Module Neurologie II ........................................................................................................................................... 8
1. Inleiding - Neuroplasticiteit ......................................................................................................................... 8
1. Neuroplasticiteit .................................................................................................................................. 8
Plasticiteit van het gezonde brein ......................................................................................................... 10
2. Onderhoud en verfijning van connecties .......................................................................................... 10
De connectiviteit van het zenuwstelsel ................................................................................................. 11
The effect of nurture and nature .......................................................................................................... 11
3. Kritische Periode................................................................................................................................ 11
Synaptische plasticiteit: long term potentiation ................................................................................... 12
Fysieke activiteit .................................................................................................................................... 14
Plasticiteit in de spier ............................................................................................................................ 14
4. Plasticiteit van beschadigde hersenen .............................................................................................. 15
Plasticiteit bij volwassenen na perifere lesie ........................................................................................ 15
Plasticiteit bij volwassenen na laesie van het centraal zenuwstelsel.................................................... 15
Het effect van motorische training na CVA op de motor cortex ........................................................... 16
5. Therapeutische toepassingen............................................................................................................ 16
Constraint-induced therapy bij cva ....................................................................................................... 16
Spiegeltherapie bij fantoompijn ............................................................................................................ 16
Kan de neurplasticiteit positief worden beïnvloed ............................................................................... 16
Maldaptieve plasticiteit ......................................................................................................................... 17
6. Conclusie............................................................................................................................................ 17
2. Theoretische basis van de neurorevalidatie (hoofdstuk 11) ..................................................................... 17
Doelstellingen van de neurorevalidatie..................................................................................................... 17
8 principes van de neurorevalidatie .......................................................................................................... 18
Neurorevalidatie als leerproces................................................................................................................. 18
Revalideren als een motorisch (her-)leerproces ................................................................................... 18
Verschillende vormen van leren ............................................................................................................ 20
Wat gebeurt er in het centraal zenuwstelsel bij leren? ........................................................................ 22
LTP ......................................................................................................................................................... 22
Motor relearning programme ............................................................................................................... 22
3 modellen van motorisch leren............................................................................................................ 23
Ecologische theorie van Newell (1991) ............................................................................................. 23
Rol van perceptuele informatie ............................................................................................................. 23
Adaptief gedrag ..................................................................................................................................... 23
Revalideren gezien als herleren ............................................................................................................ 23
Motorisch leren toegepast op de neurorevalidatie .................................................................................. 24
Motorisch leren ..................................................................................................................................... 24
1) De taak .......................................................................................................................................... 24
Deeltaken vs. globale taken........................................................................................................... 24
2) Het effect van de omgeving .......................................................................................................... 25
3) Aan welke voorwaarden moet de patiënt voldoen om te leren? ................................................. 25
Conclusie .................................................................................................................................................... 25
3. Neurorevalidatie: De revalidatie van de dwarslaesiepatiënt (hoofdstuk 4) ............................................. 25
Aetiology and incidence of spinal cord injury............................................................................................ 26
Types of Spinal Cord Injury ....................................................................................................................... 27
, Diagnosis .................................................................................................................................................... 27
Incomplete Vs. complete injury............................................................................................................. 27
Incomplete laesions and prognostic indicators ..................................................................................... 30
Anterieure merglesie ......................................................................................................................... 30
Brown-Séquard syndroom................................................................................................................. 30
Centrale merglesie............................................................................................................................. 31
Lesie van de conus medullaris ........................................................................................................... 31
Lesie van de cauda equina................................................................................................................. 31
Posterieur mergsyndroom................................................................................................................. 31
Prognosis.................................................................................................................................................... 31
Recovery of the incomplete spinal cord injury ...................................................................................... 32
Pathognese ................................................................................................................................................ 32
Acute general management ...................................................................................................................... 32
Trauma management ............................................................................................................................ 32
De acute fase na trauma ................................................................................................................... 32
Acute hospital management ................................................................................................................. 33
Special problems in spinal cord injury ................................................................................................... 34
Acute physical management ..................................................................................................................... 34
Treatment objectives in the acute phase .............................................................................................. 34
Doelstellingen: ................................................................................................................................... 34
Rehabilitation ............................................................................................................................................ 36
Assessment ............................................................................................................................................ 37
Doelstellingen ........................................................................................................................................ 37
Ademhalingsfunctie ............................................................................................................................... 38
Activopassieve en passieve bewegingen ............................................................................................... 38
Positioning of the patient ...................................................................................................................... 39
Draaien en positionering ....................................................................................................................... 39
Behandeling van spasticiteit .................................................................................................................. 39
