Neurological physiotherapy
INHOUDSOPGAVE
VESTIBULAR REHABILITATION .................................................................................................................................................... 5
1 VESTIBULAR SYSTEM .................................................................................................................................................................... 5
2 ANATOMY & PHYSIOLOGY ........................................................................................................................................................... 6
Components & tasks of the vestibular system ........................................................................................................................... 6
The labyrinth and otolith organs (sacculus and utriculus) .......................................................................................................... 6
Vestibular connections ............................................................................................................................................................... 8
Contribution of the central vestibular system .......................................................................................................................... 12
3 DIZZINESS – POSSIBLE CAUSES – VESTIBULAR DISORDERS ........................................................................................................ 13
Definitions & epidemiology ...................................................................................................................................................... 13
Causes of (vertigo) dizziness ..................................................................................................................................................... 13
Pattern recognition ................................................................................................................................................................... 14
Nystagmus ................................................................................................................................................................................ 16
4 ASSESSMENT VOR ...................................................................................................................................................................... 19
Vestibulo-Ocular Reflex (VOR) .................................................................................................................................................. 19
Assessment ............................................................................................................................................................................... 19
5 ASSESSMENT VSR ....................................................................................................................................................................... 24
Kwalitatieve balans testen ........................................................................................................................................................ 24
Kwantitatieve balans testen ..................................................................................................................................................... 24
6 ASSESSMENT AND TREATMENT BPPV (PR) ................................................................................................................................ 26
Defintie: BBPV – benigne paroxysmale positionele vertigo ...................................................................................................... 26
Pathogenese ............................................................................................................................................................................. 26
Signs and symptoms ................................................................................................................................................................. 27
Assessment ............................................................................................................................................................................... 27
Klinische bedside tests VOR ...................................................................................................................................................... 29
Behandeling .............................................................................................................................................................................. 29
Effectiviteit ................................................................................................................................................................................ 32
Conclusie (heel algemeen) ........................................................................................................................................................ 32
7 TREATMENT FOR PATIENTS WITH PVD ...................................................................................................................................... 33
Perifeer vestibulaire dysfunctie ................................................................................................................................................ 33
Medicatie .................................................................................................................................................................................. 34
Revalidatie ................................................................................................................................................................................ 34
Afgenomen activiteitsniveau (bewegingsangst) ....................................................................................................................... 37
Treatment for vestibulair dysfunction ...................................................................................................................................... 37
REHABILITATION IN COMA PATIENTS ....................................................................................................................................... 38
1 DEFINITION................................................................................................................................................................................. 38
2 STIMULATING PROGRAM ........................................................................................................................................................... 38
Physiotherapeutic rehabilitation .............................................................................................................................................. 39
3 CASES ......................................................................................................................................................................................... 40
4 HOW TO DEAL WITH A COMA PATIENT ..................................................................................................................................... 41
REHABILITATION IN PT’S WITH ATAXIA .................................................................................................................................... 41
1 DEFINITION................................................................................................................................................................................. 41
2 CAUSES ....................................................................................................................................................................................... 41
3 TYPES .......................................................................................................................................................................................... 41
, Perifere (sensorische) ataxie ..................................................................................................................................................... 41
Vestibulaire ataxie .................................................................................................................................................................... 41
Cerebellaire ataxie .................................................................................................................................................................... 42
Cerebrocerebellaire ataxie........................................................................................................................................................ 42
Spinocerebellaire ataxie (SCA) .................................................................................................................................................. 42
Vestibulocerebellaire ataxie ..................................................................................................................................................... 43
Friedreich’s ataxie ..................................................................................................................................................................... 43
4 ASSESSMENT .............................................................................................................................................................................. 43
5 THERAPY PROGRAM................................................................................................................................................................... 44
PROPRIOCEPTIVE NEUROMUSCULAR FASCILITATION (PNF) ..................................................................................................... 45
1 DEFINITIE .................................................................................................................................................................................... 45
2 PATTERNS ................................................................................................................................................................................... 45
