Functional Intervention for Neuroplasticity After a Strokekotaonline.org/events/conference/2017ConferenceHandouts/Gessler.pdf · Functional Intervention for Neuroplasticity After
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Functional Intervention
for
Neuroplasticity
After a
Stroke
Mary Gessler, BS, COTA/L
ME
BS degree from Northeastern University,
Boston, MA
Corporate employment 19 yrs.
OTA graduation in 2011
Professional employment and specialization
in CVA treatment – 6 yrs.
ME
Stroke team co-champion
Responsible for monthly community stroke support group
Began stroke community outings March 2017
Specialty Stroke Education
American Stroke Association, Stroke Rehab Specialist training
NDT training
Hemi-Move 1 & 2
And many many more …..
Stroke Facts
Stroke is the fifth leading cause of death in the
USA
Stroke kills more than 130,000 Americans each
year
Someone in the USA has a stroke every 40
seconds
Every four minutes a person dies from a stroke
Stroke Facts cont.
Yearly 795,000 strokes occur in the USA
610,000 are first strokes
185,000 are recurrent strokes
20 - 64 yr. olds make up 31% of all strokes
Stroke Facts cont.
Stroke is the leading cause of long-term disability.
Mobility is reduced more than half in stroke survivors 65
and over.
75% of stroke survivors experience UE impairments
persisting into the chronic stage.
Symptoms of Stroke for All
Confusion
Depression
Difficulty speaking
Balance issues
Numbness or weakness
Severe headache
Vision disturbance
Stroke in Multi-Cultures
The following cultures have a higher risk of strokes:
African American
Hispanics
Asian
Pacific Islanders
Women Are Different Than
Men
According to University TX Southwestern Med Center
Symptoms include:
Difficulty breathing
Feeling weak all over
Hallucinations
Seizures
Sudden behavior changes
Nausea / vomiting
Women Stroke Facts cont.
Yearly in the USA approximately 55,000 more women than men experience stroke
More women die from stroke than breast cancer yearly
After stroke, women have greater disability than men
Increased risk is due to hormone status, pregnancy, & childbirth
Risk Factors
More Common in Women High blood pressure
Diabetes
High cholesterol
Migraine headaches
Atrial fibrillation
Emotional stress
Depression
Neuroplasticity
Neuro = nervous system (brain & spinal cord)
Plasticity = plastos or moldable
Definition:
Neuroplasticity is involved in motor learning
rehabilitation after stroke
So What is
Neuroplasticity? Our brain continues to change throughout our life time
The brain has the ability to rewire itself after trauma
Research shows that the brain can generate new neurons
(known as neurogenesis)
Neuroplasticity cont.
Key to changes in Neuroplasticity:
Chemical Signals
Altering it’s Structure
Altering it’s Functional Change
Chemical
Transferring chemical signals between
neurons and triggers actions and reactions.
This represents our Short Term Memory
Change happens very rapidly
Structure
Altering the structure
Brain changes the connections between neurons which takes more time.
Physical changes takes time which represents our Long Term Memory.
Functional Changes
Altering function as you use a brain region it becomes more and more excitable easy to use again.
With learning different networks of brain activity is happening.
The brain shifts how and when they are activated
What Does Pavlov Have to do
With This? Pavlov used a type of neuroplasticity
Rang a bell = Salivation
For Motor Learning to Occur:
Challenging NEW/novel task
Repetitive Practice
Functional task
Novel environment
Motor Learning
Definition: a relatively permanent change in behavior
due to practice.
Motor learning: a set of processes associated with practice leading to a permanent change in the capacity for skilled action
Acquiring the capacity for skilled action
Learning takes practice and practice
Learning must be performed
Learning produces a change in behavior
Motor Learning
The brain should be focused on task in order for motor
activity and motor learning to occur
The activity must be:
Meaningful to the patient
Challenging
Changed frequently
Motor Learning cont.
Motor Performance is the temporary change in
movement behavior seen during a practice session
Motor Learning is a permanent change in movement
behavior measured after a retention period
Motor Learning is only due to practice
Types of Learning
Declarative Learning
Facts or Knowledge that can be expressed in declarative sentences
Remembering a phone number
Controlled by the cortex
Practice can transform declarative learning to procedural learning
Procedural Learning
Procedural Learning
Occurs without attention or conscious thought
Walking, swimming, riding a bike, dancing
Develops slowly through very high repetition
Expressed through improved performance on a task
Controlled by the cerebellum
Therefore performance is still possible in the absence of
cortex (brain injury, dementia)
Characteristics of MCA
Middle Cerebral Artery Syndrome (MCA)
Weakness on affected side of body in the arm more than the leg
Sensory and weakness on affected side in face
Gaze impairment
Homonymous Hemianopsia
Aphasia
Ataxia on the affected side
Perception difficulties
Characteristics of ACA
Anterior Cerebral Artery Syndrome (ACA)
Weakness and sensory loss
Urinary incontinence
Frontal Lobe damage
“Akinetic Mutism”
Definition: A medical term describing patients tending to neither move(akinesia) nor speak (mutism). First described in 1941 as a mental state where patients could not move or speak.