Mobilisatie ............................................................................................................................................. 40
Spasticiteit ............................................................................................................................................. 40
Beroerte (hoofdstuk 2) .................................................................................................................................. 40
Inleiding ..................................................................................................................................................... 40
Definitions.................................................................................................................................................. 41
Classification and aetiology of stroke ........................................................................................................ 41
De cerebrale circulatie........................................................................................................................... 41
Verschillende types ischemische beroerte ................................................................................................ 41
Diagnose van een beroerte ....................................................................................................................... 42
Early medical treatment ............................................................................................................................ 42
Prognostische factoren (niet vanbuiten kunnen opsommen …) ................................................................ 43
Prognosis and recovery ............................................................................................................................. 43
Herstelpatroon in de tijd ....................................................................................................................... 43
Outcome measures.................................................................................................................................... 43
Principles of physical management ........................................................................................................... 44
Acute Stage ............................................................................................................................................ 44
Sub-acute Stage ..................................................................................................................................... 44
, Chronic/long term stage ........................................................................................................................ 44
Problem-solving approach..................................................................................................................... 45
Specifieke problemen ................................................................................................................................ 45
Secundaire complicaties ........................................................................................................................ 45
Klinische neuropsychologie (hoofdstuk 17)................................................................................................... 46
Inleiding ..................................................................................................................................................... 46
De Functies van de hersenen ................................................................................................................ 46
De areas van Brodmann ........................................................................................................................ 46
Klinisch-neuropsychologisch onderzoek.................................................................................................... 46
Belangrijke aspecten ............................................................................................................................. 47
Specifieke ethiologieën.............................................................................................................................. 47
Functional areas of the brain ..................................................................................................................... 47
Lokalisatie van functies versus netwerken ............................................................................................ 48
Lateralisatie van hersenfuncties ............................................................................................................ 48
Cognitieve screening tests ......................................................................................................................... 49
Mini mental state examination (MMSE) ............................................................................................... 49
Executieve dysfunctie ............................................................................................................................ 50
Hersengebieden betrokken bij de executieve functies ..................................................................... 50
Voorbeelden van enkele neuropsychologische tests voor executieve disfunctie: ............................... 51
Taal- en/of spraakstoornissen ................................................................................................................... 52
De taalcentra in de linker hemisfeer Hoe afasie herkennen? ............................................................... 52
Broca-afasie ........................................................................................................................................... 52
Afasie van Wernicke .............................................................................................................................. 53
Globale afasie ........................................................................................................................................ 53
Anomische afasie ................................................................................................................................... 54
Lokalisatie: ......................................................................................................................................... 54
Aandachts- en concentratiestoornissen – vertraagde informatieverwerkings-snelheid ...................... 54
Ruimtelijke verwerkingsstoornissen .......................................................................................................... 54
Unilateraal spatieel neglect ~ hemineglecht ......................................................................................... 54
Hemineglect....................................................................................................................................... 55
Typische tests voor hemineglect ................................................................................................... 55
Pusher-Syndroom .............................................................................................................................. 58
Geheugenstoornissen ................................................................................................................................ 59
Agnosie ...................................................................................................................................................... 60
Object agnosie ....................................................................................................................................... 60
Prosopagnosie ....................................................................................................................................... 60
Somatoagnosie ...................................................................................................................................... 60
Nosoagnosie of anosognosie ................................................................................................................. 60
Apraxie ....................................................................................................................................................... 61
Stemmingsstoornissen............................................................................................................................... 61
Depressie bij mensen met een hersenaandoening ............................................................................... 61
Moeilijkheid bij de vaststelling van depressie bij mensen met een hersenaandoening ....................... 61
Wat is de aard van de depressie bij mensen met een hersenaandoening?.......................................... 62
Behandelingsmogelijkheden van mensen met depressie ..................................................................... 62
Gedragsstoornissen ................................................................................................................................... 63
, Perseveratie ontremd gedrag persoonlijkheidsveranderingen............................................................. 63
Cognitieve revalidatie ................................................................................................................................ 63
Gedragstherapie ........................................................................................................................................ 63
Hersentrauma en coma - Verworven hersenletsels (hoofdstuk 3) ............................................................... 64
Terminologie .............................................................................................................................................. 64
Mechanisme .............................................................................................................................................. 65
Epidemiologie ............................................................................................................................................ 65
Risicofactoren ............................................................................................................................................ 65
Preventiemaatregelen ............................................................................................................................... 65
Comadiepte ............................................................................................................................................... 65