3 BASIS PRINCIPLES (8) .................................................................................................................................................................. 45
Optimale weerstand ................................................................................................................................................................. 45
Manueel contact ....................................................................................................................................................................... 45
Verbale stimulatie ..................................................................................................................................................................... 46
Visuele feedback ....................................................................................................................................................................... 46
Body positionering en mechanica ............................................................................................................................................. 46
Tractie en approximatie (niet altijd gebruiken) ........................................................................................................................ 46
Irradiatie en reinforcement ...................................................................................................................................................... 46
Timing ....................................................................................................................................................................................... 46
Patronen ................................................................................................................................................................................... 47
4 PNF TECHNIEKEN........................................................................................................................................................................ 47
Rhymtische initiatie .................................................................................................................................................................. 47
Combination of isotonics .......................................................................................................................................................... 49
Reversal of antagonists ............................................................................................................................................................. 49
Stretching .................................................................................................................................................................................. 50
Prestretch/ repeated stretch .................................................................................................................................................... 50
Replication ................................................................................................................................................................................ 51
5 CASUSSEN................................................................................................................................................................................... 51
Casus 1 ...................................................................................................................................................................................... 51
Casus 2 ...................................................................................................................................................................................... 52
Casus 3 ...................................................................................................................................................................................... 52
Casus 4 ...................................................................................................................................................................................... 52
Casus 5 ...................................................................................................................................................................................... 53
Casus 6 ...................................................................................................................................................................................... 53
PNF CURSUS MATERIAAL BB .................................................................................................................................................... 54
1 INLEIDING ................................................................................................................................................................................... 54
2 BEGRIPPEN ................................................................................................................................................................................. 54
3 BASISPRINCIPES .......................................................................................................................................................................... 54
Optimale weerstand ................................................................................................................................................................. 54
Manueel contact ....................................................................................................................................................................... 55
Verbale stimulatie ..................................................................................................................................................................... 55
Visuele stimulatie ...................................................................................................................................................................... 55
Body position en body mechanics ............................................................................................................................................ 56
Irradiatie en reinforcement ...................................................................................................................................................... 56
Stretch ....................................................................................................................................................................................... 57
Timing ....................................................................................................................................................................................... 57
, Tractie en approximatie ............................................................................................................................................................ 58
PNF-patronen (patterns of bewegingsdiagonalen) ................................................................................................................... 58
4 PNF TECHNIEKEN........................................................................................................................................................................ 64
5 SAMENVATTING VAN DE PNF TECHNIEKEN EN HUN DOELEINDEN ........................................................................................... 66
NEUROREHABILIATATION AS A (RE)LEARNING PROCES ............................................................................................................ 67
LEARNING (BEHAVIORAL AND NEUROPHYSIOLOGICAL ASPECTS) ................................................................................................ 67
Impliciet en expliciet leren ........................................................................................................................................................ 67
Habituatie en sensitisatie.......................................................................................................................................................... 67
Associatief leren (klassieke en operante conditionering) ......................................................................................................... 67
Observationeel leren ................................................................................................................................................................ 68
Procedureel leren ..................................................................................................................................................................... 68
Congitief leren ........................................................................................................................................................................... 68
Proces in CZS tijdens leren ........................................................................................................................................................ 68
10 principes ............................................................................................................................................................................... 68
NEUROREHABILITATION AS A LEARNING PROCES ........................................................................................................................ 70
Neuropsychological conditions for learning ............................................................................................................................. 70
Learning motor skills in rehabilitation processes...................................................................................................................... 71
APPLICATIONS ............................................................................................................................................................................... 72
SOME DIDACTICAL APPLICATIONS IN NEUROREHABILITATION .................................................................................................... 72
