PHTY2030 - Week 3 Test With
Complete Solution
Understand how physiotherapy management has changed over time (traditional
methods) - ANSWER Conventional therapeutic exercise → First used to treat Polio
epidemic in the 1960s
Isotonic strengthening exercises - often with resistance
Individual joints targeted rather than whole limb movements
Passive mvts and stretching aimed at maintaining range
Equipment used extensively eg pulleys, weights, II bars, bicycle, ankle exerciser
Compensatory strategies
What are some current management strategies for stroke management - ANSWER
Motor Performance
Motivational
Psychology
Biofeedback
Functional Electrical stimulation
Treadmill training
Virtual Reality
Robotics
What are some common principles underlying Neurophysiologic Approaches - ANSWER
Rotation used in total movement patterns
Emphasisis on reflexes , posture and tone, sensation
C.N.S. is hierarchically organised with higher centres in command of lower centres (old
thought, which is now not true)
Recovery follows a predictable sequence that mimics the developmental sequence →
application of developmental sequence to progression of therapeutic exercise
Therapist can alter or facilitate a patients movement pattern by applying specific
sensory stimuli
,Motor Learning Approach - ANSWER Retraining of affected side ( not compensatory
behavior) with treatment beginning as early as possible
Analysis of functional movements to identify essential missing components of patient
movement
Movements trained simple component → complex → functional
Motivation, cognitive involvement, interaction with environment important
Practice movement patterns in context of the task
What where some Neurophysiological Approaches? - ANSWER Alexander Technique
Feldenkrais Method
Proprioceptive Neuromuscular Facilitation (PNF)
Neurodevelopment Therapy: BOBATH
NDT: Roads Sensorimotor
Brunnstroms Movement therapy
Hippotherapy (horse therapy)
Advanced neurological techniques - ANSWER BWS treadmill
Observation & Imagery
Electrical Stimulation
Emerging techniques of neurorehabilitation - ANSWER Robotics
Virtual reality
Cortical electrical stimulation
Telerehab
Cortical prosthetics
About these neurological approaches - ANSWER All of these approaches have been
founded in theory to improve motor control, symmetry, and balance in stroke patients
No single approach has been documented as superior
The most common practice is to incorporate elements of various therapy methods
No patient should be excluded from rehab unless he is too ill to participate
How do our physiotherapists interventions work? - ANSWER All work to improve
plasticity
, " In adult centres, the nerve paths are fixed, ended, immobile. Everything may die,
nothing may be regenerated" Santiago Ramon Y Cajal 1911
What is Plasticity of the intact brain - ANSWER 'The capacity of the CNS to adapt to
functional demands and therefore to the system's capacity to reorganize is largely
created and altered by experience' Your brain is changing all the time
Reaction to damage - ANSWER Symptoms are due to two phenomena:
1. Actual cell death caused by the event
2. Secondary physiologic shutdown of other neurons near the area of damage
(inhibition/Luria)
Could result from neural shock, oedema, disruption of local blood flow or denervation of
postsynaptic neurons.
2 levels of Plasticity of CNS following damage - ANSWER Intercellular level (synaptic
change)
Network level (cortical remapping)
Regions that compensate for damages - ANSWER Regions that are in close proximity of
the damaged area will resume the roles required e.g. if the motor cortex which is
responsible for the hand is damaged, it is likely that the regions that control the forearm
will be assigned the functions of the hand. They are never gonna be quite as good as the
original.
Interhemispheric Competition - ANSWER Helps prevent overstimulation of the brain,
with inhibition to the other hemispheres. This directly prevents seizures and even
autism from occurring.
In the diagram excitatory downput has been lost in the right hand (due to an affected
lesion in the left hemisphere of the brain), because of that there is increased inhibition to
the opposite hemisphere as there is no rival to decrease the stimulation.
Changes in Neural activation after stroke - ANSWER The affected hemisphere has
activity (post-stroke) but that can be also seen in the other hemisphere too (seen in
MRI). This becomes more polarised (to lateral sides of the brain) in the following weeks.
Hence to drive recovery, we need to increase excitation of the damaged hemisphere
which can be done by either activity moving the affected hand or stimulating the
affected side with electrical impulses e.g. TENs.
Same works the other way too, if we decrease inhibition on the contralateral
(non-affected) side we can increase excitation in the affected lesion we can do that
through cortical stimulation.