Glasgow coma scale: 3-15 ..................................................................................................................... 65
Ernst van TBI: ......................................................................................................................................... 66
Posttraumatische amnesie ........................................................................................................................ 66
Pathologische oorzaken ............................................................................................................................. 66
Acute aanpak van patiënten met TBI ........................................................................................................ 66
Doelstellingen ........................................................................................................................................ 67
Revalidatie ................................................................................................................................................. 67
Rol van de kinesitherapeut in de acute fase ......................................................................................... 67
Familierespons....................................................................................................................................... 67
1. ...........................................................................................................................................De acute fase
............................................................................................................................................................... 68
2. ..................................................................................................................................... De subacute fase
............................................................................................................................................................... 68
Casus Jamie........................................................................................................................................ 68
3. ....................................................................................................................................... Chronische fase
............................................................................................................................................................... 69
Rol van de kinesitherapeut in de chronische fase ................................................................................. 69
De behandeling van tonusverandering (Hoofdstuk 14) ................................................................................ 69
Inleiding .................................................................................................................................................... 69
Normale tonusregulering.......................................................................................................................... 70
Upper motor neurone syndrome .............................................................................................................. 70
Laesie van de corticospinale tractus .......................................................................................................... 70
Laesie van de capsula interna .................................................................................................................... 71
Incomplete lesie van het ruggenmerg ....................................................................................................... 71
Complete laesie van het ruggenmerg........................................................................................................ 71
Fysische behandeling van tonusafwijkingen ............................................................................................. 72
Aanvullende mogelijkheden ...................................................................................................................... 72
De modified Ashworth Scale ..................................................................................................................... 73
De ziekte van Parkinson (hoofdstuk 6) .......................................................................................................... 73
Inleiding ..................................................................................................................................................... 73
Epidemiologie en etiologie ........................................................................................................................ 73
Pathofysiologie .......................................................................................................................................... 73
Klinische tekens ......................................................................................................................................... 76
Niet-motorische symptomen ................................................................................................................ 76
Behandelingsdoelen per stadium .............................................................................................................. 76
1. Inleiding - Neuroplasticiteit ......................................................................................................................... 8
1. Neuroplasticiteit .................................................................................................................................. 8
Plasticiteit van het gezonde brein ......................................................................................................... 10
2. Onderhoud en verfijning van connecties .......................................................................................... 10
De connectiviteit van het zenuwstelsel ................................................................................................. 11
The effect of nurture and nature .......................................................................................................... 11
3. Kritische Periode................................................................................................................................ 11
Synaptische plasticiteit: long term potentiation ................................................................................... 12
Fysieke activiteit .................................................................................................................................... 14
Plasticiteit in de spier ............................................................................................................................ 14
4. Plasticiteit van beschadigde hersenen .............................................................................................. 15
Plasticiteit bij volwassenen na perifere lesie ........................................................................................ 15
Plasticiteit bij volwassenen na laesie van het centraal zenuwstelsel.................................................... 15
Het effect van motorische training na CVA op de motor cortex ........................................................... 16
5. Therapeutische toepassingen............................................................................................................ 16
Constraint-induced therapy bij cva ....................................................................................................... 16
Spiegeltherapie bij fantoompijn ............................................................................................................ 16
Kan de neurplasticiteit positief worden beïnvloed ............................................................................... 16
Maldaptieve plasticiteit ......................................................................................................................... 17
6. Conclusie............................................................................................................................................ 17
2. Theoretische basis van de neurorevalidatie (hoofdstuk 11) ..................................................................... 17
Doelstellingen van de neurorevalidatie..................................................................................................... 17
8 principes van de neurorevalidatie .......................................................................................................... 18
Neurorevalidatie als leerproces................................................................................................................. 18
Revalideren als een motorisch (her-)leerproces ................................................................................... 18
Verschillende vormen van leren ............................................................................................................ 20
Wat gebeurt er in het centraal zenuwstelsel bij leren? ........................................................................ 22
LTP ......................................................................................................................................................... 22
Motor relearning programme ............................................................................................................... 22
3 modellen van motorisch leren............................................................................................................ 23
Ecologische theorie van Newell (1991) ............................................................................................. 23
Rol van perceptuele informatie ............................................................................................................. 23
Adaptief gedrag ..................................................................................................................................... 23
Revalideren gezien als herleren ............................................................................................................ 23
Motorisch leren toegepast op de neurorevalidatie .................................................................................. 24
Motorisch leren ..................................................................................................................................... 24
