Neurologie - Learninglearning.ufs.ac.za/FST409_ON/Resources/2 Resources/4. Neurology/15... · FST 409 Neurologie Page 4 Types of learning Simple non-associative learning Habituation

Neurologie

FST 409

2012

Me. H. Nel

FST 409 Neurologie Page 2

Eenheid 6:

Motoriese leer en die herstel van funksie

1. Motoriese leer…………………………………………………………………………………….………….3

1.1 Teoretiese aspekte van onderliggende motoriese leer…………………………………….. 3

1.2 Praktiese toepassing van motoriese leer ……………………………………………….. 7

2. Herstel van funksie …..………………………………………………………………………………. 8

2.1 Sleutel aspekte ……..…………………………………………………………………………… 10

2.1 Neurale plastisiteit ………………………………………………………………………………… 10

2.2 Huidige publikasies/kongresse m.b.t. neurale plastisiteit …………………………… 11

2.3 Artikel ……………………………………………………………………………………………………… 12

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1. Motoriese leer

Die belangrikste aspekte van motoriese leer is dat:

motoriese leer ’n proses is waardeur die vermoë tot vaardige aksie aangeleer word;

motoriese leer is ’n gevolg van ondervinding en oefening;

dit nie direk meetbaar is nie (word afgelei van gedrag); en

dit tot relatiewe permanente veranderinge in gedrag lei (Shumway-Cook en

Woollacott 2001:27).

In rehabilitasie kan verskillende vorme van motoriese leer gebruik word om verskillende

aksies/funksionele doelwitte aan te leer of te bereik. Hierdie kan assosiatiewe of non-

assosiatiewe vorme van leer insluit.

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Types of learning

Simple non-associative learning

Habituation

In psychology, habituation is an example of non-associative learning in which there is a progressive diminution of behavioral response probability with repetition of a stimulus. It is another form of integration. An animal first responds to a stimulus, but if it is neither rewarding nor harmful the animal reduces subsequent responses. One example of this can be seen in small song birds - if a stuffed owl (or similar predator) is put into the cage, the birds initially react to it as though it were a real predator. Soon the birds react less, showing habituation. If another stuffed owl is introduced (or the same one removed and re-introduced), the birds react to it again as though it were a predator, demonstrating that it is only a very specific stimulus that is habituated to (namely, one particular unmoving owl in one place).

Sensitization

Sensitization is an example of non-associative learning in which the progressive amplification of a response follows repeated administrations of a stimulus (Bell et al., 1995). An everyday example of this mechanism is the repeated tonic stimulation of peripheral nerves that will occur if a person rubs his arm continuously. After a while, this stimulation will create a warm sensation that will eventually turn painful. The pain is the result of the progressively amplified synaptic response of the peripheral nerves warning the person that the stimulation is harmful. Sensitization is thought to underlie both adaptive as well as maladaptive learning processes in the organism.

Associative learning

Associative learning is the process by which an element is learned through association with a separate, pre-occurring element.

Operant conditioning

The four procedures are:

1. Positive reinforcement (Reinforcement) occurs when a behavior (response) is followed by a favorable stimulus (commonly seen as pleasant) that increases the frequency of that behavior. In the Skinner box experiment, a stimulus such as food or sugar solution can be delivered when the rat engages in a target behavior, such as pressing a lever.

2. Negative reinforcement (Escape) occurs when a behavior (response) is followed by the removal of an aversive stimulus (commonly seen as unpleasant) thereby increasing that behavior's frequency. In the Skinner box experiment, negative reinforcement can be a loud noise continuously sounding inside the rat's cage until it engages in the target behavior, such as pressing a lever, upon which the loud noise is removed.

3. Positive punishment (Punishment) (also called "Punishment by contingent stimulation") occurs when a behavior (response) is followed by an aversive stimulus, such as introducing a shock or loud noise, resulting in a decrease in that behavior.

