, it is never static. Neither is the brain. It means that there is a
constant proces of change going on in the brain, based on experience. Neuro rehab =
Giving movement experience and practice in repeated interaction between patients
and therapists.
o Learning and neuroplasticity are related.
Learning implies memory, meaning imprinting storage, motor memory.
o Neural plasticity is the biological basis of memory and learning. Learning is the
process and plasticity is the underlying neurobiological mechanism.
- Levels of training
Focus op oefenen van bepaalde skills: consistenter
maken, ook bij verstoring door bv. omgeving
Gestructureerde en herhaalde fysieke activiteit:
lichamelijke fitness
Dagelijkse routine beweging: energie
verbruik stimuleren als T
o Alle verschillende niveaus hebben andere uitkomsten
o Als T focus je niet op 1 niveau, maar denk je aan de gevolgen van veranderingen op 1
niveau op de andere niveaus: grote interactie tussen
o Grotendeels ongeweten hoe gestructureerd oefeningen de fysieke activiteit
beïnvloed en hoe je de verschillende lagen het best aanspreekt tijdens de
verschillende ziektestadia
- Experience-dependent neuroplasticity
- Level 1: hersenniveau
- Level 2: neurale systemen
- Level 3: gedrag
3
COURSE 2022-2023
Tanya
KULEUVEN | 1E MASTER KINE
,Inhoud
Lesson 1: Introduction............................................................................................................................3
Neurological rehabilitation.................................................................................................................3
Plasticity in Parkinson.........................................................................................................................6
Levodopa medicatie...........................................................................................................................8
Plasticiteit, herstel en leermogelijkheden in context van acute en chronische pathologie...........10
Lesson 2+3: assessment with UPDRS....................................................................................................13
Introduction......................................................................................................................................13
Secundaire problemen van de ziekte................................................................................................24
Cardiovasculair.............................................................................................................................25
Musculoskeletaal..........................................................................................................................26
Lesson 4: Anatomy and function of the Basal Ganglia..........................................................................28
Parkinson Disease pathology............................................................................................................28
Basal Ganglia anatomy......................................................................................................................29
BG parallel loops...............................................................................................................................31
Neurophysiology of the basal ganglia...............................................................................................31
BG pathways.....................................................................................................................................33
Summary BG.................................................................................................................................35
Role of Dopamine.............................................................................................................................35
Key cortical connections of the BG and their roles...........................................................................37
Neural basis of tremor......................................................................................................................39
Neuro lesson 5: Gait and balance related problems in PD....................................................................40
Introduction......................................................................................................................................40
Continuous gait problems.................................................................................................................41
Episodic problems of gait: falls.........................................................................................................42
Episodic problems of gait: freezing + festination..............................................................................43
Neuro lesson 6: Freezing and cueing....................................................................................................45
Freezing and levodopa......................................................................................................................45
Why does freezing occur?.................................................................................................................46
Motor network dysfunction..........................................................................................................46
Limbic network alterations...........................................................................................................47
Cognitive network dysfunction.....................................................................................................48
Lesson 7: Evicende Based Medicine EBM.............................................................................................55
Introduction......................................................................................................................................55
How to deliver exercise?...................................................................................................................56
1
, Which exercise and what is the evidence?.......................................................................................56
Walking as training.......................................................................................................................57
Progressive strenght training........................................................................................................58
Endurance training – aerobic training...........................................................................................59
High challenge balance training....................................................................................................60
Adding cognitive load...................................................................................................................61
Exercise for falling – skill learning how to get up from the floor...................................................62
High amplitude training: PWR! Moves..........................................................................................64
Lesson 8: Parkinsonism.........................................................................................................................65
Introduction......................................................................................................................................65
Muskuloskeletal deformities.............................................................................................................66
Multiple System Atrophy – MSA.......................................................................................................67
Lewy Body Dementia - LBD...............................................................................................................69
Progressive Supranuclear Palsy - PSP................................................................................................69
Pure akinesia with gait freezing (PAGF).........................................................................................73
Cortical basal degeneration/ syndrome – CBD..................................................................................73
Final remarks....................................................................................................................................74
Lesson 9: Hyperkinetic Movement Disorders.......................................................................................75
Hyperkinetic MD’s: not amenable to PT...........................................................................................75
Tics................................................................................................................................................75
Chorea and athetosis....................................................................................................................76
Dystonia – amenable to PT...............................................................................................................76
Therapeutic approach dystonia........................................................................................................79
Huntington’s disease.........................................................................................................................82
Note: Exam will be written and includes open questions. One question will be dedicated to a case report on
paper. Students will be required to adopt clinical reasoning on the basis of a few given clinical details. On the
basis of this they will be asked to discuss a treatment plan in a written format. This last part will be practised
during the course and scoring criteria presented.
Written 3 open questions:
o Neurophysiological insight (25%)
o Making links between motor and cognitive OR X and Y (broader perspective) (50%)
o Practical application – translation to rehabilitation (25%)
2
, Lesson 1: Introduction
Neurological rehabilitation
- Learning implies neuroplasticity
o Learning = a more or less permanent change of behavior or capacity on the basis of
experience.
o Intervention mostly consists of learning, giving movement experience and practice in
a repeated interaction between patient and therapist and/or the environment
o Learning is central word, it is never static. Neither is the brain. It means that there is a
constant proces of change going on in the brain, based on experience. Neuro rehab =
Giving movement experience and practice in repeated interaction between patients
and therapists.
o Learning and neuroplasticity are related.
Learning implies memory, meaning imprinting storage, motor memory.
o Neural plasticity is the biological basis of memory and learning. Learning is the
process and plasticity is the underlying neurobiological mechanism.
- Levels of training
Focus op oefenen van bepaalde skills: consistenter
maken, ook bij verstoring door bv. omgeving
Gestructureerde en herhaalde fysieke activiteit:
lichamelijke fitness
Dagelijkse routine beweging: energie
verbruik stimuleren als T
o Alle verschillende niveaus hebben andere uitkomsten
o Als T focus je niet op 1 niveau, maar denk je aan de gevolgen van veranderingen op 1
niveau op de andere niveaus: grote interactie tussen
o Grotendeels ongeweten hoe gestructureerd oefeningen de fysieke activiteit
beïnvloed en hoe je de verschillende lagen het best aanspreekt tijdens de
verschillende ziektestadia
- Experience-dependent neuroplasticity
- Level 1: hersenniveau
- Level 2: neurale systemen
- Level 3: gedrag
3