1 Duration, specificity and intensity of training ........................................................................................................................ 72
2 Feedback ................................................................................................................................................................................ 73
3 Mental practice ...................................................................................................................................................................... 74
4 Conlusie .................................................................................................................................................................................. 74
GAIT ANALYSIS IN PATIENTS AFTER A STROKE .......................................................................................................................... 75
REFRESHER MODULE .................................................................................................................................................................... 75
Gait analysis - Normal gait pattern ........................................................................................................................................... 75
1 GAIT AND GAINT ANALYSIS IN STROKE ...................................................................................................................................... 75
2 IDENTIFICATION CAUSES OF HEMIPARETIC GAIT ....................................................................................................................... 75
Problem identification .............................................................................................................................................................. 75
Timing identification (fases van gangpatroon) ......................................................................................................................... 78
3 CHANGES IN GAIT PATTERN AFTER STROKE .............................................................................................................................. 78
Spatiotemoral time parameters................................................................................................................................................ 78
Kinematic .................................................................................................................................................................................. 79
Kinetic & muscle activity ........................................................................................................................................................... 79
4 IMPLICATIONS FOR GAIT REHABILITATION ................................................................................................................................ 79
5 CASE ........................................................................................................................................................................................... 79
Onderzoek ................................................................................................................................................................................. 79
Hypothesevorming .................................................................................................................................................................... 81
Behandeling .............................................................................................................................................................................. 81
RECOVERY PROCESSES (AFTER A CENTRAL NEUROLOGICAL INJURY) ........................................................................................ 82
1 DEFINITIE NEUROPLASTICITEIT .................................................................................................................................................. 82
2 MECHANISMES ........................................................................................................................................................................... 82
Structurele plasticiteit ............................................................................................................................................................... 82
Functionele plasticiteit .............................................................................................................................................................. 83
3 COMPENSATOIRE REORGANISATIE: OUDEREN .......................................................................................................................... 83
, 4 COMPENSATOIRE REORGANISATIE: STROKE .............................................................................................................................. 84
5 COMPENSATOIRE REORGANISATIE: PARKINSON ....................................................................................................................... 85
PERFETTI CONCEPT (COGNITIVE THERAPEUTIC EXERCISES) ...................................................................................................... 86
1. BACKGROUND ........................................................................................................................................................................... 86
2. NORMAL MOVEMENT ............................................................................................................................................................... 86
Tactile – kinesthetic perception ................................................................................................................................................ 86
Visual perception & perceptive hypothesis .............................................................................................................................. 86
Guided movement/ somatosensory circle ................................................................................................................................ 86
3. ABNORMAL MOVEMENT .......................................................................................................................................................... 87
4. CHARACTERISTICS OF THE PERFETTI CONCEPT ......................................................................................................................... 88
Eyes closed ................................................................................................................................................................................ 88
A distal to proximal method ..................................................................................................................................................... 88
Attention ................................................................................................................................................................................... 88
Therapeutic resources .............................................................................................................................................................. 88
Concious control ....................................................................................................................................................................... 88
Exercise on 3 levels ................................................................................................................................................................... 89
PELVIC FLOOR DYSFUNCTION IN A NEUROLOGICAL POPULATION ............................................................................................ 90
HYDROTHERAPY ....................................................................................................................................................................... 90
ORTHOSES IN NEUROLOGICAL PATIENTS .................................................................................................................................. 90
PHYSCIAL ACTIVITY AND AEROBIC CAPACITY IN STROKE .......................................................................................................... 91
1 INTRODUCTIE ............................................................................................................................................................................. 91
2 PHYSICAL ACTIVITY, RISK FACTOR IN STROKE ............................................................................................................................ 91
3 WHAT DETERMINES HOW PHYSICAL ACTIVE A STROKE PATIENT LIVES .................................................................................... 91
4 PHYSICAL ACTIVITY IN DIFFERENT PHASES OF RECOVERY ......................................................................................................... 92
5 PHYSICAL ACTIVITY MEASURES .................................................................................................................................................. 93
6 MEASURES TO DETERMINE CARDIORESPIRATORY FITNESS AFTER STROKE .............................................................................. 95
7 CARDIORESPIRATORY FITNESS AFTER STROKE ........................................................................................................................... 96
8 CONSEQUENCES OF REDUCED CARDIORESPIRATORY FITNESS .................................................................................................. 96
9 GUIDELINES AEROBIC EXERCISE AFTER STROKE ......................................................................................................................... 97
10 CARDIORESPIRATORY INTERVENTIONS AFTER STROKE ........................................................................................................... 97
11 TELEREHABILITATION TO IMPROVE CARDIORESPIRATORY FITNESS ...................................................................................... 100
12 CASE ....................................................................................................................................................................................... 100