4. Negative punishment (Penalty) (also called "Punishment by contingent withdrawal") occurs when a behavior (response) is followed by the removal of a favorable stimulus, such as taking away a child's toy following an undesired behavior, resulting in a decrease in that behavior.

Avoidance learning is a type of learning in which a certain behavior results in the cessation of an aversive stimulus. For example, performing the behavior of shielding one's eyes when in the sunlight (or going indoors) will help avoid the aversive stimulation of having light in one's eyes.

Extinction occurs when a behavior (response) that had previously been reinforced is no longer effective. In the Skinner box experiment, this is the rat pushing the lever and being rewarded with a food pellet several times, and then pushing the lever again and never receiving a food pellet again. Eventually the rat would cease pushing the lever.

Noncontingent reinforcement refers to delivery of reinforcing stimuli regardless of the organism's (aberrant) behavior. The idea is that the target behavior decreases because it is no longer necessary to receive the reinforcement. This typically entails time-based delivery of stimuli identified as maintaining aberrant behavior, which serves to decrease the rate of the target behavior. As no measured behavior is identified as being strengthened, there is controversy surrounding the use of the term noncontingent "reinforcement".

Classical conditioning

The typical paradigm for classical conditioning involves repeatedly pairing an unconditioned stimulus (which unfailingly evokes a particular response) with another previously neutral stimulus (which does not normally evoke the response). Following conditioning, the response occurs both to the unconditioned stimulus and to the other, unrelated stimulus (now referred to as the "conditioned stimulus"). The response to the conditioned stimulus is termed a conditioned response.

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1.2 Praktiese toepassing van motoriese leer

Motoriese leer in die rehabilitasie proses kan vermeerder/aangehelp word deur die

fisioterapeut deur gebruik te maak van twee aspekte, naamlik terugvoer aan die pasiënt,

asook die aanpassing van die oefeningstoestande waarin rehabilitasie plaasvind.

Terugvoer is baie belangrik met betrekking tot motoriese leer en daarom is ’n vorm van

terugvoer noodsaaklik vir leer om plaas te vind. Die mees omvattende definisie van

terugvoer is dat terugvoer “alle sensoriese inligting insluit wat beskikbaar is as ’n gevolg van

beweging” (Shumway-Cook en Woollacott 2001:39). Terugvoer kan intrinsiek of ekstrinsiek

wees. Intrinsieke terugvoer kan gedefinieer word as die terugvoer wat gegee word deur die

verskillende sensoriese sisteme, bv. visueel en/of somatosensories. Ekstrinsieke terugvoer

aan die ander kant, is inligting verskaf (deur die fisioterapeut) bykomend tot intrinsieke

terugvoer. Ekstrinsieke terugvoer kan dus gegee word terwyl die taak/beweging uitgevoer

word of nadat die taak/beweging voltooi is (terminale/eindterugvoer). Voorbeelde van

ekstrinsieke terugvoer kan verbale of manuele leiding deur die fisioterapeut insluit. ’n Ander

vorm van ekstrinsieke, terminale terugvoer is kennis van resultate (knowledge of results

(KR)), wat terugvoer in terme van die uitkoms van die beweging met betrekking tot die doel

van die beweging insluit. Kennis van uitvoering (knowledge of performance (KP)) aan die

ander kant, sluit terugvoer met betrekking tot die bewegingspatrone in wat gebruik is om

die doel te bereik.

Voorbeelde vir die praktiese toepassing van terugvoer:

Intrinsiek

Ekstrinsiek (KR)

Ekstrinsiek (KP)

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2. Herstel van funksie

2.1 Kernaspekte (Shumway-Cook en Woollacott 2001:44-45)

Funksie

Optimale funksie kan beskryf word as gedrag wat effektief en doeltreffend is vir die

bereiking van ’n doel in ’n relevante omgewing.

Herstel

Herstel verwys na die terugkry/herwinning van funksie wat verlore was na ’n besering.