1) De taak .......................................................................................................................................... 24
Deeltaken vs. globale taken........................................................................................................... 24
2) Het effect van de omgeving .......................................................................................................... 25
3) Aan welke voorwaarden moet de patiënt voldoen om te leren? ................................................. 25
Conclusie .................................................................................................................................................... 25
3. Neurorevalidatie: De revalidatie van de dwarslaesiepatiënt (hoofdstuk 4) ............................................. 25
Aetiology and incidence of spinal cord injury............................................................................................ 26
Types of Spinal Cord Injury ....................................................................................................................... 27
, Diagnosis .................................................................................................................................................... 27
Incomplete Vs. complete injury............................................................................................................. 27
Incomplete laesions and prognostic indicators ..................................................................................... 30
Anterieure merglesie ......................................................................................................................... 30
Brown-Séquard syndroom................................................................................................................. 30
Centrale merglesie............................................................................................................................. 31
Lesie van de conus medullaris ........................................................................................................... 31
Lesie van de cauda equina................................................................................................................. 31
Posterieur mergsyndroom................................................................................................................. 31
Prognosis.................................................................................................................................................... 31
Recovery of the incomplete spinal cord injury ...................................................................................... 32
Pathognese ................................................................................................................................................ 32
Acute general management ...................................................................................................................... 32
Trauma management ............................................................................................................................ 32
De acute fase na trauma ................................................................................................................... 32
Acute hospital management ................................................................................................................. 33
Special problems in spinal cord injury ................................................................................................... 34
Acute physical management ..................................................................................................................... 34
Treatment objectives in the acute phase .............................................................................................. 34
Doelstellingen: ................................................................................................................................... 34
Rehabilitation ............................................................................................................................................ 36
Assessment ............................................................................................................................................ 37
Doelstellingen ........................................................................................................................................ 37
Ademhalingsfunctie ............................................................................................................................... 38
Activopassieve en passieve bewegingen ............................................................................................... 38
Positioning of the patient ...................................................................................................................... 39
Draaien en positionering ....................................................................................................................... 39
Behandeling van spasticiteit .................................................................................................................. 39
Mobilisatie ............................................................................................................................................. 40
Spasticiteit ............................................................................................................................................. 40
Beroerte (hoofdstuk 2) .................................................................................................................................. 40
Inleiding ..................................................................................................................................................... 40
Definitions.................................................................................................................................................. 41
Classification and aetiology of stroke ........................................................................................................ 41
De cerebrale circulatie........................................................................................................................... 41
Verschillende types ischemische beroerte ................................................................................................ 41
Diagnose van een beroerte ....................................................................................................................... 42
Early medical treatment ............................................................................................................................ 42
Prognostische factoren (niet vanbuiten kunnen opsommen …) ................................................................ 43
Prognosis and recovery ............................................................................................................................. 43
Herstelpatroon in de tijd ....................................................................................................................... 43
Outcome measures.................................................................................................................................... 43
Principles of physical management ........................................................................................................... 44
Acute Stage ............................................................................................................................................ 44
Sub-acute Stage ..................................................................................................................................... 44
, Chronic/long term stage ........................................................................................................................ 44
Problem-solving approach..................................................................................................................... 45
Specifieke problemen ................................................................................................................................ 45
Secundaire complicaties ........................................................................................................................ 45
Klinische neuropsychologie (hoofdstuk 17)................................................................................................... 46
Inleiding ..................................................................................................................................................... 46
De Functies van de hersenen ................................................................................................................ 46
De areas van Brodmann ........................................................................................................................ 46
Klinisch-neuropsychologisch onderzoek.................................................................................................... 46
Belangrijke aspecten ............................................................................................................................. 47
Specifieke ethiologieën.............................................................................................................................. 47
Functional areas of the brain ..................................................................................................................... 47
Lokalisatie van functies versus netwerken ............................................................................................ 48
Lateralisatie van hersenfuncties ............................................................................................................ 48
Cognitieve screening tests ......................................................................................................................... 49
Mini mental state examination (MMSE) ............................................................................................... 49
Executieve dysfunctie ............................................................................................................................ 50
Hersengebieden betrokken bij de executieve functies ..................................................................... 50
Voorbeelden van enkele neuropsychologische tests voor executieve disfunctie: ............................... 51