INHOUDSOPGAVE
VESTIBULAR REHABILITATION .................................................................................................................................................... 5
1 VESTIBULAR SYSTEM .................................................................................................................................................................... 5
2 ANATOMY & PHYSIOLOGY ........................................................................................................................................................... 6
Components & tasks of the vestibular system ........................................................................................................................... 6
The labyrinth and otolith organs (sacculus and utriculus) .......................................................................................................... 6
Vestibular connections ............................................................................................................................................................... 8
Contribution of the central vestibular system .......................................................................................................................... 12
3 DIZZINESS – POSSIBLE CAUSES – VESTIBULAR DISORDERS ........................................................................................................ 13
Definitions & epidemiology ...................................................................................................................................................... 13
Causes of (vertigo) dizziness ..................................................................................................................................................... 13
Pattern recognition ................................................................................................................................................................... 14
Nystagmus ................................................................................................................................................................................ 16
4 ASSESSMENT VOR ...................................................................................................................................................................... 19
Vestibulo-Ocular Reflex (VOR) .................................................................................................................................................. 19
Assessment ............................................................................................................................................................................... 19
5 ASSESSMENT VSR ....................................................................................................................................................................... 24
Kwalitatieve balans testen ........................................................................................................................................................ 24
Kwantitatieve balans testen ..................................................................................................................................................... 24
6 ASSESSMENT AND TREATMENT BPPV (PR) ................................................................................................................................ 26
Defintie: BBPV – benigne paroxysmale positionele vertigo ...................................................................................................... 26
Pathogenese ............................................................................................................................................................................. 26
Signs and symptoms ................................................................................................................................................................. 27
Assessment ............................................................................................................................................................................... 27
Klinische bedside tests VOR ...................................................................................................................................................... 29
Behandeling .............................................................................................................................................................................. 29
Effectiviteit ................................................................................................................................................................................ 32
Conclusie (heel algemeen) ........................................................................................................................................................ 32
7 TREATMENT FOR PATIENTS WITH PVD ...................................................................................................................................... 33
Perifeer vestibulaire dysfunctie ................................................................................................................................................ 33
Medicatie .................................................................................................................................................................................. 34
Revalidatie ................................................................................................................................................................................ 34
Afgenomen activiteitsniveau (bewegingsangst) ....................................................................................................................... 37
Treatment for vestibulair dysfunction ...................................................................................................................................... 37
REHABILITATION IN COMA PATIENTS ....................................................................................................................................... 38
1 DEFINITION................................................................................................................................................................................. 38
2 STIMULATING PROGRAM ........................................................................................................................................................... 38
Physiotherapeutic rehabilitation .............................................................................................................................................. 39
3 CASES ......................................................................................................................................................................................... 40
4 HOW TO DEAL WITH A COMA PATIENT ..................................................................................................................................... 41
REHABILITATION IN PT’S WITH ATAXIA .................................................................................................................................... 41
1 DEFINITION................................................................................................................................................................................. 41
2 CAUSES ....................................................................................................................................................................................... 41
3 TYPES .......................................................................................................................................................................................... 41
, Perifere (sensorische) ataxie ..................................................................................................................................................... 41
Vestibulaire ataxie .................................................................................................................................................................... 41
Cerebellaire ataxie .................................................................................................................................................................... 42
Cerebrocerebellaire ataxie........................................................................................................................................................ 42
Spinocerebellaire ataxie (SCA) .................................................................................................................................................. 42
Vestibulocerebellaire ataxie ..................................................................................................................................................... 43
Friedreich’s ataxie ..................................................................................................................................................................... 43
4 ASSESSMENT .............................................................................................................................................................................. 43
5 THERAPY PROGRAM................................................................................................................................................................... 44
PROPRIOCEPTIVE NEUROMUSCULAR FASCILITATION (PNF) ..................................................................................................... 45
1 DEFINITIE .................................................................................................................................................................................... 45
2 PATTERNS ................................................................................................................................................................................... 45