Herstel kan daarom optrede insluit wat vergelykbaar is met dié van voor die besering of

optrede wat effektief en doeltreffend is, maar nie noodwendig uitgevoer word op dieselfde

manier as voor die besering nie.

Kompensasie

Kompensasie verwys na gedragsvervanging of –aanpassing (of met ander woorde

alternatiewe of aangeneemde gedragstrategieë) om ’n taak of doel te bereik.

Sparing van funksie

Sparing van funksie verwys na sekere funksie(s) wat behoue gebly het ten spyte van ’n

breinbesering wat opgedoen is.

Herstel kategorieë

Herstel kan in twee hoof kategorieë ingedeel word, naamlik spontane herstel en geforseerde

herstel. Geforseerde herstel is baie belangrik in rehabilitasie aangesien dit verkry word deur

spesifieke intervensie(s) wat daarop gerig is om sekere neurale meganismes te beïnvloed.

Bydraende faktore tot die herstel van funksie

Die bydraende faktore tot die herstel van funksie kan ouderdom, die eienskappe van die

letsel, die effek van farmakologie en die effek van oefening, insluit.

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Leer en geheue

Aangesien leer gesien word as die verkryging van kennis, verwys geheue na die stoor en

retensie van kennis. In rehabilitasie, speel geheue (insluitende korttermyn en langtermyn

geheue) ’n belangrike rol in die aanleer van vaardighede. Dit is ook belangrik om daarop te

let dat latere stadia van geheue ook strukturele veranderinge in sinaptiese aansluitings

reflekteer.

Sellulêre respons tot besering

Ses verskillende response tot besering kom voor. Hierdie response sluit in: diaschisis,

edeem, denervasie supersensitiwiteit, die blootlê van onaktiewe sinapse, neurale

regenerasie (“regenerative synaptogenesis”) en kollaterale spruiting (“reactive

synaptogenesis/collateral sprouting”).

Diaschisis A sudden loss of function in a portion of the brain connected to but at a distance of a

damaged area.

Denervation supersensitivity A high degree of sensitivity induced by some specific procedure such as denervation,

administration of another drug, etc.

Regenerative synaptogenesis The formation of nerve synapses

Collateral sprouting Collateral sprouting of axons is a branching outgrowth of new axon terminals from

uninjured axons.

Neurale plastisiteit

Neurale plastisiteit verwys na die meganismes wat verband hou met neural aanpasbaarheid.

Hierdie neurale aanpasbaarheid kan gesien word “as ’n kontinuum van korttermyn

veranderinge in die doeltreffendheid of sterkte van sinaptiese aansluitings tot die

langtermyn strukturele veranderinge in die organisasie en hoeveelheid van aansluitings

tussen neurone” (Shumway-Cook and Woollacott 2001:92). Leer, aan die ander kant, kan

dieselfde continuum van korttermyn tot langtermyn verandering in aksie of uitvoer van

verskillende take volg.

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2.2 Neurale plastisiteit

Neuroplasticity (also known as cortical re-mapping) refers to the ability of the human brain to change as a result of one's experience, that the brain is 'plastic' and 'malleable'. The discovery of this feature of the brain is rather modern; the previous belief amongst scientists was that the brain does not change after the critical period of infancy.[1]

The brain consists of nerve cells (or "neurons") and glial cells which are interconnected, and learning may happen through change in the strength of the connections, by adding or removing connections, and by the formation of new cells. "Plasticity" relates to learning by adding or removing connections, or adding cells.