Taal- en/of spraakstoornissen ................................................................................................................... 52
De taalcentra in de linker hemisfeer Hoe afasie herkennen? ............................................................... 52
Broca-afasie ........................................................................................................................................... 52
Afasie van Wernicke .............................................................................................................................. 53
Globale afasie ........................................................................................................................................ 53
Anomische afasie ................................................................................................................................... 54
Lokalisatie: ......................................................................................................................................... 54
Aandachts- en concentratiestoornissen – vertraagde informatieverwerkings-snelheid ...................... 54
Ruimtelijke verwerkingsstoornissen .......................................................................................................... 54
Unilateraal spatieel neglect ~ hemineglecht ......................................................................................... 54
Hemineglect....................................................................................................................................... 55
Typische tests voor hemineglect ................................................................................................... 55
Pusher-Syndroom .............................................................................................................................. 58
Geheugenstoornissen ................................................................................................................................ 59
Agnosie ...................................................................................................................................................... 60
Object agnosie ....................................................................................................................................... 60
Prosopagnosie ....................................................................................................................................... 60
Somatoagnosie ...................................................................................................................................... 60
Nosoagnosie of anosognosie ................................................................................................................. 60
Apraxie ....................................................................................................................................................... 61
Stemmingsstoornissen............................................................................................................................... 61
Depressie bij mensen met een hersenaandoening ............................................................................... 61
Moeilijkheid bij de vaststelling van depressie bij mensen met een hersenaandoening ....................... 61
Wat is de aard van de depressie bij mensen met een hersenaandoening?.......................................... 62
Behandelingsmogelijkheden van mensen met depressie ..................................................................... 62
Gedragsstoornissen ................................................................................................................................... 63
, Perseveratie ontremd gedrag persoonlijkheidsveranderingen............................................................. 63
Cognitieve revalidatie ................................................................................................................................ 63
Gedragstherapie ........................................................................................................................................ 63
Hersentrauma en coma - Verworven hersenletsels (hoofdstuk 3) ............................................................... 64
Terminologie .............................................................................................................................................. 64
Mechanisme .............................................................................................................................................. 65
Epidemiologie ............................................................................................................................................ 65
Risicofactoren ............................................................................................................................................ 65
Preventiemaatregelen ............................................................................................................................... 65
Comadiepte ............................................................................................................................................... 65
Glasgow coma scale: 3-15 ..................................................................................................................... 65
Ernst van TBI: ......................................................................................................................................... 66
Posttraumatische amnesie ........................................................................................................................ 66
Pathologische oorzaken ............................................................................................................................. 66
Acute aanpak van patiënten met TBI ........................................................................................................ 66
Doelstellingen ........................................................................................................................................ 67
Revalidatie ................................................................................................................................................. 67
Rol van de kinesitherapeut in de acute fase ......................................................................................... 67
Familierespons....................................................................................................................................... 67
1. ...........................................................................................................................................De acute fase
............................................................................................................................................................... 68
2. ..................................................................................................................................... De subacute fase
............................................................................................................................................................... 68
Casus Jamie........................................................................................................................................ 68
3. ....................................................................................................................................... Chronische fase
............................................................................................................................................................... 69
Rol van de kinesitherapeut in de chronische fase ................................................................................. 69
De behandeling van tonusverandering (Hoofdstuk 14) ................................................................................ 69
Inleiding .................................................................................................................................................... 69
Normale tonusregulering.......................................................................................................................... 70
Upper motor neurone syndrome .............................................................................................................. 70
Laesie van de corticospinale tractus .......................................................................................................... 70
Laesie van de capsula interna .................................................................................................................... 71
Incomplete lesie van het ruggenmerg ....................................................................................................... 71
Complete laesie van het ruggenmerg........................................................................................................ 71
Fysische behandeling van tonusafwijkingen ............................................................................................. 72
Aanvullende mogelijkheden ...................................................................................................................... 72
De modified Ashworth Scale ..................................................................................................................... 73
De ziekte van Parkinson (hoofdstuk 6) .......................................................................................................... 73
Inleiding ..................................................................................................................................................... 73
Epidemiologie en etiologie ........................................................................................................................ 73
Pathofysiologie .......................................................................................................................................... 73
Klinische tekens ......................................................................................................................................... 76
Niet-motorische symptomen ................................................................................................................ 76
Behandelingsdoelen per stadium .............................................................................................................. 76