3 BASIS PRINCIPLES (8) .................................................................................................................................................................. 45
Optimale weerstand ................................................................................................................................................................. 45
Manueel contact ....................................................................................................................................................................... 45
Verbale stimulatie ..................................................................................................................................................................... 46
Visuele feedback ....................................................................................................................................................................... 46
Body positionering en mechanica ............................................................................................................................................. 46
Tractie en approximatie (niet altijd gebruiken) ........................................................................................................................ 46
Irradiatie en reinforcement ...................................................................................................................................................... 46
Timing ....................................................................................................................................................................................... 46
Patronen ................................................................................................................................................................................... 47
4 PNF TECHNIEKEN........................................................................................................................................................................ 47
Rhymtische initiatie .................................................................................................................................................................. 47
Combination of isotonics .......................................................................................................................................................... 49
Reversal of antagonists ............................................................................................................................................................. 49
Stretching .................................................................................................................................................................................. 50
Prestretch/ repeated stretch .................................................................................................................................................... 50
Replication ................................................................................................................................................................................ 51
5 CASUSSEN................................................................................................................................................................................... 51
Casus 1 ...................................................................................................................................................................................... 51
Casus 2 ...................................................................................................................................................................................... 52
Casus 3 ...................................................................................................................................................................................... 52
Casus 4 ...................................................................................................................................................................................... 52
Casus 5 ...................................................................................................................................................................................... 53
Casus 6 ...................................................................................................................................................................................... 53
PNF CURSUS MATERIAAL BB .................................................................................................................................................... 54
1 INLEIDING ................................................................................................................................................................................... 54
2 BEGRIPPEN ................................................................................................................................................................................. 54
3 BASISPRINCIPES .......................................................................................................................................................................... 54
Optimale weerstand ................................................................................................................................................................. 54
Manueel contact ....................................................................................................................................................................... 55
Verbale stimulatie ..................................................................................................................................................................... 55
Visuele stimulatie ...................................................................................................................................................................... 55
Body position en body mechanics ............................................................................................................................................ 56
Irradiatie en reinforcement ...................................................................................................................................................... 56
Stretch ....................................................................................................................................................................................... 57
Timing ....................................................................................................................................................................................... 57
, Tractie en approximatie ............................................................................................................................................................ 58
PNF-patronen (patterns of bewegingsdiagonalen) ................................................................................................................... 58
4 PNF TECHNIEKEN........................................................................................................................................................................ 64
5 SAMENVATTING VAN DE PNF TECHNIEKEN EN HUN DOELEINDEN ........................................................................................... 66
NEUROREHABILIATATION AS A (RE)LEARNING PROCES ............................................................................................................ 67
LEARNING (BEHAVIORAL AND NEUROPHYSIOLOGICAL ASPECTS) ................................................................................................ 67
Impliciet en expliciet leren ........................................................................................................................................................ 67
Habituatie en sensitisatie.......................................................................................................................................................... 67
Associatief leren (klassieke en operante conditionering) ......................................................................................................... 67
Observationeel leren ................................................................................................................................................................ 68
Procedureel leren ..................................................................................................................................................................... 68
Congitief leren ........................................................................................................................................................................... 68
Proces in CZS tijdens leren ........................................................................................................................................................ 68
10 principes ............................................................................................................................................................................... 68
NEUROREHABILITATION AS A LEARNING PROCES ........................................................................................................................ 70
Neuropsychological conditions for learning ............................................................................................................................. 70
Learning motor skills in rehabilitation processes...................................................................................................................... 71
APPLICATIONS ............................................................................................................................................................................... 72
SOME DIDACTICAL APPLICATIONS IN NEUROREHABILITATION .................................................................................................... 72