During the 20th century, the consensus was that lower brain and neocortical areas were immutable in structure after childhood, meaning learning only happens by changing of connection strength, whereas areas related to memory formation, such as the hippocampus and dentate gyrus, where new neurons continue to be produced into adulthood, were highly plastic. This belief is being challenged by new findings, suggesting all areas of the brain are plastic even after childhood.[2]

Hubel and Wiesel had demonstrated that ocular dominance columns in the lowest neocortical visual area, V1, were largely immutable after the critical period in development.[3] Critical periods also were studied with respect to language; the resulting data suggested that sensory pathways were fixed after the critical period. However, studies determined that environmental changes could alter behavior and cognition by modifying connections between existing neurons and via neurogenesis in the hippocampus and other parts of the brain, including the cerebellum.[4]

Decades of research have now shown that substantial changes occur in the lowest neocortical processing areas, and that these changes can profoundly alter the pattern of neuronal activation in response to experience. According to the theory of neuroplasticity, experience can actually change both the brain's physical structure (anatomy) and functional organization (physiology) from top to bottom. Neuroscientists are presently engaged in a reconciliation of critical period studies demonstrating the immutability of the brain after development with the more recent research showing how the brain can, and does, change.

A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location; this can result from normal experience and also occurs in the process of recovery from brain injury. Neuroplasticity is the fundamental issue that supports the scientific basis for treatment of acquired brain injury with goal-directed experiential therapeutic programs in the context of rehabilitation approaches to the functional consequences of the injury.

The adult brain is not "hard-wired" with fixed and immutable neuronal circuits. There are many instances of cortical and subcortical rewiring of neuronal circuits in response to training as well as in response to injury. There is solid evidence that neurogenesis (birth of brain cells) occurs in the adult, mammalian brain—and such changes

can persist well into old age.[2] The evidence for neurogenesis is mainly restricted to the hippocampus and olfactory bulb, but current research has revealed that other parts of the brain, including the cerebellum, may be involved as well.[4]

In the rest of the brain, neurons can die, but they cannot be created. However, there is now ample evidence for the active, experience-dependent re-organization of the synaptic networks of the brain involving multiple inter-related structures including the cerebral cortex. The specific details of how this process occurs at the molecular and ultrastructural levels are topics of active neuroscience research. The manner in which experience can influence the synaptic organization of the brain is also the basis for a number of theories of brain function including the general theory of mind and epistemology referred to as Neural Darwinism and developed by immunologist Nobel laureate Gerald Edelman. The concept of neuroplasticity is also central to theories of memory and learning that are associated with experience-driven alteration of synaptic structure and function in studies of classical conditioning in invertebrate animal models such as Aplysia. This latter program of neuroscience research has emanated from the ground-breaking work of another Nobel laureate, Eric Kandel, and

his colleagues at Columbia University College of Physicians and Surgeons.

http://en.wikipedia.org/wiki/Neuroplasticity

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2.3 Huidige publikasies/kongresse m.b.t. neurale plastisiteit

23rd Annual Meeting

Moorea (Tahiti) French Polynesia, South Pacific February 12-19, 2011

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2.4 Artikel

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Eenheid 7:

Basiese behandelingsbeginsels vir pasiënte met

neurologiese aantasting

1. Neuro-rehabilitasie ………………………..……………………………………………………….. 12

1.1 Basiese beginsels van rehabilitasie …………..……………………………………………….. 12

1.2 Behandelingsbenaderings in neuro-rehabilitasie .……………………………………… 12

1.2.1 Neuro-terapeutiese fasilitasie benadering …………………………………………………. 12

1.2.2 Taakgeoriënteerde benadering ……………………………………………………………. 15

1.2.3 Samevatting m.b.t. terapeutiese benaderings ………………………………………. 17

2. Motoriese beheer …………………………………………………………………………………. 18

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1. Neuro-rehabilitasie

1.1 Basiese beginsels van rehabilitasie

Die doel van rehabilitasie is:

die bereiking van die pasiënt se optimale rolvervulling en onafhanklikheid in sy

omgewing, alles binne die beperkinge van die onderliggende patologie en die

beskikbaarheid van hulpbronne; en

die verlening van hulp aan die pasiënt om die beste aanpassing te maak t.o.v. die

verwagte rolle en die bereikte/bereikbare rolle.