Factors influencing the potential for recovery - Experience/practice - ANSWER Specific
Complete Solution
Understand how physiotherapy management has changed over time (traditional
methods) - ANSWER Conventional therapeutic exercise → First used to treat Polio
epidemic in the 1960s
Isotonic strengthening exercises - often with resistance
Individual joints targeted rather than whole limb movements
Passive mvts and stretching aimed at maintaining range
Equipment used extensively eg pulleys, weights, II bars, bicycle, ankle exerciser
Compensatory strategies
What are some current management strategies for stroke management - ANSWER
Motor Performance
Motivational
Psychology
Biofeedback
Functional Electrical stimulation
Treadmill training
Virtual Reality
Robotics
What are some common principles underlying Neurophysiologic Approaches - ANSWER
Rotation used in total movement patterns
Emphasisis on reflexes , posture and tone, sensation
C.N.S. is hierarchically organised with higher centres in command of lower centres (old
thought, which is now not true)
Recovery follows a predictable sequence that mimics the developmental sequence →
application of developmental sequence to progression of therapeutic exercise
Therapist can alter or facilitate a patients movement pattern by applying specific
sensory stimuli
,Motor Learning Approach - ANSWER Retraining of affected side ( not compensatory
behavior) with treatment beginning as early as possible
Analysis of functional movements to identify essential missing components of patient
movement
Movements trained simple component → complex → functional
Motivation, cognitive involvement, interaction with environment important
Practice movement patterns in context of the task
What where some Neurophysiological Approaches? - ANSWER Alexander Technique
Feldenkrais Method
Proprioceptive Neuromuscular Facilitation (PNF)
Neurodevelopment Therapy: BOBATH
NDT: Roads Sensorimotor
Brunnstroms Movement therapy
Hippotherapy (horse therapy)
Advanced neurological techniques - ANSWER BWS treadmill
Observation & Imagery
Electrical Stimulation
Emerging techniques of neurorehabilitation - ANSWER Robotics
Virtual reality
Cortical electrical stimulation
Telerehab
Cortical prosthetics
About these neurological approaches - ANSWER All of these approaches have been
founded in theory to improve motor control, symmetry, and balance in stroke patients
No single approach has been documented as superior
The most common practice is to incorporate elements of various therapy methods
No patient should be excluded from rehab unless he is too ill to participate
How do our physiotherapists interventions work? - ANSWER All work to improve
plasticity
, " In adult centres, the nerve paths are fixed, ended, immobile. Everything may die,
nothing may be regenerated" Santiago Ramon Y Cajal 1911
What is Plasticity of the intact brain - ANSWER 'The capacity of the CNS to adapt to
functional demands and therefore to the system's capacity to reorganize is largely
created and altered by experience' Your brain is changing all the time
Reaction to damage - ANSWER Symptoms are due to two phenomena:
1. Actual cell death caused by the event
2. Secondary physiologic shutdown of other neurons near the area of damage
(inhibition/Luria)
Could result from neural shock, oedema, disruption of local blood flow or denervation of
postsynaptic neurons.
2 levels of Plasticity of CNS following damage - ANSWER Intercellular level (synaptic
change)
Network level (cortical remapping)
Regions that compensate for damages - ANSWER Regions that are in close proximity of
the damaged area will resume the roles required e.g. if the motor cortex which is
responsible for the hand is damaged, it is likely that the regions that control the forearm
will be assigned the functions of the hand. They are never gonna be quite as good as the
original.
Interhemispheric Competition - ANSWER Helps prevent overstimulation of the brain,
with inhibition to the other hemispheres. This directly prevents seizures and even
autism from occurring.
In the diagram excitatory downput has been lost in the right hand (due to an affected
lesion in the left hemisphere of the brain), because of that there is increased inhibition to
the opposite hemisphere as there is no rival to decrease the stimulation.
Changes in Neural activation after stroke - ANSWER The affected hemisphere has
activity (post-stroke) but that can be also seen in the other hemisphere too (seen in
MRI). This becomes more polarised (to lateral sides of the brain) in the following weeks.
Hence to drive recovery, we need to increase excitation of the damaged hemisphere
which can be done by either activity moving the affected hand or stimulating the
affected side with electrical impulses e.g. TENs.
Same works the other way too, if we decrease inhibition on the contralateral
(non-affected) side we can increase excitation in the affected lesion we can do that
through cortical stimulation.
Factors influencing the potential for recovery - Experience/practice - ANSWER Specific