1 Duration, specificity and intensity of training ........................................................................................................................ 72
2 Feedback ................................................................................................................................................................................ 73
3 Mental practice ...................................................................................................................................................................... 74
4 Conlusie .................................................................................................................................................................................. 74
GAIT ANALYSIS IN PATIENTS AFTER A STROKE .......................................................................................................................... 75
REFRESHER MODULE .................................................................................................................................................................... 75
Gait analysis - Normal gait pattern ........................................................................................................................................... 75
1 GAIT AND GAINT ANALYSIS IN STROKE ...................................................................................................................................... 75
2 IDENTIFICATION CAUSES OF HEMIPARETIC GAIT ....................................................................................................................... 75
Problem identification .............................................................................................................................................................. 75
Timing identification (fases van gangpatroon) ......................................................................................................................... 78
3 CHANGES IN GAIT PATTERN AFTER STROKE .............................................................................................................................. 78
Spatiotemoral time parameters................................................................................................................................................ 78
Kinematic .................................................................................................................................................................................. 79
Kinetic & muscle activity ........................................................................................................................................................... 79
4 IMPLICATIONS FOR GAIT REHABILITATION ................................................................................................................................ 79
5 CASE ........................................................................................................................................................................................... 79
Onderzoek ................................................................................................................................................................................. 79
Hypothesevorming .................................................................................................................................................................... 81
Behandeling .............................................................................................................................................................................. 81
RECOVERY PROCESSES (AFTER A CENTRAL NEUROLOGICAL INJURY) ........................................................................................ 82
1 DEFINITIE NEUROPLASTICITEIT .................................................................................................................................................. 82
2 MECHANISMES ........................................................................................................................................................................... 82
Structurele plasticiteit ............................................................................................................................................................... 82
Functionele plasticiteit .............................................................................................................................................................. 83
3 COMPENSATOIRE REORGANISATIE: OUDEREN .......................................................................................................................... 83
, 4 COMPENSATOIRE REORGANISATIE: STROKE .............................................................................................................................. 84
5 COMPENSATOIRE REORGANISATIE: PARKINSON ....................................................................................................................... 85
PERFETTI CONCEPT (COGNITIVE THERAPEUTIC EXERCISES) ...................................................................................................... 86
1. BACKGROUND ........................................................................................................................................................................... 86
2. NORMAL MOVEMENT ............................................................................................................................................................... 86
Tactile – kinesthetic perception ................................................................................................................................................ 86
Visual perception & perceptive hypothesis .............................................................................................................................. 86
Guided movement/ somatosensory circle ................................................................................................................................ 86
3. ABNORMAL MOVEMENT .......................................................................................................................................................... 87
4. CHARACTERISTICS OF THE PERFETTI CONCEPT ......................................................................................................................... 88
Eyes closed ................................................................................................................................................................................ 88
A distal to proximal method ..................................................................................................................................................... 88
Attention ................................................................................................................................................................................... 88
Therapeutic resources .............................................................................................................................................................. 88
Concious control ....................................................................................................................................................................... 88
Exercise on 3 levels ................................................................................................................................................................... 89
PELVIC FLOOR DYSFUNCTION IN A NEUROLOGICAL POPULATION ............................................................................................ 90
HYDROTHERAPY ....................................................................................................................................................................... 90
ORTHOSES IN NEUROLOGICAL PATIENTS .................................................................................................................................. 90
PHYSCIAL ACTIVITY AND AEROBIC CAPACITY IN STROKE .......................................................................................................... 91
1 INTRODUCTIE ............................................................................................................................................................................. 91
2 PHYSICAL ACTIVITY, RISK FACTOR IN STROKE ............................................................................................................................ 91
3 WHAT DETERMINES HOW PHYSICAL ACTIVE A STROKE PATIENT LIVES .................................................................................... 91
4 PHYSICAL ACTIVITY IN DIFFERENT PHASES OF RECOVERY ......................................................................................................... 92
5 PHYSICAL ACTIVITY MEASURES .................................................................................................................................................. 93
6 MEASURES TO DETERMINE CARDIORESPIRATORY FITNESS AFTER STROKE .............................................................................. 95
7 CARDIORESPIRATORY FITNESS AFTER STROKE ........................................................................................................................... 96
8 CONSEQUENCES OF REDUCED CARDIORESPIRATORY FITNESS .................................................................................................. 96
9 GUIDELINES AEROBIC EXERCISE AFTER STROKE ......................................................................................................................... 97
10 CARDIORESPIRATORY INTERVENTIONS AFTER STROKE ........................................................................................................... 97
11 TELEREHABILITATION TO IMPROVE CARDIORESPIRATORY FITNESS ...................................................................................... 100
12 CASE ....................................................................................................................................................................................... 100