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Die rehabilitasie proses:

moet dinamies wees en die pasiënt in staat stel om ‘n betekenisvolle lewe te lewe in

sy/haar omgewing; en

onderrig die terapeut omtrent die betekenis en gevolge van gestremdheid vir die

individu, maar onderrig ook die pasiënt om ‘n betekenisvolle lewe te lei met

funksionele beperkings.

Intervensie strategieë moet die volgende belangrike komponente bevat:

kliënt/pasiënt georienteerd wees;

aktiwiteitsgerig wees;

effektiewe taakuitvoering insluit;

24/7 (oordrag van leer);

deurlopende evaluasie en behandelingsaanpassings moet plaasvind; en

bewys van verandering moet weerspieël word (uitkomste).

1.2 Behandelingsbenaderings in neuro-rehabilitasie

1.2.1 Neuro-terapeutiese fasilitasie benadering (Neuro-ontwikkelingsterapie)

Die neuro-terapeutiese fasilitasie benadering is ontwikkel gedurende die mid 1900’s en is

nog steeds dominant in die huidige hantering van pasiënte met neurologiese aantasting. Dit

sluit benaderings soos die Bobath benadering, Rood benadering, Brunnstrom benadering,

PNF en sensoriese integrasie (SI) terapie in (Shumway-Cook en Woollacott 2001:23).

Die neuro-terapeutiese fasilitasie benadering word geassosieer met die vroeëre refleks- en

hiërargiese teorieë van motoriese beheer. Hierdie benaderings stel dus voor dat normale

beweging vereis dat die hoër vlakke van die SSS (korteks) die laer vlakke (breinstam en

spinaalkoord) beheer. Klem word ook gelê op ’n goeie begrip van die rol van inkomende

sensoriese inligting in die stimulasie van normale bewegingspatrone. Verder word dit ook

aangeneem dat ’n besering van die hoër vlakke van die SSS die abnormal reflekse, wat

georganiseerd is in die laer vlakke van die SSS ontbloot, wat dan die pasiënt se vermoë om

normaal te beweeg, beperk. Die herstel van funksie, volgens hierdie benaderings, kan dus

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nie plaasvind indien hoër vlakke van die SSS nie stelselmatig beheer oor die laer vlakke van

die SSS oorneem nie.

Die doel van behandeling met die Bobath benadering tot intervensie is dus die bereiking

van optimale funksie d.m.v. die verbetering van posturale beheer en die beheer oor

selektiewe bewegings deur fasilitasie. Hierdie benadering tot die rehabilitasie van

volwassenes met SSS patologie het sy oorsprong gehad meer as 50 jaar gelede met die

werk gedoen deur Berta en Karel Bobath. Die rationaal vir die huidige beoefening van

hierdie benadering is gebaseer op die huidige kennis van:

motoriese beheer (“motor control”);

aanleer van motoriese vaardighede (“motor learning”);

neurale plastisiteit/aanpasbaarheid (“neural plasticity”); en

biomeganika.

Die kernaannames van die neuro-terapeutiese fasilitasie benadering is dus dat:

funksionele vaardighede sal terugkeer wanneer abnormale bewegingspatrone

geïnhibeer word en normale patrone gefasiliteer word; en

herhaling van normale patrone outomaties sal oordra na funksionele vaardighede.

Die kliniese toepassing met betrekking tot die neuro-terapeutiese fasilitasie benadering is

dat:

die teenwoordigheid/afwesigheid van normale/abnormal reflekse wat beweging

beheer, tydens die evaluering geïdentifiseer moet word;

intervensie gerig moet wees tot die modulasie/verandering van abnormale reflekse

wat beweging beheer;

sensoriese stimulasie toegepas moet word om die SSS te moduleer/verander; en

intervensie moet gerig wees op die onafhanklike beheer van beweging deur hoër

sentra.