Characteristics of PCA
Posterior Cerebral Artery Syndrome (PCA)
Memory deficits
Involuntary movements
Homonymous Hemianopsia
Difficulty recognizing people
Dyslexia with reading only, writing in tact
Characteristics of Pontine
Stroke
Double vision
Dizziness
Vertigo
Slurred speech
Imbalance
Video
Video of Carl
Cerebellum Stroke
Decreased Balance
Decreased Movement
Vertigo
Headache
Vomiting
Ataxia
Video
Video of H.B. dancing with wife.
Right Hemisphere
Damage Highly distractible; with short attention span
Poor judgment and safety
May be disoriented
Poor insight into their condition
Confusion, time, space concepts
Motor problems
Eye hand coordination
Right Hemisphere cont.
Balance issues
Visual field loss
Left Neglect
Spatial perceptual
Impulsive
Difficulty with visual cues
Left Hemisphere Damage
Aphasic
Visual deficits
Difficulty with following directions, repeating words, or actions
Slow and cautious
Perseverates
Uses yes/no inappropriately
Anomic – unable to name objects
Other Interventions
Bioness
Mirror Therapy
Modified Constraint-Induced Movement Therapy (MCIMT)
Dynavision
Mental Practice (MP)
Functional Activities – cooking, grocery shopping, laundry
Pushers
Patients who use non-affected side to push toward
affected side.
Takes approximately 3-4 weeks to resolve
Some cases can last up to 6 months
Associated more with Left hemisphere strokes
Pusher cont.…
Use a wall and mat for patient to sit on so they can’t
move unaffected side
Have a mirror with tape down the middle in front of
patient so they can see what midline looks like
Have the patient reach for an article of clothing using the
unaffected hand
Have patient look in mirror sitting up in midline position
Interventions
What’s is a routine task that’s important to the person?
Example:
Putting on a bra (Theraband, in front on table, W/C,
chair /c arms, EOB, sitting on toilet, Standing, sports bra,
back close, front close (types: hook & eye, snap, velcro,
shoe string one hand, etc)
Intervention Activity
Audience participation – pass out information
Sex is an ADL
Sexuality is a core characteristic for human beings
Important part of development and growth
The ability to be intimate with one another
Some sexual expressions include: holding hands, kissing,
flirting, and sexual intercourse
Sex is an ADL cont.…
Patients may feel more comfortable talking to their OT
The necessary aspects of therapeutic relationship
include: empathy, openness, and sensitivity
Suggest the patient and spouse, or significant other sit
down and talk with you
Ask the couple what is important to them right now in
wanting to be intimate
Tell story about H.T.
Community Resources
Avenues Rehab driving program
Ability Rehab driving program
Next Step – Stroke Foundation
Ability Rehab Program (formally known as Rehab
Institute)
Stroke Support Groups
Community Outing
Important Websites
www.stroke.org (National Stroke Association)
www.strokeassociation.org (American Stroke
Association)
www.aota.org
www.americanstroke.org (Next Step website)
www.nopw.org
References
Stroke Facts. (n.d.). Retrieved July 19, 2017, from
https://www.cdc.gov/stroke/facts.htm
2017 Stroke Fact Sheet. (n.d.). Retrieved July 19, 2017,
from www.Stroke.org
Thomas, A., & Doherty, M. (2017, June 05). Thinking it
through: Using Mental Practice to improve motor
recovery and activity performance in clients with a
stroke. OT Practice, 22(10), 1-4.
References
Bajwa, R. (n.d.). Brain Plasticity; Rewiring the brain.
Retrieved September 13, 2017, from
http://blog.cognifit.com/brain-plasticity-rewiring-brain/
Neuroplasticity. (n.d.). Retrieved July 16, 2017, from
http://www.stroke-rehab.com/neuroplasticity
References
Mac Rae, N. (n.d.). Sexuality and the Role of Occupational Therapy. Retrieved August 14, 2017, from https://www.aota.org/about-occupational-therapy/proffessionals/RDP/Sexuality.aapx
Mc grath, M., & Sakellariou, D. (2016). Why has so little progress been made in the practice of Occupational therapy in relation to sexuality. The American journal of occupational therapy,70(1), 1-5.
References
Walker, L. (2017, June 5). Group Discipline
Incorporating Evidence -Based Modified Constraint-
induced movement therapy in an inpatient rehabilitation
facility. OT Practice, 18-20.
Why are women at higher risk for stroke than men.
(2016). Retrieved July 19, 2017, from
http://www.utsmedicine.org/stories/articles/year-
2016/stroke-symptoms-women-risk
Questions
Notes
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