Die neuro-terapeutiese fasilitasie benadering het onlangs meer klem begin lê op funksionele

heropleiding en minder klem op die inhibisie van abnormale reflekse en die heropleiding van

normale bewegingspatrone (Shumway-Cook en Woollacott 2001:23-24).

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1.2.2 Taakgeoriënteerde benadering

Die taakgeoriënteerde benadering word geassosieer met die vroeëre sisteme teorie

(“systems theory”) en stel voor dat normale beweging ontstaan as ’n interaksie tussen

verskeie sisteme, wat elk bydra tot ’n verskillende aspek van beheer. Verder word

gemotiveer dat beweging georganiseer word rondom ’n gedragsdoelwit en beperk word

deur die omgewing. Omdat hierdie benadering taakgeoriënteerd is, moet ’n gedeelte van

die intervensie gerig word tot die verbetering van kompensatoriese strategieë wat gebruik

word om funksionele take uit te voer.

Die kliniese toepassing sluit in dat:

die heropleiding van die beheer oor beweging toegepas moet word deur die gebruik

van ’n identifiseerbare funksionele taak eerder as bewegingspatrone;

pasiënte moet leer deur aktief probleme op te los binne ’n vasgestelde funksionele

taak, eerder as om bewegingspatrone herhalend te oefen;

aanpassings t.o.v. veranderinge in die omgewing is deel van funksionele

heropleiding; en

pasiënte word gehelp om verskillende maniere aan te leer om ’n taak uit te voer,

eerder as ’n enkele spieraktiveringspatroon (Shumway-Cook and Woollacott

2001:24).

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1.2.3 Samevatting t.o.v. terapeutiese benaderings

Therapeutic aims

Neuro-therapeutic facilitation Contemporary task-orientated

Facilitate normal movement patterns

with proprioceptive inputs

Modify CNS from the experience of

normal movement patterns

Fractionalise movements by breaking

up abnormal synergies

Inhibit abnormal tone and primitive

reflexes

Do not allow CNS to learn abnormal

movement patterns

Practice ability to achieve task goals

Teach motor problem solving (ie.

Adaptability in contexts)

Learn strategies to coordinate efficient,

effective behaviours

Develop effective compensations

Use musculoskeletal and

environmental constraints

Dissatisfaction

Neuro-therapeutic facilitation Contemporary task-orientated

No carryover to functional activities

Patients are passive recipients

Does not take into account

musculoskeletal and environmental

effects

Inhibition of primitive reflexes does not

release normal movements

Hard to quantify effective, efficient

compensations

Less “hands-on”, too “cognitive”

How to retrain anticipatory control and

use of prior experience

Hard to provide time consuming

practice of skills

Horak, F.B. 1991. Assumptions underlying motor control for neurologic rehabilitation. In Contemporary Management of

Motor Problems.

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Fases van SVO rehabilitasie

(Baer en Durward 2004:86)

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Akute hemiplegie

Inleiding

Die doelwitte van behandeling tydens die akute sorgfase na ’n beroerte is die:

vestiging van mediese en neurologiese stabiliteit;

minimalisering van breinskade (en gevolglike gestremdheid);

voorkoming van ’n herhaalde beroerte;

hantering van risikofaktore;

beperking van geassosieerde probleme/komplikasies; en die

inisiasie van ’n rehabilitasieprogram (Ozer, Materson and Caplan 1994:27-29).

Serebrale skok

“’n Periode van serebrale skok volg onmiddelik na ’n serebrale infark. Gedurende hierdie

periode, wat kan wissel vanaf ’n paar dae tot ’n paar weke, is die persoon se spiertonus

flassied (hipotonies). Beweging aan die geaffekteerde kant is moeilik, indien nie onmoontlik

nie. Dit sluit beweging van die spiere van die gesig, tong, romp en ledemate in” (AIFO.

n.d.:1 of 1).

Evaluering

Spesiale probleme ervaar deur pasiënte na ’n SVO sluit onderstaande in en moet in ag

geneem word tydens die evaluering van hierdie pasiënte:

die pasiënt se liggaam is duidelik verdeel in twee helftes;

die tonus van die twee helftes van die liggaam verskil;

die pasiënt weet nie meer hoe om te beweeg nie; en

die pasiënt het ’n oordrewe vrees vir val (Bobath 1990:74 – 76).

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Aanvanklike objektiewe en funksionele evaluering (dag 1 na verwysing – NB: pt moet

medies en neurologies stabiel wees)

Bewussynsvlak

Sluk-, hoes- en/of respiratoriese probleme

Vel en drukdele

Spiertonus

Sensasie

Aktiewe beweging, OVB

Funksie (bv. herposisionering in die bed, rol,

brug, lê tot sit, sit, ens.)

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Behandeling

Main aim of treatment

The short-term rehabilitation aim is to get the patient out of the bed and as independent as possible with regard to

ADL and mobility.

(Bobath 1990:59; Kuwait Ministry of Health n.d.:3)

Doelwitte vir behandeling

Sensoriese stimulasie

Voorkom komplikasies bv. aspirasie, indien sluk- en/of hoesprobleme voorkom

Verbeter/behou respiratoriese funksie

Voorkom drukareas/druksere d.m.v. posisionering en opleiding van die betrokke

persone m.b.t. posisionering

Voorkom beserings a.g.v. sensasieverlies d.m.v. advies en opleiding aan betrokke

persone

Voorkom komplikasies, bv. skouersubliksasie d.m.v. posisionering en opleiding van

die betrokke persone m.b.t. posisionering, hantering en voorsorgmaatreëls

Verbeter/behou aktiewe beweging, asook OVB (algeheel)

Verbeter onafhanklikheid t.o.v. ADL en basiese funksionele aktiwiteite

Motoriese aktivering (spieraktivering)

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Sensoriese stimulasie

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Behandelingsidees (sensoriese stimulasie)

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Posisionering

Sien hfst. 5 in “Steps to follow” (Davies 2000:99-129).

Motoriese aktivering (spieraktivering)

Motor activation

“If treatment neglects the potentialities ofthe affected side in the acute stage – itmakes subsequent restoration of function ofthe affected limbs during the residual stagemore difficult and even impossible for, bythis time, over-compensation with a morethan necessary use of the sound side hasbecome firmly established; spasticity if verystrong due to associated reactions caused bythe effort needed for unilateral use of thesound side, and also through lack of balanceand fear of falling” (Bobath 1990:59-60).

Prerequisites for motor activation

• Conscious observation of movement

• Conscious motor effort

• Unconscious motor effort

• Neural plasticity

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Conscious observation of movement

• Passive movements

• Active-assisted movement

• Active movement

• Neural plasticity

• Mental practice

Conscious motor effort

• Neural plasticity

• Mental practice

• Repetition in order to develop a skill

Neural plasticity

“Cortical re-organization in patients with complete/partial UL recovery. Activation of contra-lateral and ipsilateral sensorimotorcortex, premotor areas, supplementary motor areas and parietal cortex” (Feydy et al 2002)

“Cortical activation results from:

• recruitment; and• focusing.

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Neural plasticity (cont’d)

Recruitment: “may increase the population of potentially available neurons to counteract the loss of control induced by the lesion” (Feydy et al 2002).

Focusing: “may select those neurons that potentially improve the efficiency of the impaired motor command” (Feydy et al 2002).

Behandelingsidees (motoriese aktivering)

Romp:

Heup- en kniefleksie

Alternatiewe “stepping”

Romprotasie

Brug

Hip and knee flexion Alternate stepping

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Trunk rotation

Bridging

Pelvis

Motor activation (pelvis)

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Boonste ledemaat

Motor activation (UL)

Motor activation (UL)

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Funksionele heropleiding

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Fx retraining from lying to sitting

• Start from a supported 80to 90 degrees sittingposition in bed and ask thepatient to come and sit onhis sound side edge of bed.

• Progressively bring the head of the bed down so that patient is trained to achieve lie to sit independently.

(Kuwait Ministry of Healthn.d:8)

Sitting

Patient will be placed in the sitting position with as much help as needed (Kuwait Ministry of Health n.d:6).

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Sitting (cont’d)

(Kuwait Ministry of Health n.d:5)

Sitting (cont’d)

(Kuwait Ministry of Health n.d:6)

Sitting (cont’d)

(Kuwait Ministry of Health n.d:6)

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Bed mobility

“Remember that bed mobility activities are more demanding in energy and for this reason will be

done after a few days of starting treatment”.(Kuwait Ministry of Health n.d:6)

Fx retraining (rolling)

(Kuwait Ministry of Health n.d:7)

Fx retraining (bridging)

(Kuwait Ministry of Health n.d:7)

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Transference of learning

(Kuwait Ministry of Health n.d:5)

Transference of learning

(Kuwait Ministry of Health n.d:5)

Transference of learning

(Kuwait Ministry of Health n.d:6)

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Aktiewe rehabilitasie/Intermediêre fase

Balans, rompbeheer en proksimale stabiliteit (in sit)

Inleiding

Hersien die volgende definisies:

Proksimale stabiliteit

Statiese balans in sit

Dinamiese balans in sit

Fleksie rompbeheer

Ekstensie rompbeheer

Rotasie rompbeheer

Sit

Aanvangsdoelwitte:

Proksimale stabiliteit

Postuur/Houding in sit

Gewigdra en gewigsverplasing

Sien bl. 140 – 144 in “Steps to follow” (Davies 2000)

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Notas/ander behandelingsidees:

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Statiese en dinamiese balans in sit

Sien bl. 166 – 175 in “Steps to follow” (Davies 2000)

Notas/ander behandelingsidees:

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Rompbeheer (fleksie/ekstensie/rotasie)

Sien bl. 175 – 176 in “Steps to follow” (Davies 2000)

Notas/ander behandelingsidees:

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Funksionele versterking in sit (prakties)

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Opstaan vanaf sit

Sien bl. 145 – 147 in “Steps to follow” (Davies 2000)

Notas:

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Vereistes vir opstaan vanaf sit

Ander aktiwiteite om opstaan vanaf sit te verbeter – prakties.

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Balans, rompbeheer en proksimale stabiliteit (in staan)

Sien bl. 147 – 164 in “Steps to follow” (Davies 2000)

Notas:

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Sien bl. 176 – 195 in “Steps to follow” (Davies 2000)

Notas:

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Vereistes vir staan

Ander aktiwiteite om staan te verbeter – prakties.

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Heupbeheer

Vereistes vir heupbeheer

Aktiwiteite om heupbeheer te verbeter – prakties.

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Kniebeheer

Vereistes vir kniebeheer

Aktiwiteite om kniebeheer te verbeter – prakties.

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Enkelbeheer

Vereistes vir enkelbeheer

Aktiwiteite om enkelbeheer te verbeter – prakties.

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Ander behandelingsposisies vir pasiënte met neurologiese aantasting

Hondjieposisie

Viervoetkniel

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Kniel

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Halfkniel (en opstaan vanuit halfkniel)

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Heropleiding van loop

Geassosieerde probleme met swak heupbeheer

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Geassosieerde probleme met swak kniebeheer

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AIFO. n.d. Cerebral shock.

http://www.aifo.it/english/resources/online/books/cbr/stroke-carraro/2stroke%26recovery.

pdf

Retrieved on 12 January 2011.

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Unit 8:

Conditions:

Guillain Barré

Parkinsonisme

Cerebellar deviations and Ataxia

Neurological complications of HIV/AIDS

Head injuries

Degenarative neurological conditions

Inflammatory/ infective neurological conditions

Neurological, oncological conditions